Evidence based practice (EBP) in physiotherapy Saurab Sharma
This presentation is the classroom lecture for undergraduate physiotherapy students whom I teach at Kathmandu University School of Medical Sciences in Nepal. This is an introductory lecture. Students carry on with steps of EBP in the years to come during the student life and use it for their presentations and clinical learning placement.
Other students too may benefit. I highly encourage other students, especially in some parts of India where EBP is not taught, and is reserved for Master's degree program. I completely disagree with this concept, as EBP is the pillar of a responsible physiotherapy practice. Early it starts, better it is.
Evidence based practice (EBP) in physiotherapy Saurab Sharma
This presentation is the classroom lecture for undergraduate physiotherapy students whom I teach at Kathmandu University School of Medical Sciences in Nepal. This is an introductory lecture. Students carry on with steps of EBP in the years to come during the student life and use it for their presentations and clinical learning placement.
Other students too may benefit. I highly encourage other students, especially in some parts of India where EBP is not taught, and is reserved for Master's degree program. I completely disagree with this concept, as EBP is the pillar of a responsible physiotherapy practice. Early it starts, better it is.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
Clinical reasoning is one of the pillars for good physiotherapy practice. It is an integral component of evidence based practice. It is a thought process that develops over time in a clinician. The first step is to start thinking of a clinical problem.
The lecture is delivered to first year physiotherapy students at Kathmandu University School of Medical Sciences, Nepal. The students will continue with case discussion using similar model proposed by Mark Jones and Darren Rivett in his book. Further real cases and the cases in Mark Jones will be discussed in the subsequent classes over the Bachelor of Physiotherapy course.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
Clinical reasoning is one of the pillars for good physiotherapy practice. It is an integral component of evidence based practice. It is a thought process that develops over time in a clinician. The first step is to start thinking of a clinical problem.
The lecture is delivered to first year physiotherapy students at Kathmandu University School of Medical Sciences, Nepal. The students will continue with case discussion using similar model proposed by Mark Jones and Darren Rivett in his book. Further real cases and the cases in Mark Jones will be discussed in the subsequent classes over the Bachelor of Physiotherapy course.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Scholarly research paper. This research paper investigates the patient and how they respond to treatment of spinal injuries over a specified amount of time and how their pain level was affected depending on the form of rehabilitation used. References included.
FAMILY ASSESSMENT 1
FAMILY ASSESSMENT
Institution Affiliation
Student Name
Date
Family-Focused Functional Assessment
The questions asked in the interview with the family that agreed to participate were based on the eleven functional health patterns. The family that participated in the family health assessment program was a single parent structure, a mother with two children. The questions were directed towards the personal life of the respondent; therefore, their names will not be mentioned. It was an African American parent who is single, middle class income. The family is religious, Christians and live in the Chicago neighbourhood. It is a mother who is always there for her daughters and works hard to meet their needs.
The overall health behaviour of the family include eating healthy meals, drink plenty of fluids, and children are given junk once in a while. The children snore and the mother works two jobs and gets time to sleep for only 5hours in a day because she works in the afternoon and evening. The family’s bowel movements are normal and temporary changes are experienced but it’s nothing to worry about. The mother creates time to engage in physical activities, twice a week and the types of exercises she does are morning runs and home work-out just to keep fit. She makes all the decisions that involve her children’s schooling and future plans, and she reported that she doesn’t get confused. She has healthy eyesight. She feels that the future will be great because she has done several investments that will yield positive outcomes.
Children are disciplined using praise positive behaviour because she wants her children to grow into a functional family that does not instil fear and reflect negative behaviour when they become adults. She has started seeing someone recently and has never experienced any sexual dysfunction. The most recent stressful event she experienced is increased pressure from work and creating time to spend with her children. Unfortunately, coping strategies were not well defined. The current health of the family is moderate considering the constraints that the single parent has to undergo to ensure that the children are happy and safe. The family eats a healthy diet that includes vegetables and fruits with less junk food.
