This presentation aims to summarise and simplify the EBP process and features suggestions and tips to create an EBP project. It also shows several completed EBP projects.
Learning by doing aalhe presentation handoutPat Barlow
The document discusses best practices for developing multiple choice assessments, including writing learning objectives, creating test blueprints, and developing effective item stems and response options. It provides examples and guidelines for writing clear, unambiguous questions that avoid construct irrelevant difficulty and test-wise responses. The goal is to create assessments that reliably measure important learning outcomes.
Advance Care Plans for children and young people with life-threatening and li...NIHR CLAHRC West Midlands
Advance Care Plans for children and young people with life-threatening and life-limiting conditions: Developing an evidence based strategy for improvement - Dr Karen Shaw (Theme 1 – Maternity & Child Health) - Programme Steering Committee meeting on 12th March 2015
Rapid qualitative analysis vs the 'traditional approach': early findings and ...NIHR CLAHRC West Midlands
Dr Beck Taylor of Theme 1, Maternity and Child Health, presented her latest project, comparing a rapid approach to synthesising evidence from qualitative research to traditional research methods, presented at CLAHRC WM Programme Steering Committee meeting, 22nd October 2015
The document discusses survey design and data collection. It covers several key topics in 3 sentences or less:
1. What should be measured including characteristics, channels, outcomes and assumptions based on a theory of change. Accurate and precise indicators are important.
2. Methods of data collection such as surveys, qualitative methods, and tests. Good measures are accurate without bias and precise without random error.
3. Challenges in measurement including things people don't know well or want to talk about, abstract concepts, things not directly observable, and things best directly observed through protocols. Data collection requires reliability, validity, integrity, accuracy and timeliness.
The document discusses various methods for randomizing units in an experiment evaluating a social program or intervention. It covers choosing an appropriate unit of randomization based on how the intervention is administered and outcomes are measured. Common units discussed include individual, cluster/group, classroom and school levels. The document also addresses real-world constraints and provides examples of different randomization designs that can be used, including basic lottery, phase-in, rotation, encouragement, and varying treatment levels. It emphasizes the importance of randomization in obtaining an unbiased estimate of a program's causal impact.
This document outlines criteria for selecting a good research problem. An effective research problem should be significant to the education profession, original, and feasible within constraints of time, cost, equipment/supplies, and ethical considerations. It also should be solvable, current to address modern needs, and interesting to motivate the researcher. Selecting problems that meet these criteria helps ensure research addresses important issues and generates useful results for educational practice and theory development.
This document provides guidance on conducting a literature review. It discusses the purpose and importance of literature reviews, including outlining research trends, assessing existing research strengths and weaknesses, and identifying potential gaps in knowledge. The document provides tips for searching existing literature, collecting information, and structuring the review. It emphasizes organizing the review from general to specific and covering all viewpoints without bias. The relationship between the literature review and the reader's own study should also be discussed.
The document outlines the action research process, which consists of 4 cyclical stages: planning, acting, developing, and reflecting. The planning stage involves identifying a topic, gathering information, reviewing literature, and developing a research plan. In the acting stage, the plan is implemented and data is collected. During development, an action plan is created based on findings. Finally, reflection involves sharing results and considering ways to improve the process. The goal is to engage in ongoing cycles of looking critically at a problem, thinking about how to address it, taking action, and evaluating outcomes.
Learning by doing aalhe presentation handoutPat Barlow
The document discusses best practices for developing multiple choice assessments, including writing learning objectives, creating test blueprints, and developing effective item stems and response options. It provides examples and guidelines for writing clear, unambiguous questions that avoid construct irrelevant difficulty and test-wise responses. The goal is to create assessments that reliably measure important learning outcomes.
Advance Care Plans for children and young people with life-threatening and li...NIHR CLAHRC West Midlands
Advance Care Plans for children and young people with life-threatening and life-limiting conditions: Developing an evidence based strategy for improvement - Dr Karen Shaw (Theme 1 – Maternity & Child Health) - Programme Steering Committee meeting on 12th March 2015
Rapid qualitative analysis vs the 'traditional approach': early findings and ...NIHR CLAHRC West Midlands
Dr Beck Taylor of Theme 1, Maternity and Child Health, presented her latest project, comparing a rapid approach to synthesising evidence from qualitative research to traditional research methods, presented at CLAHRC WM Programme Steering Committee meeting, 22nd October 2015
The document discusses survey design and data collection. It covers several key topics in 3 sentences or less:
1. What should be measured including characteristics, channels, outcomes and assumptions based on a theory of change. Accurate and precise indicators are important.
2. Methods of data collection such as surveys, qualitative methods, and tests. Good measures are accurate without bias and precise without random error.
3. Challenges in measurement including things people don't know well or want to talk about, abstract concepts, things not directly observable, and things best directly observed through protocols. Data collection requires reliability, validity, integrity, accuracy and timeliness.
The document discusses various methods for randomizing units in an experiment evaluating a social program or intervention. It covers choosing an appropriate unit of randomization based on how the intervention is administered and outcomes are measured. Common units discussed include individual, cluster/group, classroom and school levels. The document also addresses real-world constraints and provides examples of different randomization designs that can be used, including basic lottery, phase-in, rotation, encouragement, and varying treatment levels. It emphasizes the importance of randomization in obtaining an unbiased estimate of a program's causal impact.
This document outlines criteria for selecting a good research problem. An effective research problem should be significant to the education profession, original, and feasible within constraints of time, cost, equipment/supplies, and ethical considerations. It also should be solvable, current to address modern needs, and interesting to motivate the researcher. Selecting problems that meet these criteria helps ensure research addresses important issues and generates useful results for educational practice and theory development.
This document provides guidance on conducting a literature review. It discusses the purpose and importance of literature reviews, including outlining research trends, assessing existing research strengths and weaknesses, and identifying potential gaps in knowledge. The document provides tips for searching existing literature, collecting information, and structuring the review. It emphasizes organizing the review from general to specific and covering all viewpoints without bias. The relationship between the literature review and the reader's own study should also be discussed.
The document outlines the action research process, which consists of 4 cyclical stages: planning, acting, developing, and reflecting. The planning stage involves identifying a topic, gathering information, reviewing literature, and developing a research plan. In the acting stage, the plan is implemented and data is collected. During development, an action plan is created based on findings. Finally, reflection involves sharing results and considering ways to improve the process. The goal is to engage in ongoing cycles of looking critically at a problem, thinking about how to address it, taking action, and evaluating outcomes.
Application of assessment and evaluation data to improve a dynamic graduate m...Pat Barlow
1. The document describes the process of creating and refining assessment tools and curriculum for a graduate medical education workshop on research design and statistics.
2. They developed an initial assessment, pre-course survey, new classroom activities and homework, and post-course evaluation to gather data and feedback from students.
3. After implementing changes based on the assessment data, the workshop was much more successful and rigorous, demonstrating the importance of continuously collecting and using student feedback to improve a dynamic curriculum over time.
Maximizing Benefit: Five Strategies for Getting the Most from Your Survey Ass...Pat Barlow
This poster was presented at the 2014 American College of Surgeons (ACS) Accredited Education Institutes (AEI) conference in Chicago this past year. It highlights 5 simple strategies for getting the most out of a survey or assessment instrument. Thought I'd upload it for those of you interested more in survey design.
