This document discusses translating research into nursing practice through evidence-based practice. It defines evidence and the EBP process. It describes different types of quantitative and qualitative research methods like randomized controlled trials, cohort studies, case-control studies, systematic reviews, and meta-analyses. It discusses how to find, appraise, and apply evidence to clinical questions. The importance of validity, reliability, and applicability are covered. Overall, the document provides an overview of research translation and evidence-based nursing.
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
Meta-analysis in Epidemiology is:
Useful tool for epidemiological studies which investigates the relationships between certain risk factors and disease.
Useful tool to improve animal well-being and productivity
Despite of a wealth of suitable studies it is relatively underutilized in animal and veterinary science.
Meta-analysis can provide reliable results about diseases occurrence, pattern and impact in livestock.
It is utmost essential to take benefit of this statistical tool for produce. more reliable estimates of concern effects in animal and veterinary science data.
evidence based practice is a important tool in clinical practice.everything we do in our life can also correlated to evidence based practice. PICO is used to frame a answerable question
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
Meta-analysis in Epidemiology is:
Useful tool for epidemiological studies which investigates the relationships between certain risk factors and disease.
Useful tool to improve animal well-being and productivity
Despite of a wealth of suitable studies it is relatively underutilized in animal and veterinary science.
Meta-analysis can provide reliable results about diseases occurrence, pattern and impact in livestock.
It is utmost essential to take benefit of this statistical tool for produce. more reliable estimates of concern effects in animal and veterinary science data.
evidence based practice is a important tool in clinical practice.everything we do in our life can also correlated to evidence based practice. PICO is used to frame a answerable question
A research study Writing a Systematic Review in Clinical Research – PubricaPubrica
A systematic review summarises the findings of precisely organized healthcare research (controlled trials) and gives a high degree of evidence on the efficacy of healthcare interventions. The evidence may be used to make decisions and guide healthcare recommendations.
Reference: https://bit.ly/3morikF
For our services: https://pubrica.com/services/research-services/systematic-review/
Why Pubrica:
When you order our services, We promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Biostatistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
A research study writing a systematic review in clinical research – pubricaPubrica
A systematic review summarises the findings of precisely organized healthcare research (controlled trials) and gives a high degree of evidence on the efficacy of healthcare interventions. The evidence may be used to make decisions and guide healthcare recommendations.
Reference: https://bit.ly/3morikF
For our services: https://pubrica.com/services/research-services/systematic-review/
Why Pubrica:
When you order our services, We promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Biostatistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
THE NEED FOR EVIDENCE-BASED PRACTICE
STEPS OF EVIDENCE-BASED PRACTICE
PICOT FORMAT IN EBP
RATING SYSTEM FOR THE HIERARCHY OF EVIDENCE: QUANTITATIVE QUESTIONS
ELEMENTS OF EVIDENCE-BASED ARTICLES
INTEGRATE THE EVIDENCE
EVALUATE THE OUTCOMES OF THE PRACTICE DECISION OR CHANGE
COMMUNICATE THE OUTCOMES OF THE EVIDENCE-BASED PRACTICE DECISION
SUSTAIN KNOWLEDGE USE
NURSING RESEARCH
TRANSLATION RESEARCH
5 PHASES OF TRANSLATION RESEARCH
OUTCOMES RESEARCH
SCIENTIFIC METHOD
CHARACTERISTICS OF SCIENTIFIC RESEARCH
NURSING AND THE SCIENTIFIC APPROACH
TYPES OF RESEARCH
TYPES OF RESEARCH APPROACH
RESEARCH PROCESS
RIGHTS OF HUMAN SUBJECT
COMPARISON OF STEPS OF THE NURSING PROCESS WITH THE RESEARCH PROCESS
Performance Improvement
Performance Improvement Programs
EXAMPLES OF PERFORMANCE IMPROVEMENT MODELS
THE RELATIONSHIP BETWEEN EBP, RESEARCH, AND PERFORMANCE IMPROVEMENT
SIMILARITIES AND DIFFERENCES AMONG EVIDENCE-BASED PRACTICE, RESEARCH, AND PERFORMANCE IMPROVEMENT
KEY ELEMENTS
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
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
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Meaning of Evidence ?