Based on the findings of the role relationship, I saw this as strength because the parent disciplines her daughters through praise positive behaviour. Descriptive praise is what she mentioned that works best for her children. Descriptive praise means that a parent takes the initiative to tell their children exactly what they like. Praise helps change a child’ negative behaviour and based on what I observed her children are disciplined, they have confidence and self-esteem, (Campbell-Salome, et.al, 2019). At times, she has to use rewards to encourage her two daughters to perform well in academics and at home. The healthy diet and drinking more fluids habit is another strength t.
FAMILY ASSESSMENT 1FAMILY ASSESSMENTIn.docxmglenn3
FAMILY ASSESSMENT 1
FAMILY ASSESSMENT
Institution Affiliation
Student Name
Date
Family-Focused Functional Assessment
The questions asked in the interview with the family that agreed to participate were based on the eleven functional health patterns. The family that participated in the family health assessment program was a single parent structure, a mother with two children. The questions were directed towards the personal life of the respondent; therefore, their names will not be mentioned. It was an African American parent who is single, middle class income. The family is religious, Christians and live in the Chicago neighbourhood. It is a mother who is always there for her daughters and works hard to meet their needs.
The overall health behaviour of the family include eating healthy meals, drink plenty of fluids, and children are given junk once in a while. The children snore and the mother works two jobs and gets time to sleep for only 5hours in a day because she works in the afternoon and evening. The family’s bowel movements are normal and temporary changes are experienced but it’s nothing to worry about. The mother creates time to engage in physical activities, twice a week and the types of exercises she does are morning runs and home work-out just to keep fit. She makes all the decisions that involve her children’s schooling and future plans, and she reported that she doesn’t get confused. She has healthy eyesight. She feels that the future will be great because she has done several investments that will yield positive outcomes.
Children are disciplined using praise positive behaviour because she wants her children to grow into a functional family that does not instil fear and reflect negative behaviour when they become adults. She has started seeing someone recently and has never experienced any sexual dysfunction. The most recent stressful event she experienced is increased pressure from work and creating time to spend with her children. Unfortunately, coping strategies were not well defined. The current health of the family is moderate considering the constraints that the single parent has to undergo to ensure that the children are happy and safe. The family eats a healthy diet that includes vegetables and fruits with less junk food.
Based on the findings of the role relationship, I saw this as strength because the parent disciplines her daughters through praise positive behaviour. Descriptive praise is what she mentioned that works best for her children. Descriptive praise means that a parent takes the initiative to tell their children exactly what they like. Praise helps change a child’ negative behaviour and based on what I observed her children are disciplined, they have confidence and self-esteem, (Campbell-Salome, et.al, 2019). At times, she has to use rewards to encourage her two daughters to perform well in academics and at home. The healthy diet and drinking more fluids habit is another strength t.
Running head Project Part 2- Patterns, Challenges or Needs .docxtoltonkendal
Running head: Project Part 2- Patterns, Challenges or Needs 1
Project Part 2- Patterns, Challenges or Needs 2
Project Part 2- Patterns, Challenges or Needs
Tanyanika McMillian
South University
Summary of the case study interview
The case study is a 55 years old man named R.M, who has been living with diabetes two since he was 42 years old. The patient also suffers from the loss of vision caused by diabetes as the condition affects the blood vessels in the part of the eyes that reads images. In addition, the patient suffers from weight loss and general body weakness. The present concerns of the patient is to identify the most appropriate ways of managing the condition and prevent the occurrence of diabetes complications. The patient found it hard to cope with the condition at first due to depression but his mentality has changed and he is currently coping well with medication, practicing a healthy lifestyle, eating healthy foods, and exercising regularly.
The patient believes that he cannot be healed but can live a healthy life and manage the disease. His belief is that having good health should be a priority in life. The patient’s family has been offering him social support by making lifestyle modifications and making other changes to help him cope with the condition. He is also a member of diabetes patients support group. R. M is a Christian and believes that his faith is strong, attends church often and is of the opinion that his religion is critical in maintaining his current health. R.M’s personal health goals are to follow the instructions from his physician to manage the condition and avoid complications.
Pattern, challenge or needs associated with each parameter of the case study
On the physical parameter, the patient has the challenge of general body weakness that affects his normal movement and balance. This challenge makes the patient unable to move around well, perform the daily activities, and attend nature calls. The condition requires him to urinate severally and the inability to move properly poses one of the biggest challenges. The weakness also prevents the patient to undertake the physical exercises, which is one of the prescribed requirements for patients living with diabetes.
