This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
Janet Schnall's presentation about Evidence Based Nursing Resources at our free monthly webcast. Recording available at https://webmeeting.nih.gov/p96958659/
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Janet Schnall's presentation about Evidence Based Nursing Resources at our free monthly webcast. Recording available at https://webmeeting.nih.gov/p96958659/
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
discussing all aspects of evidence based medicine, Introduction
History of EBM
Need of EBM
Steps to practice
Discussion - advantages/disadvantages/critical analysis
Evidence based medicine, by prof Badr Mesbah. Professor of pediatric, Suez canal university
Lecture presented in Port said fourth neonatology conference, 24-25 October 2013, Port said, Egypt
Slide presentation for the June 4, 2014 joint PCORI/ National Institute on Aging (NIA) of the National Institutes of Health webinar. This webinar announced the selection of the research team that will carry out a major, five-year, $30 million patient-centered study of the effectiveness of individually tailored care plans to help older individuals avoid falls and related injuries.
Concise explaining of Evidence-Based Medicine and discussing the following: 1-What is Evidence-Based Medicine?
2-Why Evidence-based Medicine?
3-Options for changing clinicians' practice behaviour
4- EBM Process- Five Steps
5-Seven alternatives to evidence-based medicine
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
discussing all aspects of evidence based medicine, Introduction
History of EBM
Need of EBM
Steps to practice
Discussion - advantages/disadvantages/critical analysis
Evidence based medicine, by prof Badr Mesbah. Professor of pediatric, Suez canal university
Lecture presented in Port said fourth neonatology conference, 24-25 October 2013, Port said, Egypt
Slide presentation for the June 4, 2014 joint PCORI/ National Institute on Aging (NIA) of the National Institutes of Health webinar. This webinar announced the selection of the research team that will carry out a major, five-year, $30 million patient-centered study of the effectiveness of individually tailored care plans to help older individuals avoid falls and related injuries.
Concise explaining of Evidence-Based Medicine and discussing the following: 1-What is Evidence-Based Medicine?
2-Why Evidence-based Medicine?
3-Options for changing clinicians' practice behaviour
4- EBM Process- Five Steps
5-Seven alternatives to evidence-based medicine
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
'Demystifying Knowledge Transfer- an introduction to Implementation Science M...NEQOS
Powerpoint presentation from 'Demystifying Knowledge Transfer: an introduction to Implementation Science' - 28th May 2014.
Facilitated by Professor Jeremy Grimshaw and Dr Justin Presseau
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
Comparison of registered and published intervention fidelity assessment in cl...valéry ridde
A methodologically oriented systematic review was conducted to study current practices concerning the assessment of intervention fidelity in CRTs of public health interventions conducted in LMICs.
Evidence based nursing practice is one of most important for perfect and accurate in terms of saving a life.this presentation covers almost all aspect of EBD
Evidence based dentistry, public health , Prosthodontics and EBD,
history of ebd steps, evidence based medicine,evidence based practise. steps in ebd. advantages ,disadvantages, limitations.
prosthodontic considerations.
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
I need between 100-120 words for each assignment, and I want ind.docxflorriezhamphrey3065
I need between 100-120 words for each assignment, and I want individual references with each response. Please, no plagiarized work
Module 1
DQ 1
Outcome measures are significant in showing the worth of the Doctor of Nursing Practice's role in health care. Identify a practice-level outcome study or project and describe the expectation of its effect on health care. Which outcome measure do you think aligns with your DPI project (Quality Improvement Project)? Why? Provide examples and literature support.
DQ 2
In this week's readings, theories of accident causation, human error, foresight, resilience, and system migration were discussed. Identify a safety theory and propose quality measures to improve patient safety. Which theory or framework are you using to guide your DPI Project's intervention and outcome? Please define what constructs of your chosen DPI Project theory will help you change/improve clinical practice to improve a specific patient outcome? Provide examples and literature support.
Resources
Henneman, E. A. (2017). Recognizing the ordinary as extraordinary: Insight into the “way we work” to improve patient safety outcomes.