Creating Tests that Measure Critical Thinking in Nursing EducationExamSoft
Writing a good test engages both sides of your brain: indeed, test item writing is both an art and a skill. The good news is that practice can help you enhance your talents in both of these areas. Preparing multiple-choice and alternative-formatted questions, when done well, challenges you to use your knowledge of sound clinical practice gained over years of experience. But instead of just using this knowledge to determine if a student can recognize some basic facts, when you combine your talents and skills in creating a test that measures critical thinking ability, students’ answers to your well-written test questions can reveal not just whether or not they know the basic facts, but if they can apply them in a real-life situation that requires a high level of decision-making or problem-solving. Because most health science instructors were first clinicians and became academic faculty members much later as they moved along their career paths, the task of constructing critical-thinking test items and reliable and valid tests can seem overwhelming. Join this discussion about honing those item writing skills, and discover your talents using both sides of your brain to create a great test!
What is Research ? | Introduction To Research | Basic & Applied Research | Re...FaHaD .H. NooR
What is Research? | Modern technology has made research an exciting and a relatively smooth process.
Personal computer with any means to an Internet connection places one within easy reach of knowledge of what is happening in the global markets and how the world economy is impacting on business |
This document discusses measuring the impact of women in leadership positions in India. It presents a theory of change where reservations for women in local government lead to more female leaders whose preferences and priorities differ from male leaders. Data is presented measuring each step of this theory, including administrative data on reservations, transcripts from village meetings on issues raised by men and women, and village surveys measuring public investments in areas preferred by women, like drinking water and education. The results show reservations significantly increase female leadership and that areas with more women leaders invest relatively more in issues preferred by women. This supports the hypothesis that putting more women in power can impact public spending priorities.
The document discusses different methods for evaluating the impact of an education program called the Balsakhi program in India. It compares the results of 4 different evaluation methods: 1) pre-post comparison showed a test score gain of 26.42 points, 2) simple difference comparison showed Balsakhi students scored 5.05 points lower, 3) difference-in-differences estimated an impact of 6.82 points, and 4) a regression controlling for covariates estimated an impact of 1.92 points. Randomization was proposed as the best method to construct a valid counterfactual for estimating true program impact.
The document provides information on defining a research problem, including:
- Conducting a background survey to justify the choice of research area and need for the study.
- Narrowing the broad problem area to specific issues by starting with broad questions and focusing to operationalize the study.
- Defining the problem as an issue to understand, an existing problem to solve, or an area needing conceptual clarity.
- Formulating a clear, precise problem statement that introduces the importance and significance of the study.
The document outlines the components of impact evaluation including needs assessment, theory of change, process evaluation, impact evaluation, and cost-effectiveness analysis. It discusses framing impact evaluation through a theory of change and using randomized evaluations as the gold standard for measuring a program's causal impact. Randomized evaluations compare outcomes between participants who are randomly assigned to a treatment group or control group to estimate the counterfactual.
This document provides an overview of research, including definitions of research, the nature and types of business research, and differences between qualitative and quantitative research methods. It discusses scientific research processes and characteristics. The key points are:
- Business research is defined as the systematic and objective process of generating information to aid decision-making. It can describe efforts to investigate and solve specific problems encountered in business settings.
- There are differences between qualitative research, which focuses on depth, meaning and subjectivities, and quantitative research, which relates to numbers that can be quantified.
- Research should be undertaken when time allows, information is inadequate, decisions are important, and research benefits outweigh costs. Ethical considerations like informed consent,
What happens to your grant once it gets to a study section?
In this presentation, Dr. Paul Martin leverages his experience as a seasoned National Institutes of Health grant reviewer, including his tenure as Chair of the Cancer Immunopathology and Immunotherapy Study Section, to provide insight into the workings of NIH study sections.
Learn how to:
- Identify the fundamentals of grant review, including an overview of study sections and grant scoring;
- Determine differences between "impact" and "significance";
- Recognize effective strategies in writing and how to avoid frequent mistakes.
This document provides an introduction to research methods. It defines research as a systematic process of investigating problems to find solutions. Business research specifically aims to solve issues in areas like accounting, finance, and management. There are two main types: applied research solves current organizational problems, while basic research generates generalizable knowledge. Managers benefit from understanding research as it helps them identify and address problems effectively. The document also discusses internal vs. external researchers and the importance of ethics in business research.
This document provides an introduction to business research. It discusses what research is, defining it as a process of studying and analyzing problems to find solutions. Business research specifically aims to investigate and solve problems encountered in the workplace. The document outlines different types of problems that can arise in management and marketing. It then discusses research methods, distinguishing between quantitative and qualitative approaches. Various research types are defined, including applied vs basic research, descriptive vs analytical, and qualitative methods like narrative research and case studies. The document also covers internal vs external data sources and ethics in business research.
The document discusses defining research problems and developing problem statements. It covers identifying broad problem areas in organizations, gathering preliminary information through primary and secondary data, reviewing existing literature, and clearly stating the research problem. The problem statement should be relevant, feasible, and interesting. It establishes importance, creates reader interest, and shows how the study adds to literature. Examples are provided of properly structured problem statements that introduce the general research area, specify the research gap, and investigate a clear problem or research question.
TIARA Module 1: Definition, Background, & RationaleMadeline Best
Implementation science aims to address problems in translating research evidence into healthcare practice. It uses systematic approaches to plan and execute the adoption of evidence-based practices. Barriers and facilitators to implementation are identified using frameworks, and interventions are designed using behavior change techniques linked to relevant determinants. For example, to implement an ABCDE bundle for mechanically ventilated patients, barriers like nurses' lack of skills are addressed through goal setting, feedback and encouragement. Implementation requires considering evidence strength, complexity of new practices and beliefs about improved outcomes. Resources provide funding, models and training to advance the field.
This chapter outlines the scientific investigation process and key hallmarks of scientific research. It discusses the hypothetical-deductive method which involves observation, preliminary information gathering, theory formulation, hypothesis generation, further data collection, data analysis, and deduction. The key steps are observation of a problem, gathering preliminary information to better understand it, formulating a theoretical framework to integrate relevant factors, generating testable hypotheses, collecting more data to test the hypotheses, analyzing the data, and deducing conclusions. Rigor, testability, replicability, precision, objectivity, generalizability, and parsimony are important hallmarks of scientific research.
This document discusses the importance of evaluating clinical literature for doctors. It notes that to provide best practice, doctors must systematically identify and critically appraise clinical research rather than relying on outdated information. It also summarizes that over 10,000 new medical articles are published per week, but most published research is not applicable to clinical practice. The document then provides guidance on how to efficiently and critically evaluate medical literature, including understanding journal article structures, identifying biases, and applying evidence-based healthcare practices.
This document discusses evidence-based research (EBR) and its importance in nursing practice. It defines EBR as using scientific research findings to make decisions about patient care rather than relying solely on opinion. The key advantages of EBR include improving clinical outcomes, reducing costs, and enhancing nurses' confidence and critical thinking. The document outlines the 5 steps of EBR - asking questions, acquiring evidence, appraising evidence quality, applying evidence, and assessing outcomes. It also discusses common barriers to implementing EBR and strategies to overcome them, such as promoting a culture of learning and allocating sufficient resources.
This document provides an overview of how to read clinical papers and summarizes their typical structure and components. It explains that clinical papers are used by medical representatives to present evidence for product claims and understand what is being discussed. The key parts of clinical papers are typically the title, authors, abstract, introduction, methods, results, discussion, and references. The document provides details on each of these sections and advises the reader to critically analyze the research questions, study design, results and conclusions. It emphasizes comparing the reported data to the authors' analysis and relating the findings to prior research.
Application of assessment and evaluation data to improve a dynamic graduate m...Pat Barlow
1. The document describes the process of creating and refining assessment tools and curriculum for a graduate medical education workshop on research design and statistics.