On the emotional parameter, the patient has the challenges of recurring emotions of anger and sadness that the patient gets due to the challenges and pain caused by the illness. During the times when the condition is affecting him a lot, R.M becomes angry and stressed and ha at times suffered from depression. However, as stated in the interview, the patient has been having emotional stability but he loses the stability at times. This recurrence of these bad emotions creates the need for means to assist the patient to be emotionally stable.
The changes in the stability of emotions at tim ...
71719, 1124 PMEvidence–Based Health Evaluation and Applicat.docxblondellchancy
7/17/19, 11'24 PMEvidence–Based Health Evaluation and Application Transcript
Page 1 of 3http://media.capella.edu/CourseMedia/MSN6011/evidenceBasedHealthEvaluation/transcript.html
Evidence–Based Health Evaluation and Application
Introduction
Public health improvement initiatives (PHII) provide invaluable data for patient–centered care, but their research is often conducted in a context
different from the needs of any individual patient. Providers must make a conscious effort to apply their findings to specific patients' care.
In this activity, you will learn about a PHII, and explore its application to a particular patient's care plan.
Overview
You continue in your role as a nurse at the Uptown Wellness Clinic. You receive an email from the charge nurse, Janie Poole. Click the button to read
it.
Good morning!
At last week's conference I spoke with Alicia Balewa, Director of Safe Headspace. They're a relatively new nonprofit working on improving outcomes
for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This
may be related to his hypertension, but he believes it's related to the time he was hospitalized many years ago after falling out of a tree, and
expressed distress that this might be the beginning of a rapid decline.
Ms. Balewa will be on premises next week, and I'd like to set aside some time for you to talk.
— Janie
Alicia Balewa
Director of Safe Headspace
Overview
Interview Alicia Balewa to find out more about a public health improvement initiative that might apply to Mr. Nowak's care.
Interview:
I have a patient who might benefit from some of the interventions for TBI and PTSD
you recently studied. What populations did your public health improvement initiative
study?
7/17/19, 11'24 PMEvidence–Based Health Evaluation and Application Transcript
Page 2 of 3http://media.capella.edu/CourseMedia/MSN6011/evidenceBasedHealthEvaluation/transcript.html
My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD,
TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That's
excellent news for veterans in treatment now, but they're not looking at my dad, and how his TBI and PTSD have affected him through mid–life and
now as a senior. That's why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help
them.
Which treatments showed the strongest improvement?
Exercise. We were able to persuade about half of our participants — that's around 400 people, mostly men ages 45–80 — to follow the CDC's
recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After
that a lot of participants dropped out, which is disappointing. But of t ...
A Mindful Way to Staying Mentally Healthy at UniversityBarry Tse
A deck prepared for an online talk given to the University of Liverpool students and staff in Feb 2022 Feel Good Month. The talk touched on common psychological issues identified in a recent study in the UK and explained some of the problems that plagued our modern lifestyle. Secular mindfulness is then introduced as a tool to regain control of our declining ability to focus and our stress response that has constantly been put on hyperdrive due to our evolution, neurological wiring, and psychological processes needed for our survival.
Research ProposalLaShanda McMahonPsych665Debbra Jenni.docxronak56
Research Proposal
LaShanda McMahon
Psych/665
Debbra Jennings
12/4/17
Running head: RESEARCH PROPOSAL
1
RESEARCH PROPOSAL
8
Introduction
Reiki is a form of energy healing and is an alternative treatment method. Reiki is a healing technique based on the principle that a Reiki Master can channel energy by means of touch to the client that activates a natural healing process. The goal of Reiki is to move the energy around the patient’s body to restore physical ailments and promote well-being. Reiki is a Japanese technique where there is unseen, spiritually guided life-force energy that flows through us to improve one’s health and enhance the quality of life (The International Center for Reiki Training, 2017).