American Journal of Critical Care
,
26
(4), 272–277. doi:10.4037/ajcc2017812
Smith, S. A., Yount, N., & Sorra, J. (2017). Exploring relationships between hospital patient safety culture and Consumer Reports safety scores.
BMC Health Services Research
,
17,
1-9. doi:10.1186/s12913-017-2078-6
Module 2
DQ 1
Discuss economic methodology, including the concept of cost-based analysis. If you will not be addressing this in your DPI Project, provide an example of a program where it could be used to show outcomes. Provide examples and literature support.
DQ 2
Discuss a change theory and how it can be or has been applied in nursing practice to integrate care delivery sustainability. How will you use change theory in the design of your project to support the sustainability of your practice improvement intervention? Provide examples and literature support.
Resources
Uluskan, M., McCreery, J. K., & Rothenberg, L. (2018). Impact of quality management practices on change readiness due to new quality implementations.
International Journal of Lean Six Sigma
,
9
(3), 351-373. doi:10.1108/IJLSS-05-2017-0049
Steele Gray, C., Wilkinson, A., Alvaro, C., Wilkinson, K., & Harvey, M. (2015). Building resilience and organizational readiness during healthcare facility redevelopment transitions: Is it possible to thrive?
HERD: Health Environments Research & Design Journal
,
9
(1), 10-33. doi:10.1177/1937586715593552
Allen, B. (2016). Effective design, implementation and management of change in healthcare.
Nursing Standard
,
31
(3), 58. doi:10.7748/ns.2016.e10375
Module 3
DQ 1
New health care delivery models are being presented to accommodate the shift in health care objectives. Many of these models are community-based and focused on improving quality outcomes, population health, and reducing readmissions.
Personalised medicine holds great promised for both improving patients’ outcomes and enhancing the efficiency of treatment. Medicines paired with diagnostics are the backbone of personalised medicine, presenting new challenges in for health technology assessment. The situation in England, particularly how NICE might respond to this challenge, was the focus of the third networking event co-sponsored by the Association of the British Pharmaceutical Industry association (ABPI) and the British In Vitro Diagnostics Association. At this one-day event, speakers set the stage for discussion by presenting defining the context of this challenge for England.
OHE’s Adrian Towse presented on the economics. He discussed the elements of value of a diagnostics test (see our earlier blog post) and described the context necessary to produce useful assessments and to ensure subsequent use in the marketplace. His topics included issues of evidence generation, incentives for innovation, flexible approaches to access coincident with evidence development, and encouraging uptake and use.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
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Off-target Effects: Unintended DNA edits can have unforeseen consequences.
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Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. The Culture of Health Care
Evidence-Based Practice
Lecture g
This material (Comp2 Unit 5) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award
Number 90WT0002.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
3. Evidence-Based Practice
Learning Objectives
• Define the key tenets of evidence-based medicine (EBM) and its
role in the culture of health care (Lectures a, b).
• Construct answerable clinical questions and critically appraise
evidence answering them (Lecture b).
• Explain how EBM can be applied to intervention studies, including
the phrasing of answerable questions, finding evidence to answer
them, and applying them to given clinical situations (Lecture c).
• Describe how EBM can be applied to key clinical questions of
diagnosis, harm, and prognosis (Lectures d, e).
• Discuss the benefits and limitations to summarizing evidence
(Lecture f).
• Describe how EBM is used in clinical settings through clinical
practice guidelines and decision analysis (Lecture g).
3
5. What Is a Clinical Practice
Guideline?
• Series of steps for providing clinical care
• May consist of text/tables or algorithms
• Algorithm steps (Ohno-Machado et al., 1998)
– Action: Perform a specific action
– Conditional: Carry out action based on criterion
– Branch: Direct flow to one or more other steps
– Synchronization: Converge paths back from
branches
5
7. Appraising a Clinical
Practice Guideline
(Richards, 2006)
• Did the developers carry out a comprehensive,
reproducible literature search within the last 12 months?
• Is each of its recommendations both tagged by the level
of evidence upon which it is based and linked to a
specific citation?
• Is the guideline applicable in a particular clinical setting?
That is, is there
– High enough burden of illness to warrant use?
– Adequate belief about the value of interventions and their
consequences?