2. They developed an initial assessment, pre-course survey, new classroom activities and homework, and post-course evaluation to gather data and feedback from students.
3. After implementing changes based on the assessment data, the workshop was much more successful and rigorous, demonstrating the importance of continuously collecting and using student feedback to improve a dynamic curriculum over time.
Maximizing Benefit: Five Strategies for Getting the Most from Your Survey Ass...Pat Barlow
This poster was presented at the 2014 American College of Surgeons (ACS) Accredited Education Institutes (AEI) conference in Chicago this past year. It highlights 5 simple strategies for getting the most out of a survey or assessment instrument. Thought I'd upload it for those of you interested more in survey design.
Creating Tests that Measure Critical Thinking in Nursing EducationExamSoft
Writing a good test engages both sides of your brain: indeed, test item writing is both an art and a skill. The good news is that practice can help you enhance your talents in both of these areas. Preparing multiple-choice and alternative-formatted questions, when done well, challenges you to use your knowledge of sound clinical practice gained over years of experience. But instead of just using this knowledge to determine if a student can recognize some basic facts, when you combine your talents and skills in creating a test that measures critical thinking ability, students’ answers to your well-written test questions can reveal not just whether or not they know the basic facts, but if they can apply them in a real-life situation that requires a high level of decision-making or problem-solving. Because most health science instructors were first clinicians and became academic faculty members much later as they moved along their career paths, the task of constructing critical-thinking test items and reliable and valid tests can seem overwhelming. Join this discussion about honing those item writing skills, and discover your talents using both sides of your brain to create a great test!
What is Research ? | Introduction To Research | Basic & Applied Research | Re...FaHaD .H. NooR
What is Research? | Modern technology has made research an exciting and a relatively smooth process.
Personal computer with any means to an Internet connection places one within easy reach of knowledge of what is happening in the global markets and how the world economy is impacting on business |
This document discusses measuring the impact of women in leadership positions in India. It presents a theory of change where reservations for women in local government lead to more female leaders whose preferences and priorities differ from male leaders. Data is presented measuring each step of this theory, including administrative data on reservations, transcripts from village meetings on issues raised by men and women, and village surveys measuring public investments in areas preferred by women, like drinking water and education. The results show reservations significantly increase female leadership and that areas with more women leaders invest relatively more in issues preferred by women. This supports the hypothesis that putting more women in power can impact public spending priorities.
The document discusses different methods for evaluating the impact of an education program called the Balsakhi program in India. It compares the results of 4 different evaluation methods: 1) pre-post comparison showed a test score gain of 26.42 points, 2) simple difference comparison showed Balsakhi students scored 5.05 points lower, 3) difference-in-differences estimated an impact of 6.82 points, and 4) a regression controlling for covariates estimated an impact of 1.92 points. Randomization was proposed as the best method to construct a valid counterfactual for estimating true program impact.
The document provides information on defining a research problem, including:
- Conducting a background survey to justify the choice of research area and need for the study.
- Narrowing the broad problem area to specific issues by starting with broad questions and focusing to operationalize the study.
- Defining the problem as an issue to understand, an existing problem to solve, or an area needing conceptual clarity.
- Formulating a clear, precise problem statement that introduces the importance and significance of the study.
The document outlines the components of impact evaluation including needs assessment, theory of change, process evaluation, impact evaluation, and cost-effectiveness analysis. It discusses framing impact evaluation through a theory of change and using randomized evaluations as the gold standard for measuring a program's causal impact. Randomized evaluations compare outcomes between participants who are randomly assigned to a treatment group or control group to estimate the counterfactual.
This document provides an overview of research, including definitions of research, the nature and types of business research, and differences between qualitative and quantitative research methods. It discusses scientific research processes and characteristics. The key points are:
- Business research is defined as the systematic and objective process of generating information to aid decision-making. It can describe efforts to investigate and solve specific problems encountered in business settings.
- There are differences between qualitative research, which focuses on depth, meaning and subjectivities, and quantitative research, which relates to numbers that can be quantified.
- Research should be undertaken when time allows, information is inadequate, decisions are important, and research benefits outweigh costs. Ethical considerations like informed consent,
What happens to your grant once it gets to a study section?
In this presentation, Dr. Paul Martin leverages his experience as a seasoned National Institutes of Health grant reviewer, including his tenure as Chair of the Cancer Immunopathology and Immunotherapy Study Section, to provide insight into the workings of NIH study sections.
Learn how to:
- Identify the fundamentals of grant review, including an overview of study sections and grant scoring;
- Determine differences between "impact" and "significance";
- Recognize effective strategies in writing and how to avoid frequent mistakes.
This document provides an introduction to research methods. It defines research as a systematic process of investigating problems to find solutions. Business research specifically aims to solve issues in areas like accounting, finance, and management. There are two main types: applied research solves current organizational problems, while basic research generates generalizable knowledge. Managers benefit from understanding research as it helps them identify and address problems effectively. The document also discusses internal vs. external researchers and the importance of ethics in business research.
This document provides an introduction to business research. It discusses what research is, defining it as a process of studying and analyzing problems to find solutions. Business research specifically aims to investigate and solve problems encountered in the workplace. The document outlines different types of problems that can arise in management and marketing. It then discusses research methods, distinguishing between quantitative and qualitative approaches. Various research types are defined, including applied vs basic research, descriptive vs analytical, and qualitative methods like narrative research and case studies. The document also covers internal vs external data sources and ethics in business research.
The document discusses defining research problems and developing problem statements. It covers identifying broad problem areas in organizations, gathering preliminary information through primary and secondary data, reviewing existing literature, and clearly stating the research problem. The problem statement should be relevant, feasible, and interesting. It establishes importance, creates reader interest, and shows how the study adds to literature. Examples are provided of properly structured problem statements that introduce the general research area, specify the research gap, and investigate a clear problem or research question.
TIARA Module 1: Definition, Background, & RationaleMadeline Best
Implementation science aims to address problems in translating research evidence into healthcare practice. It uses systematic approaches to plan and execute the adoption of evidence-based practices. Barriers and facilitators to implementation are identified using frameworks, and interventions are designed using behavior change techniques linked to relevant determinants. For example, to implement an ABCDE bundle for mechanically ventilated patients, barriers like nurses' lack of skills are addressed through goal setting, feedback and encouragement. Implementation requires considering evidence strength, complexity of new practices and beliefs about improved outcomes. Resources provide funding, models and training to advance the field.
This chapter outlines the scientific investigation process and key hallmarks of scientific research. It discusses the hypothetical-deductive method which involves observation, preliminary information gathering, theory formulation, hypothesis generation, further data collection, data analysis, and deduction. The key steps are observation of a problem, gathering preliminary information to better understand it, formulating a theoretical framework to integrate relevant factors, generating testable hypotheses, collecting more data to test the hypotheses, analyzing the data, and deducing conclusions. Rigor, testability, replicability, precision, objectivity, generalizability, and parsimony are important hallmarks of scientific research.
This document discusses the importance of evaluating clinical literature for doctors. It notes that to provide best practice, doctors must systematically identify and critically appraise clinical research rather than relying on outdated information. It also summarizes that over 10,000 new medical articles are published per week, but most published research is not applicable to clinical practice. The document then provides guidance on how to efficiently and critically evaluate medical literature, including understanding journal article structures, identifying biases, and applying evidence-based healthcare practices.