The author will perform a literature review based on the submitted annotated bibliography assignment, state the research question and hypothesis, explain the methods used in the sample, procedure, and analysis. Ethical considerations will be considered and reviewed relating to the research question. Expected results will be examined, potential limitations, and conclusions drawn. All references will be cited so readers can follow and locate any sources relative to this study.
Literature Review
In the first article, the increasing use of Reiki as a complementary therapy in specialist palliative care, the authors exam development in the last decade the increase in the integration and usage of complementary therapies (CT’s) as an adjunct therapy to conventional medication care and treatment. According to Burden, Herron-Marx, and Clifford (2005), “Documented benefits of relaxation, decreased perception of pain, reduced anxiety and improved sense of wellbeing have been shown to enable an enhanced quality of life, where curative treatment is no longer an option” (Introduction). Moreover, Reiki is a recent addition to a recognized CT for cancer patients as an energy-healing intervention. Reiki has gained popularity as a non-invasive and non-pharma logical treatment that produces profound relaxation, relief from anxiety, stress, pain, and promotion of a feeling of wellbeing. Although there is no evidence supporting its effects within clinical practice, the article takes the position of Reiki as an emerging CT, but does infer the need for more research. This peer-reviewed article was a blind peer review performed in United Kingdom.
The next article by Jane Hart, discusses how she started an energy based, medicine practice with therapeutic touch and created a program providing a philosophy of care based on an energy healing technique, also known as a form of Reiki, based in San Antonio, Texas. This article highlights the increasing acceptance of energy medicine as an alternative healing modality as an important healing practice in the medical community. This type of energy medicine therapies is more common and is offered in hospitals as a complementary therapy. Energy medicine is becoming widely accepted and are prescribed ...
Similar to Searching with PICO and Alternative question formulation framework--Physical Therapy (20)
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A Strategic Approach: GenAI in EducationPeter Windle
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Macroeconomics- Movie Location
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Searching with PICO and Alternative question formulation framework--Physical Therapy
1. Searching the literature in
Physical Therapy
Jill Boruff, MLIS, AHIP
Associate Librarian
Liaison to the School of Physical and Occupational Therapy
jill.boruff@mcgill.ca
2. Objectives
1. Recognize the importance of question formulation and searching in the
EBP cycle
2. Demonstrate how to design a search strategy from a case scenario using
a question formulation framework
3. Use MeSH and keywords to search effectively in MEDLINE
4. Locate the library resources available at McGill
3. Outline of today’s workshop
1. How MEDLINE works when searching subject headings and
keywords
2. Discussion of the question formulation framework and how to use
it in practical situations to search MEDLINE
6. Evidence-Based Practice Cycle
Appraising
the Evidence
Incorporating evidence
into decision-making
Evaluating
the Process
Formulating The Clinical
Question
Searching
the Evidence
8. Find this article!
Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with
musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of
Occupational Therapy, 71, 7101180010. https://doi.org/10.5014/ajot.2017.023234
12. Boolean Logic connectors
AND = every reference contains
both (or all) of the search terms
specified.
OR = every reference contains
at least one of the search
terms
13. What are we searching?
IDEA 1
_____________
OR
_____________
IDEA 2
_____________
OR
_____________
IDEA 3
_____________
OR
_____________
18. When to search keywords
Reason Example
When the database does not have controlled
vocabulary
Google, Scopus, Web of Science
When subject headings do not fully capture the
idea you are searching
Yoga/ but you want specifically “hot yoga” or
“bikram yoga”
When there is more than one name for an idea Transcutaneous Electric Nerve Stimulation/ or
tens.mp.
When the idea is new and there is not a subject
heading for it yet or the subject heading is new
Constraint-induced movement therapy
19. “controlled vocabulary”
Database will search descriptor
field
Should be the focus of the article
because the process involves
humans
Different in each database, but
standardized across articles
“natural language”
Database will search multiple
fields
May not be the focus of the
article
Necessary if subject heading does
not exist for your term
20. Do a search in MEDLINE
Mr. Monty Smith is 43 years old and has a history of Multiple Sclerosis first diagnosed 3
years ago. He had one relapse since diagnosis and walked with a cane post-relapse. He was
admitted to hospital 2 years ago with a second relapse. During that admission he developed
increased weakness in his legs. It has taken him a long time to recover but he has achieved his
goal of walking with a cane. He continues to have good strength in his upper extremities. During
the last year, Mr. Smith is struggling to keep up with his usual activities due to generalized
fatigue. He is referred to you for a physical therapy program to address his fatigue. You know
that exercise therapy can be effective but you wonder if energy conservation might work well
with Mr. Smith.