Evidence in best practice includes:
Research evidence
Clinical knowledge - experience of the individual
practitioner
Patient and practitioner preference
Basic principles from theory and logic
3. Process
Defined question
Identify pertinent evidence
Exhaustive search strategy
Critically appraise & synthesize
Reported in standard format
Implement evidence into practice considering
patient preferences & values
5. Finding the information
Electronic databases
Journal Articles (electronic and paper)
Internet
Patient information
Healthcare records
Practice based data
Textbooks
6. Examples of Where to Find
Evidence
Electronic Search Engines
Web sources for EBP guidelines
Professional Organizations
Literature
Determine what the search will be from what the question
focuses on.
7.
8. Different types of Research Methods…
Randomised Controlled Systematic Meta-Analysis
Trial Review
Cohort Study
Quantitative
Case Control Study
Descriptive Studies
Qualitative
9. Quantitative Research
In quantitative studies, researchers use objective,
quantifiable data (such as blood pressure or pulse
rate) or use a survey instrument to measure
knowledge, attitude.
Quantitative research involves analysis of numerical
data.
10. Types of Quantitative Research
Randomized Controlled Trials
Cohort study
Descriptive study
Case control study
11. Randomized Controlled Trials RCT’s
The randomized controlled trial is one of the simplest yet
powerful tools of research.
RCTs are quantitative, comparative, controlled
experiments in which investigators study two or more
interventions in a series of individuals who receive them
in random order.
12. Randomized Controlled Trials cont.
RCT - A study in which people are allocated at random (by
chance alone) to receive one of several clinical
interventions.
One of these interventions is the standard of comparison
or control.
The control may be a standard practice, a placebo, or no
intervention at all.
RCT seek to measure and compare the outcomes after
the participants receive the interventions.
13. Cohort Study
A cohort study is a research program investigating a particular group with a
certain trait, and observes over a period of time.
Observed for the occurrence of certain health effects over some period of
time, commonly years rather than weeks or months.
The occurrence rates of the disease of interest are measured and related
to estimated exposure levels.
Cohort studies can either be performed prospectively or retrospectively
from historical records.
14. Case-control Study
Investigates why certain people develop a
specific illness, have an adverse reaction to a
particular treatment or behave in a particular
way.
15. Case-Control Study
Research that retrospectively compares individuals who
have a specific condition or disease ("cases") with a group
of individuals without the condition or disease
("controls").
An application of medical history-taking that aims to
identify the cause of disease among a group of people, or
the cause-effect relationships of a condition of interest.
16. Design of a Case-Control Study
Not Not Exposed
Exposed Exposed Exposed
Disease No Disease
“CASES” “CONTROLS”
17. Case control study
Often conducted to identify variables that might
predict a condition or disease.
Case-control studies have proved particularly useful
in studying very rare conditions.
18. Descriptive Study
Examine differences in disease rates among
populations in relation to :
age
gender
race
and differences in temporal or environmental
conditions.
19. Descriptive Study Continued
These studies are often very useful for generating hypotheses
for further research.
Useful in health service evaluation
Can yield valuable information about a population's health
status, and they can be used to measure risks.
Used periodically to determine whether a particular service is
improving, if serial description studies all show evidence of
reduced sickness or disability rates over a period of years.
20. Descriptive Study Continued
can only identify patterns or trends in disease occurrence over
time or in different geographical locations.
cannot ascertain the causal agent or degree of exposure.
Examples include the U.S. National Health Care Survey, and
periodic reports from cancer registries.
Descriptive studies include case reports or case series,
surveillance systems, correlational ( ecological studies) cross-
sectional studies and cluster investigations.
22. Systematic Reviews
Uses a detailed search
strategy to find
relevant evidence to
answer a clinical
question.
23. Need for Systematic Reviews
Complexity of the studies
Volume of research literature on a given topic
Bias existing in single studies
Contradictory results from similar studies
Sample size variation
25. Systematic Review
A summary of evidence, conducted by an expert or
expert panel on a specific topic.
Uses rigorous process for
Identifying
Appraising
Synthesizing studies
To answer a specific clinical question & draw conclusions &
implications of all research available on a clinical question
based on the data collected.
26. Value of Systematic Reviews
Brings together and assesses all available research
evidence into a single report about efficacy and
effectiveness of specific practices
Efficiently integrates valid information
Provides a basis for rational decision making
Resolves inconsistencies
Establishes generalizability
Assembles evidence
Increases power and validity of the cause-and-effect
relationship between intervention and outcome
Limits bias and reduces chance effects
28. Meta-analysis
combines the results of several studies that address a set
of related research hypotheses.
the statistical synthesis of the data from a set of
comparable studies of a problem.
yields a quantitative summary of the pooled results.