This document discusses evidence-based research (EBR) and its importance in nursing practice. It defines EBR as using scientific research findings to make decisions about patient care rather than relying solely on opinion. The key advantages of EBR include improving clinical outcomes, reducing costs, and enhancing nurses' confidence and critical thinking. The document outlines the 5 steps of EBR - asking questions, acquiring evidence, appraising evidence quality, applying evidence, and assessing outcomes. It also discusses common barriers to implementing EBR and strategies to overcome them, such as promoting a culture of learning and allocating sufficient resources.
This document provides an overview of how to read clinical papers and summarizes their typical structure and components. It explains that clinical papers are used by medical representatives to present evidence for product claims and understand what is being discussed. The key parts of clinical papers are typically the title, authors, abstract, introduction, methods, results, discussion, and references. The document provides details on each of these sections and advises the reader to critically analyze the research questions, study design, results and conclusions. It emphasizes comparing the reported data to the authors' analysis and relating the findings to prior research.
introduction to research and healthcare study designs, a focus on Qualitative research and the qualitative data analysis.
Presented by Clinical Pharmacists Ahmed Nouri, PharmD
This document discusses identifying research problems in nursing. It defines research as a systematic, organized inquiry aimed at finding answers to specific problems. Nursing research builds the body of nursing knowledge and provides a scientific basis for practice. Some key points made about identifying research problems include that they should be verifiable, needed, important, feasible, and add to nursing knowledge. Well-defined problems specify what will be studied, how it will be studied, who or what will be studied, and where. Sources of research problems include intuition, experience, literature, social issues, and discussions with experts.
Presentation on research methodologiesBilal Naqeeb
The document provides an overview of research methodologies. It defines research as an organized and systematic way of finding answers to questions. It notes that research is systematic because there are definite procedures and steps followed, and organized because there is a planned structure. The main purpose of research is to find answers to questions. The document then discusses different types of research such as primary and secondary research, as well as pure, applied, scientific and social research. It also outlines tools and techniques used for data collection in research such as surveys, experiments, interviews and case studies. Finally, it discusses key research concepts like variables, hypotheses, sampling, questionnaires and how to design good questions.
This document provides an overview of evidence-based practice (EBP) for speech and language pathologists. It defines EBP as integrating the best research evidence, clinical expertise, and client values and preferences. The 5 steps of EBP are discussed: 1) developing an answerable clinical question, 2) finding the evidence, 3) critically appraising the evidence, 4) making an informed clinical decision, and 5) evaluating and improving the process. Key aspects of each step like developing PICO questions, searching various sources of evidence, critically evaluating research quality, and incorporating client values are explained. The importance of reflection, communication, and applying EBP principles in clinical practice is emphasized.
The document provides guidance on critically appraising research articles. It defines critical appraisal as carefully analyzing research methodology to assess validity, results, and relevance. The process examines bias and evaluates internal/external validity. Critical appraisal is important for literature reviews, program evaluation, policymaking, and more. It involves reading the abstract, introduction, methodology, results, and discussion sections to evaluate study design, measures, sample size, analysis, conclusions, and comparison to prior research. The example shows how to appraise a cohort study by assessing exposure and outcome definitions, follow up time, measurement methods, attrition, confounding, results, and applicability.
This proposal outlines the key components and guidelines for writing an effective research proposal. It discusses including: an introduction that establishes the problem, significance and purpose; a literature review to define concepts and gaps; hypotheses or research questions linked to a theoretical framework; methodology detailing design, sample, data collection and analysis; and consideration of resources and ethics. The proposal emphasizes developing ideas logically, following guidelines, and avoiding common criticisms like an unfocused or unoriginal project. The goal is to communicate a well-planned, significant study that generates support and demonstrates the researcher's qualifications.
This document provides an introduction and overview of nursing research. It discusses the objectives of understanding the differences between qualitative and quantitative research, the tools used for conducting research, what research is, the process of doing nursing research, and its importance. Nursing research helps develop knowledge about health and develops evidence-based practices to improve patient care and outcomes. It explains the research process which involves defining a problem, developing a hypothesis, collecting and analyzing data, discussing results. Both qualitative and quantitative methodologies are covered, with qualitative focusing on open-ended methods to understand perspectives and quantitative using numerical data to find patterns. Nursing research is important for adopting evidence-based practices and developing consistent, well-founded practices that improve health outcomes and reduce costs.
Developing a fundable research question: 27 June 2017 RDSLondon
This document outlines the five steps to developing a fundable research question:
1. Developing the initial idea from various sources of inspiration
2. Focusing the broad idea into a specific research topic
3. Using the PICOT framework and FINER criteria to develop a clear research question
4. Formulating a testable hypothesis using the "three S" guidelines
5. Defining the overarching research aims and specific, measurable objectives
The workshop guides attendees through each step interactively with examples and group work to help attendees develop their own research topic ideas.
Biostatistics is one of the most unavoidable area in the modern day practice of evidence based medicine . In the ppt , trying to give a glimpse on how a clinician should approach Biostatistics
This document provides an overview of evidence-based practice (EBP) and database basics. It discusses the EBP process and different types of studies used for EBP including practice guidelines, review articles, and research articles. The document then covers key aspects of the search process such as formulating questions, choosing search terms, using subject headings versus keywords, Boolean operators, and selecting appropriate databases. Examples are provided to illustrate searching PubMed and other resources.
This document discusses the importance of keeping up to date with medical literature for physicians. It notes that over 10,000 new articles are published per week, making it impossible for doctors to read everything. The document then provides guidance on critically evaluating medical literature, including understanding study designs and assessing validity, results, and applicability. It emphasizes applying a systematic approach to identify relevant information and avoid bias. Specific guidance is provided on appraising different study types, such as randomized trials, diagnostic tests, systematic reviews, cohort studies, and case-control studies.
This document provides an overview of research methodology. It defines research as a systematic process using scientific methods to gain new knowledge. The document discusses why research is important, noting it allows for progress through inquiry. It also outlines the typical steps in conducting research, including selecting a topic, reviewing literature, developing research questions and objectives, determining methodology, collecting and analyzing data, discussing results, and presenting conclusions. Finally, it provides guidance on writing research articles, such as how to structure the paper, format references, and address ethical considerations.
This document provides an introduction to research methodology. It defines research as a systematic process of investigating questions in a rigorous, empirical and unbiased manner. The goal of research is to increase understanding and solve problems. It discusses different types of research such as descriptive, correlational, explanatory and exploratory research. Research can be applied to improve professional practice and services. Both qualitative and quantitative approaches have merits, and a combination may be best. Overall, research requires a structured, evidence-based inquiry to answer questions in a valid and verifiable way.
Presentation how to write a research protocolSushma Sharma
This document provides guidance on developing a research protocol. It explains that a protocol establishes the design and methodology for a research study. The key components of a protocol include the title, introduction/background, objectives, study design, population and recruitment, variables, data collection tools, analysis plan, timeline, and dissemination strategy. Developing a clear protocol is important to gain approval, plan the study, avoid mistakes, and evaluate the research. It should provide enough detail that the study could be replicated by others.