21. Discussion
1. What did you find?
2. Did everyone find the same information? Is this important?
23. Evidence-Based Practice Cycle
Appraising
the Evidence
Incorporating evidence
into decision-making
Evaluating
the Process
Formulating The Clinical
Question
Searching
the Evidence
Start here!
24. Clinical Question
What is it and why do we use it?
A question that is “directly relevant to the problem at hand… [and] phrased to
facilitate searching for a precise answer.”
From: Richardson, WS. Wilson, MC. Nishikawa J. Hayward, RS. The well-built clinical question: a key to
evidence-based decisions. ACP Journal Club. Nov-Dec 1995.
“ To benefit patients and clinicians, such questions need to be both directly relevant
to patients’ problems and phrased in ways that direct your search to relevant and
precise answers.”
Centre for Evidence-Based Medicine. (n.d.). Asking focused questions. Centre for Evidence-Based Medicine.
Retrieved from http://www.cebm.net/asking-focused-questions/.
25. Clinical Question
• Directly relevant to the patient’s problem:
Mother comes with her child with autism in your office
There is a specific issue you would like to address
• Phrased to facilitate searching for a relevant and precise answer:
“Is occupational therapy effective in treating children with autism?”
“Does sensory integration improve social behaviour in children with autism?”
27. Best evidence for your question
Question Best Evidence
Therapy •Systematic reviews / meta-analyses
•Randomized controlled trials
Diagnosis •Diagnostic validation studies
•Prospective studies / blind comparison to a gold standard
Prevention •Systematic reviews / meta-analyses
•Randomized controlled trials
•Cohort studies, case control studies
Prognosis •Inception cohort studies
•Case control studies
•Case series
Cost-effectiveness •Economic analyses
For more information: http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036068
28. A framework for search question
Elements Answer
Patient or Population
Intervention
Comparison
Outcome
Type of question
Answerable clinical
question
29. A framework for search question
Elements Answer
Problem
Population
Patient stakeholder
Professional stakeholder
Type of question
Answerable clinical question
Elements Answer
Intervention
Context
Outcome measure
Time
30. Mrs. Holiday is a 65 year old female who is living with the effects of a stroke that
happened two years ago. Her recovery has allowed her to get back to work and return to
leisure activities, albeit in a modified manner. Her stroke was in her left middle cerebral
artery and was considered moderate. She is consulting you, the physical therapist,
because for the last two months she is having difficulty completing her weekly hikes due
to difficulty controlling her right leg during the walks. You have determined one of the
main contributing factors to this problem is the presence of spasticity in the right leg. You
know that transcutaneous electric nerve stimulation is used to address this problem, but
you wonder if a combined therapy modality might be more effective for Mrs. Holiday in
order to improve her ability to control the right leg during walks?
31. Elements Answer
Patient or Population
Intervention
Comparison
Outcome
Type of question
Answerable clinical
question:
Mrs. Holiday is a 65 year old female who is living with the effects of a stroke that happened two years ago. Her recovery has
allowed her to get back to work and return to leisure activities, albeit in a modified manner. Her stroke was in her left
middle cerebral artery and was considered moderate. She is consulting you, the physical therapist, because for the last two
months she is having difficulty completing her weekly hikes due to difficulty controlling her right leg during the walks. You
have determined one of the main contributing factors to this problem is the presence of spasticity in the right leg. You know
that transcutaneous electric nerve stimulation is used to address this problem, but you wonder if a combined therapy
modality might be more effective for Mrs. Holiday in order to improve her ability to control the right leg during walks?
65 year old female stroke survivor with spasticity in right leg
Combined therapy modality
Transcutaneous electric nerve stimulation
Improved motor function
Therapy
In stroke survivors with lower limb spasticity, is
a combined therapy modality more effective
than transcutaneous electric nerve stimulation
alone to improve motor function?