29. Meta-analysis continued
aggregates the data and results of many studies, that
used the same or similar methods and procedures.
reanalyzing the data from all these combined studies.
generates larger numbers, more stable rates &
proportions for statistical analysis & significance
testing than can be achieved by any single study.
30. Qualitative Research
Qualitative researchers use methods such as interviews or
narrative analyses to help understand a particular
phenomenon
Qualitative research involves analysis of data in non
numeric forms such as words (e.g., from personal
interviews), pictures (e.g., video), or objects (e.g., an
artifact).
31. Both
Triangulated approaches use both quantitative and
qualitative methods
Regardless of the method they use, researchers must
adhere to certain approaches to ensure both the quality
and the accuracy of the data and related analyses.
The intent of each approach is to answer questions and
develop knowledge using the scientific method.
32.
33. TRIP
Turning Research Into Practice (TRIP) Data Base Plus.
A Data base doing research searches.
34. Implementing Research Findings in
Practice (EBP Cycle)
Need for
a
decision
Implement
findings Information need
Appraise for Formulate
validity and answerable
usefulness Find evidence question
from research
35. Examples of Nursing Research
Randomized clinical trial examining best practice for
orthopedic-pin site care
Reliability of methods used to determine NG tube
placement
The effects of relaxation and guided imagery on
preoperative anxiety
Quality of life in patients with chronic pain
The relationship of a preoperative teaching program
for joint replacement surgery and patient outcomes
36. Importance of EBP
Evidence-based practice helps nurses provide high-
quality patient care based on research and
knowledge.
Rather than because “this is the way we have always
done it,” or based on myths, hunches, traditions, or
outdated textbooks.
38. Study Design
Good Design = Control
Researchers need to control several variables
that might affect the outcome of the study:
Environment
Subject selection
Treatment
Measurement
39. EBP - critically appraise the
evidence for validity
Validity
Reliability
Applicability - transferability
Then synthesize that evidence.
40. Establishing Validity
Are the result of the study valid?
What were the results?
Will the results help me in caring for my patients?
41. Validity
Validity- were the results of the study
obtained via sound scientific research
methods ?
Bias or other confounding variables may
compromise the validity of the findings.
42. Bias
Anything that distorts study findings in a
systematic way – often arises from study
methodology.
Any tendency to influence the results of a
trial (or their interpretation) other than
the experimental intervention.
43. Bias
Bias is any deviation of results or inferences from the
truth because of the way(s) in which the study is
conducted.
Blinding: A technique used in research to eliminate bias
by hiding the intervention from the patient, clinician,
and/or other researchers who are interpreting
results.
44. Study Design
Special types of control:
Blind: Unaware of assigned treatment.
Double blind: Provider also unaware of assigned treatment.
Placebo: A look-alike treatment with no efficacy.
46. Reliability – do the numbers add up?
Do the results of the study have have sufficient
influence on practice clinically and
statistically?
Can the results be counted on to make a
difference when practitioners apply them to
their practice?
How large the reported intervention effect was
& how precisely that effect was estimated.
Together these determine reliability.
47. Reliability – do the numbers add up?
Do the results of the study have have sufficient
influence on practice clinically and
statistically?
Can the results be counted on to make a
difference when practitioners apply them to
their practice?
How large the reported intervention effect was
& how precisely that effect was estimated.
Together these determine reliability.
48. Another case of
“economy” class
syndrome.
Shouldn’t everyone
take an aspirin and
wear stockings?
What do you think about “flight socks?”
49. Applicability
Whether or not the results of the study
are appropriate for a particular a patient
situation
50. Applying it to the Patient
What do the results
mean on average?
What do they mean for
this patient?
52. Are the studies consistent?
Are variations in results between studies consistent
with chance?
(Test of homogeneity: has low power)
If NO, then WHY?
Variation in study methods (biases)
Variation in intervention
Variation in outcome measure (e.g. timing)
Variation in population
54. Null Hypothesis
States that there is no Tylenol is better than
relationship between the Advil for headaches
variables being studied.
Exercising 30 minutes a
Opposite of what you are day is good for your
trying to find out. health
Lefthanders are prone to
accidents
55. P-value
Probability that the Small p-value dismiss
outcomes are due to chance
chance
Large p-value means
Accepted reference that anything is possible
point is .05 (chance, actual effect, or
confounding factors)
Less than .05 is
statistically significant
56. Statistical Significance
How strong are the statistical findings?
What is the strength of the associations/
differences between 2 or more groups?