Similar to Evidence based practice in application (20)
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Evidence Based Practice in application
By:
Ahmad Amirdash
MS, APRN, AG-ACNP-BC, CCRN,
BBA
You are Welcome to use slides but please reference my post
when you do so to maintain the integrity of authorship
2. Objectives
To provide tips for completing an EBP project
To highlight obstacles that you may face
To offer solutions for anticipated problems
To suggest methods to save time and keep you on
track
To present examples of completed EBPs
3. Why the EBP approach?
• highest quality of care
• Decreased cost, enhanced safety, reduced
mistakes, proven results
• Maintain consistency in practice
• professional development and the utilization of
critical thinking
• Precursor to future projects
4. Understanding EBP and choosing your
topic of Interest
• critical approach for evaluating the latest
literature to support or discontinue a certain
practice
• EBP is not research
• Gathering resources, and critically reviewing and
appraising literature to collect evidence
• questioning a practice or to answer a burning
question
• Choose an issue related directly to your practice
and is promising
5. Picot or Pico question
• Before formulating a picot perform a quick
literature search
• Start with a broader or more General search
• Not enough articles?
• Low evidence level?
• Established guidelines
• A tip for a fast search, focus on titles and abstracts
6. Literature search
• In-depth search, note the results, and pick the
articles that are most relevant
• Know your available resources like the databases
available to you, peer reviewed journals, and
internet searches
• Develop a habit of searching literature and using
the several databases
• If you are conducting your project as a group, it
may help that each of you perform their own
search
• literature within the last 5 years
7. Evaluating and Appraising
• Statistical terms
• Types of studies
• Study design
• Inclusion and exclusion criteria
• Strengths &weaknesses
• Hierarchy of Evidence
• Your own conclusion
8. The evidence table
• Summarize your findings
• Be very brief when forming your evidence table
• Use a standard or common format
9. Citation Conceptual Framework Design/Method Sample/setting Major Variables Studied and Their
Definitions
Measurement Data Analysis Findings Appraisal: Worth to Practice
10. Creating an effective poster presentation
• stick to a standard format. Example: title,
introduction, objectives, PICOT question,
evidence table, outcome, Future plans,
References
• Phrase your PICOT and you may elaborate on
each
• Describe your search methods, databases used,
number of articles found, number of Articles
utilized depending on your inclusion criteria
• Strong level of evidence and written in very
concise manner
11. Creating an effective poster presentation
• Visually appealing
• 30/90 rule
• Graphics, photos, figures or tables
• font and size and color
• Design the printing service uses
• How big a font will appear
• Concise, use bullet points or summaries
12. Creating an effective poster presentation
• Acronym use
• Keep your message clear and explicit
• Mind your grammar and spelling
• Make sure that your poster has a good
organization meaning
• emphasize a point use italics or bold format
rather than using all caps
• Design to read from left to right
• Review your APA format
13. Creating an effective poster presentation
• Poster size & style
• Design format
• Use a service that would print a copy if your final
poster in smaller size
• Plan extra time to allow changes if needed
• Inquire about the processing time, which is
usually 7 to 10 days
14. Planning and next steps
• Capitalize on your project by submitting it for
consideration in a conference
• Plan wisely, distribute tasks among team
members. this would be especially helpfulwhen
appraising the articles
• Stick to deadlines and allow enough time for each
step of your project
15. Introduction
Pediatric patients are anxious when they come
to the emergency room.
Distraction is a cognitive-behavioral
intervention to reduce pain and distress.
An effective distractor stimulates the senses, is
developmentally suitable, and able to compete
with negative stimuli to get the child’s attention.
Objective
This Evidence-Based Project suggests that
distraction is an easy intervention to ease
procedural anxiety, distress and pain in children.
P.I.C.O. Question
Patient population: Pediatric oncology patients
ages 0-18
Intervention: Age appropriate distraction therapy
like Nintendo Wii, toys and cartoon stickers.
Comparison: Distraction versus routine care.
Outcome: Decrease procedural anxiety and fear
Distraction Therapy to Relieve Anxiety and Fear in Pediatric Oncology Patients during ER Visits
Participants: Maureen Fernandes RN, BSN, CPON; Lyla Jacob RN, BSN
Mentors: Ahmad Amirdash, RN, BSN, CCRN; Faisal Aboul-Enein, DPH, MSN, RN, FNP-BC
Citation Research
Question/
hypothesis
Design &
level of
Evidence
Independent
Variables &
measures
Dependent
Variables &
measures
Sample
size
Results Strengths Weakness/bias
/ Limitations
Uman et al
(2010)
The use of
psychological
interventions to
reduce
procedural pain
Systematic
Review.
Level 1
• Cognitive
interventions
(Distraction,
imagery, hypnosis,
parent education,
and virtual reality)
• Behavioral
interventions
(behavioral
distraction,
breathing
exercises, parent
training, virtual
reality)
• Cognitive
and behavioral
combined
( Nonspecific
treatment, standard
care)
Pain and distress
as measured by
• self report
(VAS, NRS,
VRS,)
• Observation
reports
• Behavioral
measures
(FLACC)
• Physiological
measures (HR,
RR, BP, O2 sat,
cortisol levels)
28 trials with
1951
participants
were
included.
Together,
these
studies
included
1000
participants
in treatment
conditions
and 951 in
control
conditions
Largest effect size
and efficacy
compared to controls
in order:
• Distraction
95% CI (-0.45,-0.04)
• Hypnosis
95%CI (-2.67,-0.27)
• Combined
cognitive behavioral
interventions
95% CI (-1.65,-0.12)
• Limited evidence
for other psychological
interventions.
• Only
randomized
control trials
included.
• Two
independent
reviewers for
data
extraction
using Rev-
Man 4.0.
• Oxford
quality scale
used to rate
studies and
assign
scores.
• Many studies
lacked
randomization
procedure
description, drop
out rates and
reasons.
• Studies
With negative
results lacking.
• Exact
definition for
intervention not
always consistent.
Yip et al
(2010)
The use of non
pharmacological
interventions for
assisting pain.
Systematic
Review.
Level 1
Non
pharmacological
adjunctive
therapies(NAT)
• Hypnosis.
• Complementary
and alternative
medicine
Presence or
absence of:
• Children
distress or
anxiety
• Children
cooperation
• Caregiver
anxiety
Measures:
• Psychological
• Behavioral
17 Trials
from
developed
countries,
involving
1796
children,
ages 0-17
years
• Presence of
parents during
induction of general
anesthesia does not
reduce their child’s
anxiety (8 trials).
• Promising non
pharmacologic and
hand held video
games proved
effective at induction
compared to controls
(significant results but
in single trials).
• Above measures
were promising but
need further
investigation and
validation in more
than one study.
• Search not
limited by
language or
publication
status.
• Large
Sample
studies
conducted in
USA and
Europe
• Data
extraction
conducted
independently
by 2 authors
using Rev
Man 5.0
software and
checked by a
3rd reviewer.
• Not all included
studies were
blinded and some
did not report
randomization.
• Trials were
specific to induction
of general
anesthesia only.
• Measures of
pain, anxiety, and
stress were not
consistent.
Rheingans
(2007)
The use of non
pharmacological
adjunctive
therapy for
symptom
management
Systematic
Review
Level 1
Hypnosis,
distraction,
relaxation, cognitive
behavioral
therapies,
relaxation, imagery,
play, art therapy,
Breathing and hand
holding.
Pain, distress,
anxiety, nausea,
vomiting, fear and
depression.
41 eligible
studies
publication
dates
ranged from
1975 to
2006 with
37% within
the past 10
years.
Non pharmacologic
adjunctive therapies
(NAT) for procedures:
• Age appropriate
distraction was
successful in general ,
same for hypnosis.
Ex: video games.
• NAT for
procedures
significantly reduced
anxiety (breathing and
distraction) and
improved cognitive
behavior
• Wide
search and
trials from
many
countries.
73% of
studies
examined
procedural
symptoms.
• Some non
randomized trials or
case studies were
included.
• Most studies
lacked specific
definitions of
“anxiety” “distress”
and “hypnosis”.