– Costs and barriers too high for the community?
7
8. Should They Be Distributed on
Paper or Electronically?
• Hibble and coauthors (1998) found 855
guidelines had been disseminated to
practices in an area of England
– Pile was 68 cm high and weighed 28 kg (27
inches high and 62 pounds)
• Electronic dissemination, especially
codified for EHRs, may be a better
approach
– Can be encoded in decision logic
8
9. Physicians Do Not Adhere
to Guidelines
• Cabana and colleagues (1999) found guidelines not
used because physicians unaware of them, disagreed
with them, or did not want to change existing practice
(Kung, 2012; Manikam, 2015)
• Physicians and nurses in highly regarded practices in UK
rarely accessed or used research evidence, instead use
“mindlines” (Gabbay & le May, 2004)
• Lin and colleagues (2008) found lack of adherence to
recommendation of major guideline on use of stress
testing before percutaneous coronary intervention
– Diamond and Kaul (2008) attributes to financial incentives and
advocates “evidence-based reimbursement”
9
10. Limitations of Guidelines
• May not apply in complex patients—for 15 common
diseases, following best-known guidelines in elderly
patients with comorbid diseases may have undesirable
effects and implications for pay-for-performance
schemes (Boyd et al., 2005)
• Difficult to implement in EHRs—issues include precise
coding of logic and integration into workflow (Maviglia et
al., 2003)
• May be influenced by pharmaceutical industry—87% of
authors have ties to industry, 58% receive financial
support for research, and 38% serve as employees or
consultants (Choudhry, Stelfox, & Detsky, 2002; Norris,
2011) 10
11. The Future of Guidelines
• Many health care systems are convinced
they help standardize and improve care
and/or lower cost (Bristow, 2013)
• Use will likely increase with proliferation of
electronic health records and/or quality
improvement efforts (Peleg, 2013)
• Growing number are available from
National Guidelines Clearinghouse (link at
http://www.guideline.gov)
11
12. Decision Analysis
• Applies a formal structure for integrating
evidence about beneficial and harmful
effects of treatment options with
associated values and preferences
• They can be applied to guide decision
making of single patient or to inform
decisions about clinical policy
12
13. Decision Analysis for
Anticoagulation in Atrial Fibrillation
• Diamond is a
decision node
• Circles are
chance nodes
5.7 Chart: Decision analysis for anticoagulation in atrial fibrillation.
Adapted from Guyatt (2014).
13
14. Using a Decision Analysis
• Elicit utility values for outcomes from
patient, such as risk of adverse events
from disease or treatment
• Calculate probabilities of events based on
best evidence
• “Fold back” decision tree to calculate
overall utility
14
15. Limitations of Decision Analysis
• Presents idealized situation that may not
apply to a patient but give a framework for
making decisions and/or deviating from
standard approach
• Decision analyses are time-consuming on
individual level and may be dependent on
quantification of values and fuzzy
situations
15
16. Evidence-Based Practice
Summary – Lecture g
• Two main approaches for making
recommendations based on evidence
• Clinical practice guidelines provide steps
and decision points for providing clinical
care
• Decision analysis allows elucidation of a
framework for making optimal decisions
16
17. Evidence-Based Practice
Summary
• EBM provides a set of tools and a disciplined
approach to informing clinical decision
making
• Helps to find the best evidence to answer the
four basic types of clinical questions:
interventions, diagnosis, harm, and prognosis
• Provides two approaches to making
recommendations: clinical practice guidelines
and decision analyses
17
18. Evidence-Based Practice
References – Lecture g
References
Boyd, C., Darer, J., Boult, C., Fried, L., Boult, L., & Wu, A. (2005). Clinical practice guidelines and
quality of care for older patients with multiple comorbid diseases: Implications for pay for
performance. Journal of the American Medical Association, 294, 716–724.
Bristow, R. E., Chang, J., Ziogas, A., & Anton-Culver, H. (2013). Adherence to treatment guidelines for
ovarian cancer as a measure of quality care.Obstetrics & Gynecology, 121(6), 1226-1234.