What is the proportion of the variance that is
accounted for?
Statistical significance p-value 0.05 is accepted in
nursing.
57. Confidence interval
Confidence interval (CI): The range around a
study's result within which we would expect
the true value to lie. CIs account for the
sampling error between the study population
and the wider population the study is
supposed to represent.
58. Confidence Intervals
Quantifies the uncertainty in measurement.
A 95% confidence interval (CI) means that one can be
95% confident that the population value falls within a
certain range
Example: A study states that 40% of a sample of 1000
people are smokers with a CI of 95% +/- 3% means
the frequency of smoking is between 37% and 43%.
59. Risk
Relative Risk or risk ratio (RR) is the risk for achieving
an outcome in the treatment group relative to that in
the control group
Relative Risk Reduction (RRR) is the increase in
outcome with the treatment compared to the control
(often expressed as a percentage)
Absolute Risk Reduction (ARR) is the difference in
outcome rates for two groups, usually treatment and
control
60. Relative Risk or Risk ratio
Indicates the likelihood (i.e. Risk) that the
outcome would occur in one group compared
to the other.
61. Relative Risk Reduction
Not a good way to compare outcomes
Amplifies small differences and makes insignificant
findings appear significant
Does not reflect the baseline risk of the outcome
event
Can make weak results look good
Making weak results look good makes them popular,
thus they are reported in many journal articles
RRR can mislead
62. Absolute Risk Reduction
A better statistic to evaluate outcome
Does not amplify small differences, but shows
the true difference between the experimental
and control interventions
63. Is the review any good?
FAST appraisal
Question – What is the PICO?
Finding
Did they find most studies?
Appraisal
Did they select good ones?
Synthesis
What do they all mean?
Transferability of results
Applicability – will the results help me care for my patients?
64. Critical Appraisal of Quantitative Studies
Why was the study done?
What is the sample size?
Are the measurements of major variables valid and
reliable?
How were the data analyzed?
Where there any untoward events during the conduct of
the study?
How do the results fit with previous research in the
area?
What does this mean for clinical practice?
Melnyk /Fineout-overholt 2011
65. Critical Appraisal of Qualitative Evidence
Are the results valid/trustworthy and credible?
Are the implications of the research stated?
What is the effect on the reader?
What were the result s of the study?
How does the research identify the study approach?
Is the significance/importance of the study explicit?
Is the sampling study clear and guided by the study needs?
Are data collection procedures clear?
Are data analysis procedures described?
Melnyk/ Fineout-overholt 2011
66. Assessing the Studies
Our job as critical readers is to determine whether
the weakness is serious enough to warrant
reinterpretation of the study's finding.
We need to question whether the study measures
what it intended to measure and whether the
researchers have accounted for bias and confounding
variables.
67. References
Greiner, A., & Knebel, E., (Eds.). (2003). Health
professions education: A bridge to quality.
Washington, DC: The National Academies Press.
Bio medical library University of Minnesota, Evidence
Practice (power point)
http://hsl.lib.umn.edu/learn/ebp/modo1/pico.html
Malloch, K., Poter-OGrady, T., (2006)Introduction to
Evidence -Based Practice in Nursing and Healthcare .
Sudbury, MA, .Jones and Bartlet
68. Ireland M. C.(2010) Evidence -Based Practice What does it
mean? Innovations and Perspectives Virginia Department
of Education. 1,2
Glasziou P. Introduction to EBM 2010(power point)
www.cebm.net/index.aspx?0=1382
Moseley, M., Evidence - Based Practice - an opportunity
for nursing (2006) (power point) Rocky Mountain
University Provo, Utah. ww.rmuohp.edu/index.
69. Melnyk, Fine-Overholt Evidence based practice
(2011). Evidence-based Practice in Nursing &
Healthcare. 2nd edition. Philadelphia PA : Lippincot
Williams & Wilkins
Oakes, J. Evidence Based Practice for Beginners
(power point) www.evidencebasedpractice.org.uk
Dontje K. J.(2007)Evidence-Based Practice:
Understanding the Process .Topics in Advanced
practice Nursing Journal ,7,4.
70. Academy of Medical Surgical Nurse, Evidence-based
practice module 1,2 (power point)
www.amsn.org/cgi-bin/WebObjects/AMSNMain
Glover ,J. Izzo, D.,Odato, K.,Wang, L. (2006) EBM
Pyramid . Yale University School of Medicine.
http://www.ebmpyramid.org/samples/complicated.h
tml