32. Elements Answer
Problem
Population
Patient stakeholder
Professional stakeholder
Type of question
Answerable clinical question
Elements Answer
Intervention
Context
Outcome measure
Time
Mrs. Holiday is a 65 year old female who is living with the effects of a stroke that happened two years ago. Her
recovery has allowed her to get back to work and return to leisure activities, albeit in a modified manner. Her stroke
was in her left middle cerebral artery and was considered moderate. She is consulting you, the physical therapist,
because for the last two months she is having difficulty completing her weekly hikes due to difficulty controlling her
right leg during the walks. You have determined one of the main contributing factors to this problem is the presence
of spasticity in the right leg. You know that transcutaneous electric nerve stimulation is used to address this problem,
but you wonder if a combined therapy modality might be more effective for Mrs. Holiday in order to improve her
ability to control the right leg during walks?
Spasticity in right leg TENS, combined modality therapy
Improved motor function
In stroke survivors with lower limb spasticity, is a combined
therapy modality more effective than transcutaneous electric
nerve stimulation alone to improve motor function?
Therapy
65 year old female Leisure activities
Stroke 2 years agoPhysical Therapist
33. What are we searching?
IDEA 1
Stroke/
IDEA 2
Muscle Spasticity/
IDEA 3
Transcutaneous Electric Nerve
Stimulation/
IDEA 4
Combined modality
therapy/
AND
34. Evidence-Based Practice Cycle
Appraising
the Evidence
Incorporating evidence
into decision-making
Evaluating
the Process
Formulating The Clinical
Question
Searching
the Evidence
Move to
the next
step
35.
36. Back to our first search
Mr. Monty Smith is 43 years old and has a history of Multiple Sclerosis first diagnosed 3
years ago. He had one relapse since diagnosis and walked with a cane post-relapse. He was
admitted to hospital 2 years ago with a second relapse. During that admission he developed
increased weakness in his legs. It has taken him a long time to recover but he has achieved his
goal of walking with a cane. He continues to have good strength in his upper extremities. During
the last year, Mr. Smith is struggling to keep up with his usual activities due to generalized
fatigue. He is referred to you for a physical therapy program to address his fatigue. You know
that exercise therapy can be effective but you wonder if energy conservation might work well
with Mr. Smith.
37. Elements Answer
Patient or Population
Intervention
Comparison
Outcome
Type of question
Answerable clinical
question:
Mr. Monty Smith is 43 years old and has a history of Multiple Sclerosis first diagnosed 3 years ago. He had
one relapse since diagnosis and walked with a cane post-relapse. He was admitted to hospital 2 years ago with a
second relapse. During that admission he developed increased weakness in his legs. It has taken him a long
time to recover but he has achieved his goal of walking with a cane. He continues to have good strength in his
upper extremities. During the last year, Mr. Smith is struggling to keep up with his usual activities due to
generalized fatigue. He is referred to you for a physical therapy program to address his fatigue. You know that
exercise therapy can be effective but you wonder if energy conservation might work well with Mr. Smith.
Adult male with multiple sclerosis-related fatigue post second relapse
Energy conservation
Exercise Therapy
Reduced fatigue
Therapy
In patients with multiple sclerosis-related
fatigue, is energy conservation more
effective than exercise therapy in reducing
fatigue?
38. Mr. Monty Smith is 43 years old and has a history of Multiple Sclerosis first diagnosed 3 years ago. He had one
relapse since diagnosis and walked with a cane post-relapse. He was admitted to hospital 2 years ago with a second
relapse. During that admission he developed increased weakness in his legs. It has taken him a long time to recover
but he has achieved his goal of walking with a cane. He continues to have good strength in his upper extremities.
During the last year, Mr. Smith is struggling to keep up with his usual activities due to generalized fatigue. He is
referred to you for a physical therapy program to address his fatigue. You know that exercise therapy can be effective
but you wonder if energy conservation might work well with Mr. Smith.
Elements Answer
Problem
Population
Patient stakeholder
Professional stakeholder
Type of question
Answerable clinical question
Elements Answer
Intervention
Context
Outcome measure
Time
Fatigue
In patients with multiple sclerosis-related fatigue, is energy
conservation more effective than exercise therapy in reducing
fatigue?