Cabana, M., Rand, C., Powe, N., Wu, A., Wilson, M., Abboud, P., & Rubin, H. (1999). Why don’t
physicians follow clinical practice guidelines? A framework for improvement. Journal of the
American Medical Association, 282, 1458–1465.
Choudhry, N., Stelfox, H., & Detsky, A. (2002). Relationships between authors of clinical practice
guidelines and the pharmaceutical industry. Journal of the American Medical Association, 287,
612–617.
Diamond, G., & Kaul, S. (2008). The disconnect between practice guidelines and clinical practice—
Stressed out. Journal of the American Medical Association, 300, 1817–1819.
Gabbay, J., & LeMay, A. (2004). Evidence based guidelines or collectively constructed “mindlines”?
Ethnographic study of knowledge management in primary care. British Medical Journal, 329,
1013.
Guyatt, G., Rennie, D., Meade, M., & Cook, D. (2014). Users’ guides to the medical literature:
Essentials of evidence-based clinical practice, 3rd ed. New York: McGraw-Hill.
18
19. Evidence-Based Practice
References – Lecture g Continued
References
Hibble, A., Kanka, D., Penchion , D., & Pooles, F. (1998). Guidelines in general practice: The new
Tower of Babel? British Medical Journal, 317, 862–863.
Khodambashi, S., & Nytrø, Ø. (2015). Lessons Learnt from Evaluation of Computer Interpretable
Clinical Guidelines Tools and Methods: Literature Review. Studies in health technology and
informatics, 216, 980. Retrieved from
https://www.researchgate.net/profile/Soudabeh_Khodambashi2/publication/281409241_Lessons_
Learnt_from_Evaluation_of_Computer_Interpretable_Clinical_Guidelines_Tools_and_Methods_Lit
erature_Review/links/55e5d7ac08aebdc0f58b88c0.pdf
Kung, J., Miller, R. R., & Mackowiak, P. A. (2012). Failure of clinical practice guidelines to meet
institute of medicine standards: two more decades of little, if any, progress. Archives of internal
medicine, 172(21), 1628-1633. Retrieved from
http://archinte.jamanetwork.com/article.aspx?articleid=1384245
Lin, G., Dudley, R., Lucas, F., Malenka, D., Vittinghoff, E., & Redberg, R. (2008). Frequency of stress
testing to document ischemia prior to elective percutaneous coronary intervention. Journal of the
American Medical Association, 300, 1765–1773.
Manikam, L., et als. (2015). What drives junior doctors to use clinical practice guidelines? A national
cross-sectional survey of foundation doctors in England & Wales. BMC medical education, 15(1),
1. Retrieved from http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0510-3
19
20. Evidence-Based Practice
References – Lecture g Continued 2
References
Maviglia, S., Zielstorff, R., Paterno, M., Teich, J., Bates, D., & Kuperman, G. (2003). Automating
complex guidelines for chronic disease: Lessons learned. Journal of the American Medical
Informatics Association, 10, 154–165.
Norris, S. L., Holmer, H. K., Ogden, L. A., & Burda, B. U. (2011). Conflict of interest in clinical practice
guideline development: a systematic review. PloS one, 6(10), e25153. Retrieved from
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0025153
Ohno-Machado, L., Gennari, J., Murphy, S., Jain, N., Tu, S., Oliver, D., . . . Barnett, G. (1998). The
GuideLine Interchange Format: A model for representing guidelines. Journal of the American
Medical Informatics Association, 5, 357–372.
Peleg, M. (2013). Computer-interpretable clinical guidelines: a methodological review. Journal of
biomedical informatics, 46(4), 744-763.
Richards, D. (2006). Guidelines and the killer B’s. Evidence-based Dentistry 7, 1–2.
Charts
5.6 Chart: Example guideline algorithm for the flu shot (Hersh, William, OHSU, 2010
5.7Chart: Decision analysis for anticoagulation in atrial fibrillation. Adapted from Guyatt, 2014
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21. The Culture of Health Care
Evidence-Based Practice
Lecture g
This material was developed by Oregon Health &
Science University, funded by the Department of
Health and Human Services, Office of the National
Coordinator for Health Information Technology
under Award Number IU24OC000015. This
material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
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