• Lack of sample
size in some
studies to establish
NAT effectiveness.
Evidence Table
Emergency Center
References
• Cavender K, Goff MD, Hollon EC, Guzzetta CE. Parents' positioning and
distracting children during venipuncture: Effects on children's pain, fear, and
distress. Journal of Holistic Nursing. 2004;22:32–56.
• Dahlquist LM, McKenna KD, Jones KK, Dillinger L, Weiss KE, Ackerman CS.
Health Psychol. 2007 Nov;26(6):794-801.
• Kleiber C, Harper DC. Effects of distraction on children's pain and distress during
medical procedures: A meta-analysis. Nursing Research. 1999;48(1):44–49.
• Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for
symptom management in children with cancer. J Pediatr Oncol Nurs. 2007 Mar-
Apr;24(2):81-94. Review.
• Salmon K, Price M, Pereira JK. Factors associated with young children's long-
term recall of an invasive medical procedure: A preliminary investigation. Journal
of Developmental & Behavioral Pediatrics. 2002;23:347–352.
• Uman LS, Chambers CT, McGrath PJ, Kisely S. A systematic review of
randomized controlled trials examining and distress in children and adolescents:
An abbreviated Cochrane review. psychological interventions for needle-related
procedural pain Journal of Pediatric Psychology. 2008;33:842–854.
• Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for
assisting the induction of anaesthesia in children. Cochrane Database of
Systematic Reviews 2009,
Project Plan
Provide children with
age appropriate
distractions like toys,
stickers, cartoons, video
games and movies
Educate staff about
age-appropriate care.
Outcome
Providing age appropriate distractions will
decrease the pediatric patients stress and
anxiety and increase the ER staff’s
efficiency in giving optimal care to the
patients and satisfaction to the parents.
16. Introduction
Pain, stress, and anxiety are common problem
among cancer patients.
Treatments like chemotherapy, radiation and
hormone therapy cause muscular neuropathic,
and herpetic pain along with mucositis.
In addition to medication, it is important to
have further options such as music therapy to
help manage pain and discomfort.
Objective
This Evidence-Based project attempts to
examine the effects of Music Therapy on stress,
anxiety, and pain in cancer patients.
P.I.C.O. Question
• P – All cancer patients.
• I – Music Intervention
• C – Standard care alone
• O – Improved psychological and physical
outcome
Outcomes
1. Different age groups (23-91) had different
preference of music therapy.
2. Positive impact on mood after therapy.
3. Significantly less pain with the music
therapy group versus control group.
Next Steps
1. Initiate patient education on arrival and
promote awareness.
2. Elicit patient feedback to assess efficacy.
3. Encourage participation from staff in
implementing music therapy.
References
• Cole LC, Lobiondo-Wood G. Music as an Adjuvant
Therapy in Control of Pain and Symptoms in Hospitalized Adults: A Systematic
Review. Pain Manag Nurs. 2012 Oct 26. doi:pii: S1524-9042(12)00144-0.
0.1016/j.pmn.2012.08.010.0
• Huang ST, Good M, Zauszniewski JA. The effectiveness of
music in relieving pain in cancer patients: a randomized controlled trial. Int J
Nurs Stud. 2010 Nov;47(11):1354-62. doi: 10.1016/j.ijnurstu.2010.03.008.
• Zhang JM, Wang P, Yao JX, Zhao L, Davis MP,
Walsh D, Yue GH. Music interventions for psychological and physical outcomes
in cancer: a systematic review and meta-analysis. Support Care Cancer. 2012
Dec;20(12):3043-53. doi:10.1007/s00520-012-1606-5.
Music Therapy: Pain and Stress Relief in Adult Cancer Patients
Participants: Giovanni Maloto, RN; Priya George, RN; Cicily Cyriac, RN
Mentors: Ahmad Amirdash, RN, BSN, CCRN; Faisal Aboul-Enein, DPH, MSN, RN, FNP-BC
Citation Research
Question/
hypothesis
Design &
level of
Evidence
Independent
Variables &
measures
Dependent
Variables &
measures
Sample size Results Strengths Weakness/bias /
Limitations
Cole &
Lobiondo
-Wood
2012
review the use
of music as an
adjuvant
therapy for pain
control in adult
hospitalized
patients.
Systematic
Review.
Level 1
• Music was
played for
different
RCTs for
• 15-60
minutes
daily.
• Music
delivered
one time, or
before
surgery, or
daily.
• Music-based
imagery
(MBI) was
provided in
one study.
• Pain
• Anxiety
• Physical
discomfort
• Mood
Combination
of
complaints.
Measures:
• Vital
signs
• VAS.
• Other
pain
scales.
• Opioid
use.
• Labs e.g.
cortisol
• A
Cochrane
collaboration
review of
studies
between
1966-2004.
• 60 trials
identified.
• 17 met
inclusion
criteria for
RCTs.
• Music group had
less pain than
control group.
• Pain and opioid
use lower in study
group.
• Analgesia use
higher in control
group
• Significant
changes in
muscle tension &
anxiety with music
therapy.
• All groups had
similar
demographics
on age,
anesthesia &
surgery.
• Several music
options
provided.
• Patients served
as own
controls.
• Study allowed self-
selection of music.
• No indication whether
effect of music sustains
further with post op stay.
• Limited music choices.
4 subjects withdrew
because of limited
selections.
• Authors did not identify %
of patients in each group
who had past experience.
• Sample size small. 50
participants needed for
power and only had 17.
Zhang et
al 2012
• Examine
effect of
music
interventions
on
psychologic
al & physical
outcome
measures in
cancer
patients.
Systematic
Review.
Level 1
• Music
intervention
or music
medicine
ranging from
15-60min/
• 1-2 times a
day for 5-15
days.
• Pain
• Fatigue
• Anxiety
• Quality Of
Life.
• Nine
databases
reviewed
from 1966
to March
2011.
• All
randomized
controlled
trials were
included.
• 32
randomized
trials met
inclusion
criteria (10
english and
22 chinese
articles).
• Most studies
reported music
interventions
reduced anxiety
and depression
before, during and
after procedures.
• To some extent,
music improved
quality of life.
• No restrictions
on age, gender,
ethnicity, or
type of setting.
• English and
Chinese-
speaking
cancer patients
were included.
• Interventions
compared with
standard care
alone or plus
other therapies.
• Treatment effect may be
small & unconvincing to
caregivers, patients and
families.
• Differences in study
design, intensity of
interventions, type,
duration, and the
therapist may produce
varying results.
• Limited information was
reported regarding
rationale and process of
musical selections.
• Musical interventions
differ in mode of delivery,
onset and duration of
beneficial effects.
Huang et
al 2010
What is the
effect of music
on cancer
Pain?
Intent to
treat RCT
level 2
The
experimental
group listened
to sedative
music for 30min
(No.62).
Control group
rested in
bed(No.64).
Sensation
and distress
related to
cancer pain.
Measures:
Sensation
and distress
of pain using
Visual analog
scale(VAS)
N=126 • Decrease in pain
sensation and
distress in the
music group: 37%
less sensation
and 44% less
distress at post
test than control
group.
• On VAS scale 0-
10,the music
group averaged
1.5 units less pain
than controls.
• no side effects of
music reported.
• Results
clinically
significant
P< 0.001.
• Multivariate
analysis of
covariance
(MANCOVA),
with sensation
and distress as
the multivariate
factor.
• Large enough
sample.
• All oncology
patients.
• Patients with mild pain
VAS < 3 were excluded.
• Most participants had a
high school education or
less(92%).
• All participants
Taiwanese
• Only four types of music
were offered.
• Long term use of music
or longer duration of
effects not measured.
• Pain outcome measured
at only one time point.
Evidence Table
Emergency Center
17. Introduction
Blood Clots are the second leading cause of
death in cancer patients. It is preventable with
appropriate measures and treatment .
Prevalence
VTE’s (venous thromboembolism, ie DVT, PE)
higher prevalence among cancer patients
contributes to 2 fold or greater risk of mortality
compared to cancer patient who do not develop
thromboembolism.
• VTE prevalence in general population: 0.1%
• VTE among cancer patient 0.6% to 8%.
• Chemotherapy patients: 11 to 75%.
PICO QUESTION
P- Cancer patients aged 30 to 65 years old
I - Pharmacologic therapy & application of
GES
C - Pharmacologic therapy alone.
O -decrease incidence of VTE with the
addition of GES.
..
VTE Mortality in a population of >66,000 adult,
hospitalized neutropenic patients. 7
vvvv
Conclusion
The burden of VTE in cancer patient requires
multidisciplinary intervention i.e. both
pharmacological and non-pharmacological
measures. GES usage enables EC personnel
initiate early prevention.
The outcome will be measured by degree of
compliance and assessment of EC
personnel’s skills pertaining to GES utilization.
References
Di Nisio M, Porreca E, Ferrante N, Otten HM, Cuccurullo F, Rutjes AW. Primary prophylaxis for venous
thromboembolism in ambulatory cancer patients receiving chemotherapy. Cochrane Database Syst Rev. 2012
Feb 15;2:CD008500. doi: 10.1002/14651858.CD008500.pub2. Review.
Fig.1, http://www.stoptheclot.org/learn_more/learn_thrombosis.htm retrieved April 21, 2013
Fig. 2, Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6;358(10):1037-52.
doi: 10.1056/NEJMra072753. Review
Fig3. http://www.oref.org/site/PageServer?pagename=grants_dvt_results retrieved April 21, 2013
Fig.4 http://scienceroll.com/?s=virchow&searchbutton=go retrieved April 21, 2013
Fig.5 http://www.cancerthrombosis.org/moduleArticle? retrieved April 22, 2013
Fig.6 Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in
hospitalized neutropenic cancer patients. J Clin Oncol. 2006 Jan 20;24(3):484-90..
Giannoukas AD, Labropoulos N, Michaels JA. Compression with or without early ambulation in the prevention of
post-thrombotic syndrome: a systematic review. Eur J Vasc Endovasc Surg. 2006 Aug;32(2):217-21. Epub 2006
Mar 20. Review.
Ricky Autar, A review of the evidence for the efficacy of Anti-Embolism Stockings (AES) in Venous
Thromboembolism (VTE) prevention, Journal of Orthopaedic Nursing, Volume 13, Issue 1, February 2009, Pages
41-49, ISSN1361-3111, 10.1016/j.joon.2009.01.003.
(http://www.sciencedirect.com/science/article/pii/S1361311109000041)
0
10
20
30
40
50
60
70
80
Prevalence
Pharmacologic
Vitamin K antagonist
Unfractionated Heparin
LMWH eg Lovenox
Fondaparinux
Direct thrombin
inhibitor eg Pradaxa.
Non pharmacological:
IPC (Intermittent
pneumatic
compression).
GES (Graduated Elastic
Stockings).
Current VTE Prophylaxis Citation Research question/
Hypothesis
Design/Level
of Evidence
Independent/ Dependent
Variables
Nisio et
al
(2012)
1.Measure the effectiveness and
safety of blood thinning
agents(anticoagulant)/
Mechanical interventions when
used to prevent blood clots in
cancer patients receiving
chemotherapy.
2. compare the efficacy and
safety of primary
thromboprophylaxis with
placebo or no
thromboprophylaxis in
ambulatory patients with cancer
receiving chemotherapy.
3.The effectiveness of using
non-pharmacological
interventions in cancer patients
in high risk of major bleeding.
Cochrane
Database of
Systematic
Reviews
2012
Level 1
Pharmacologic
Interventions:
Anticoagulant:
1.Vitamin K antagonist
2.Unfractionated Heparin
3.Low molecular weight
heparin ( LMWH)
4.Fondaparinux
Mechanical Interventions:
1.IPC (Intermittent
Pneumatic Copmpression)
2.GES (Graduated elastic
stockings)
Placebo or no
thromboprophylaxis
Dependent Variable
VTE (DVT, PE)
Sample Size/
Who
Results
Nine RCT’s
with a total of
3538 patients.
Ambulatory
cancer
patients
receiving
chemotherapy
.
1.Overall LMWH, when compared with inactive control, there is significant
reduced incident of symptomatic VTE by 45%. However 60% increase in
major bleeding when compared with inactive control
2. lack of power hampers definite conclusions on the effect on major safety
outcomes, which mandates additional studies to determine the risk to
benefit ratio of LMWH.
3.The effect of K antagonist (warfarin) on preventing symptomatic VTE
showed insignificant result.
4.Mechanical Interventions ( IPC and GES) alone not tested.
Strengths Weakness/bias/Limitations
• Mechanical Interventions( Graduated
elastic stockings and Intermittent pneumatic
compression) maybe a valid option in cancer
patients who are at risk of bleeding and are
not candidate for pharmacologic
interventions. Needs further studies on this.
• The cost related to the management of
VTE may be considerable, resulting from the
expenses related to drugs and
hospitalization.
• The occurrence of (unrecognized) VTE
may delay the delivery of cancer treatments
such as chemotherapy with a further negative
impact on morbidity and potential mortality.
• Heparin and Fondaparinux requires
daily
subcutaneous injections, which represents
a considerable burden for the patient.
• Vitamin K antagonist requires frequent
monitoring for dose adjustments and can be
difficult to administer because of nausea
and vomiting, poor nutrition and interaction
with other medication.
• None of the studies tested other
anticoagulant treatment including
unfractionated heparin, fondaparinux, direct
factor Xa inhibitors or mechanical
interventions (IPC, GES).
Project Plan
• Educate EC personnel
about GES application and
indication.
• Patient education.
• Identify appropriate EC
patients for GES usage.
Assess for bleeding risks.
• Add GES application to
pharmacologic treatment
Develop a
protocol
utilizing
GES as
VTE
prophylaxis
in the EC.
Citation Research/
Hypothesis
Design/Level
of Evidence
Independent/ Dependent Variables
Measure
Ricky
Autar,
(2009)
Use of Anti-
embolism Stockings
(AES) alone or as
an adjuvant therapy
is very efficacious in
venous prophylaxis.
Systematic
review/Meta-
analysis
Level 1
Independent
Anti-embolic Stockings (AES), (thigh-
high/knee-high);
Pharmacologic agents, such as low-dose
Heparin, (LMWH) Low molecular weight
Heparin, Mechanical prophylaxis
Dependant VTE incidence
Sample size/
Who
Results Strengths Weakness/
Limitations
• Varied
studies of
surgical patients,
over 25-30 years
span;
• 70 to
2000 patients per
study
• When used alone,
AES (anti- embolic
stockings) reduced
incidence of VTE by
57-64%.
• As an adjuvant to
pharmacological or
mechanical method of
prophylaxis, use of AES
reduced DVT incidence
by up to 85%.
• AES (anti-embolic
stockings), used alone
or in conjunction with
mechanical or
pharmacological agents
has shown to decrease
incidence of VTE in
surgical patients.
• Also considered
the gold standard for
leg compression.
• There is no
evidence if knee-
high AES is more
effective than thigh
high AES.
• Currently, there
is limited information
of comparative
efficacy of different
brands of stockings.
Citation Research/Hypothesis Design/Level
of Evidence
Independent/ Dependent
Variables Measure
Giannoukas
et al (2006)
To assess if there is enough
evidence to suggest that
compression with or without
early ambulation after proximal
DVT reduces risk of post-
thrombotic syndrome (PTS).
Systematic
Review
Level 1
Independent
Compression stockings,
Ambulation
Dependant:
risk of post-thrombotic
syndrome (PTS).
Sample
size/ Who
Results Strengths Weakness/Limitations
Varied
studies
from
1997-
2004;
80-194
medical-
surgical
patients
2-25% developed
PTS (post 0
thrombotic
syndrome) in
patients who were
treated with elastic
compression
stockings, plus
early ambulation;
while 47-82% bed
rest and no
compression
• The study
significantly suggests
compression has
more favorable
outcome in
preventing PTS(post
thrombotic
syndrome); compared
to Bed rest without
compression.
• Due to diversity and subjectivity
in method of studies, there is no
definite conclusion.
• further research is needed on
optimal timing to start elastic
compress ion after episode of
DVT.
• The minimum required duration
wearing EAS to have the most of
benefit to patients.
Fig. 3
Fig. 1 Acute DVT Left Leg, Post Thrombotic
Syndrome Right Leg
The impact of cancer and its treatment on
each element of Virchow’s triad.
Virchow’s triad
Fig.5
Oral anticoagulants
18.7%
Compression stockings
18.2%
LMWH
16.6%
Pneumatic compression
15.0%
Aspirin
12.5%
Unfractionated heparin
10.0%
Pentasaccharides
8.9%
Fig.4
Fig.6
Fig.2
Venous Thromboembolism Prevention with GES
(Graduated Elastic Stockings) among cancer patients
Susan Gonzales BSN, RN; Marie Pansacola-Rouchon BSN, RN, CCRN
Ahmad Amirdash BSN, RN, CCRN; Faisal Aboul-Enein DPH, MSN, FNP-BC
Emergency Center
18.
19. LoBiondo-Wood, G. & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal
for Evidence-Based Practice, 2006 6th Ed. Philadelphia: Elsevier-Mosby
Deliver highest quality of care
Decreased cost, enhanced safety, reduced mistakes, proven results. provide care that is based on Research instead of practices rooted in Tradition
Maintain consistency in practice and decrease pattern variation
Prepares you for a lifelong journey of learning professional development and the utilization of critical thinking
EBP is the initial step to establish updated guidelines, QI projects, Publications, and presentations
EBP Is the critical approach for evaluating the latest literature to support or discontinue a certain practice, however EBP is not research
Remember that at this stage you are gathering resources, and critically reviewing and appraising literature to collect evidence in order to come up with a conclusion that supports or answers your question
Initial approach begins with questioning a practice or to answer a burning question regarding a nursing intervention that is not fully explained or included in your facilities practice
Try to think of an issue related directly to your practice which is promising and could lead to positive change and quality improvement in the future
Once you determine your topic or subject of interest and before formulating a picot perform a quick literature search and determine the abundance and level of evidence of articles addressing your question
You can start with a broader or more General search to gather as many relevant articles as you can then transition to more specific terms that would apply to your picot
After searching several databases, if you are not able to find enough articles related to your topic, it may be very hard for you to continue your project
You may also find several articles that are based on a low level evidence such as expert opinion. Then you could predict that your project would be somewhat week
Conversely it is not advisable to pick a topic that is already well-established or is a guideline or gold standard of practice
You can speed up your initial search by focusing on titles or abstracts when available to get an idea of literature available and the level of evidence
This is where you do an in-depth search, note the results, and pick the articles that are most relevant and that meet you inclusion criteria
Remember the following
Know your available resources like the databases available to you, peer reviewed journals, and internet searches use this with caution, visit reputable sites such as AHRQ AACN ANA.
Get in the habit of searching literature and using the several databases to become more familiar with these. This will help you in your future practice as well as in school
Many databases will allow you to register and this may give you a chance to keep track of your searches, save your relevant articles, and sometimes even give you access outside your Institution
If you are conducting your project as a group, it may help that each of you perform their own search. This will increase the likelihood of finding articles that are more relevant to your topic
Try to pick the latest articles. A common practice is utilizing literature within the last 5 years
Familiarize yourself with the basic statistical terms such as significance, p-value or Alpha, specificity, sensitivity, type 1 and type 2 errors, measures of reliability, validity, nominal and ordinal data, scales of measurement, interval ratio, confidence intervals, mean, median, mode, standard deviation, sample skew, statistical tests used (Anova, correlation, chi-square). For example the P value determines the significance of your findings and is considered an approved Criterion that helps you form a conclusion
Know the types of studies, the design used and its meaning: what is a systematic review, meta-analysis, randomized controlled study (RCT), cohort, cross-sectional, descriptive, case studies, quantitative, qualitative, concepts of blinding, randomization, etc
Be weary of relying solely on the authors conclusions. look for conflicts of interest, for financial support from a private Institution like a pharmaceutical company
Study design, statistics used,samples can be found in the methods section.
Strengths, weaknesses, limitations are typically found in the body of the article or sometimes the conclusion
Be very cognizant of the hierarchy of evidence. When selecting youtr articles a stronger level of evidence supports a stronger conclusion
The evidence table
This is where you summarize your findings. Remember the level of evidence makes or breaks your project
Be very brief when forming your evidence table
Use a standard or common format
Creating an effective poster presentation
For an EBP project stick to a standard format. Example: title, introduction, objectives, PICOT question, evidence table, outcome, plus min future Direction or plans on how to utilize your findings. Finally list year references in APA format
For example the introduction may include the background of the topic, your inquiry, Gap in knowledge Etc
Phrase your PICOT and you may elaborate on each
Describe your search methods, databases used, number of articles found, number of Articles utilized depending on your inclusion criteria
Your evidence table is ideally based on a strong level of evidence and written in very concise manner
Remember you need to create a visually appealing and one that stands out. Ask yourself what is your trigger to choose which poster to view
You can use the rule of 30/90 which means that it could capture your viewers attention within 30 seconds and sustain their attention for at least 90 seconds
Since visual appeal is significant, remember to use Graphics, photos, figures or tables. These need to be related to your topic and listed next to the related text
Stick to one font and size and color for reading ease. Serif or non serif is at your discretion
An important factor is to find out what design the printing service uses and how big a font will appear
Less is more so keep your poster concise, use bullet points or summaries since you can always elaborate during a discussion about you poster
Try not to use too many acronyms and if you do spell it out. no one likes and alphabet soup
Keep your message clear and explicit
Mind your grammar and spelling
Make sure that your poster has a good organization meaning does it flow logically
If you need to emphasize a point use italics or bold format rather than using all caps
Design to read from left to right
Review your APA format
Decide on the size of your poster the format used for printing. Some use PowerPoint slides and paste in different Colunms
Find out about the kind of Imaging used such as digital, High acuity, lamination, framing, foldable type common is tri-fold, time to process and cost
Use a service that would print a copy if your final poster in smaller size
Plan extra time to allow changes if needed
Inquire about the processing time, which is usually 7 to 10 days
Capitalize on your project by submitting it for consideration in a conference
Plan wisely, distribute tasks among team members. this would be especially helpfulwhen appraising the articles
Stick to deadlines and allow enough time for each step of your project