Therapy
Adult male w/ multiple sclerosis
Physical Therapist
Exercise therapy
General activities
Reduced fatigue
Post second relapse
39. What are we searching?
IDEA 1
Multiple sclerosis/
IDEA 2
Exp exercise therapy/
IDEA 3
Energy methabolism/ or
Energy conservation.mp
IDEA 4
Fatigue/
AND
40.
41. When is this framework useful?
• To identify your clinical question
• To select the best resource(s) or study design to answer your question
• To focus your search on the most important elements
42. Database Subject areas Publication types
included
Dates
covered
Controlled
vocabulary
Medline /
PubMed
Biomedicine and health care Journal articles,
editorials
1946 to
present
Yes
EMBASE Biomedicine, rehabilitation,
pharmacology
Journal articles,
editorials, conferences
1947 to
present
Yes
CINAHL Nursing and allied health Journal articles,
editorials, trade
magazines
1937 to
present
Yes
PsycInfo Psychological, social, behavioral,
and mental health
Journals articles, books,
book chapters
1806 to
present
Yes
Database comparison
44. Reviewing what we learned
1. The importance of question formulation and searching in the EBP
cycle
2. Using the question formulation framework to refine your question
and focus your search
3. Designing a search strategy from a case scenario:
• use subject headings and keywords according to your needs
• choosing the type of study you are looking for
45. Need Help?
Osler Library of the History of
Medicine
• Located in the McIntyre Medical
Building
• Reserve materials, holds, and ILL
pick-up available
• Study space
Schulich Library of Physicial Sciences,
Life Sciences, and Engineering
• Located on lower campus
• Library service hours with librarian
on duty: Monday to Friday, Sunday
• Non-reserve materials for Life
Sciences
• Extended hours for study
• My office!
State the objectives of this lesson;
State your expectations for students' participation and the importance of searching for their academic and professional practices.
Content broken up into two parts: technical and practical
First we will look at how the database works
http://www.redorbit.com/media/uploads/2013/06/KidMathShapes_062513-617x416.jpg
Question 1: (to look for evidence to support our practices)
Question 2: (focused on our specific needs; they contain the most updated knowledge)
Discussion about database search
Ask them the first question and have a whole-class discussion. Then move on to the second question. Let at least 3 students talk.
Cycle of "decision making"
Present the cycle of literature search. Emphasize the importance of a good search for a good practice—but don’t spend much time here as we spend more time on it later.
Finding MEDLINE/OVID database
Navigate here from PT/OT subject guide
Point out that they need to be on Advanced search, MEDLINE, “map term to subject heading”
While still in Ovid, tell them that you will show them how to find an article by title. Have them click on the “title” button. Then tell them that you will put up the title on the next slide.
Give them some time to find the article. Then go back to ovid and find it yourself to show them how to click on the title to see the full record.
Tell them that they should see something like this with all this info
And we will focus on these three parts (cut down so that you can see better!)
Emphasize that Subject headings search the Subject heading field (and that they will learn how to do that in a moment)
And keywords search the title and abstract field, not the full text.
Ask them to read the abstract and give 3 ideas that are representative of that article
If possible, write the 3 ideas in the PPT presentation (bubbles). Discuss different ways of describing each idea
Now, to find an article, what do we do?
Explain the role of AND/OR logic connectors
Emphasize that they fundamentally work in our favor to find the best type of evidence (OR expands our search, AND filters our search).
Show them how to connect the different ideas to find articles in the database
The following examples will show you why subject headings are important and why we use them
Tie back to the ideas you put into the bubbles on slide 17
Then go to Ovid and search Carpal Tunnel Syndrome. Point out “explode” and “focus”. Will explain explode in next example. “Focus” gives you articles where the subject heading is the main idea, but not recommended to use especially with PT questions. Will see why in example. Explain that subheadings narrow your search even more, again, not a useful tool for PT questions.
Then move back to powerpoint
Importance of subject headings: No key word for Carpal Tunnel syndrome
Focus: If you used FOCUS on Carpal Tunnel, you wouldn’t have gotten this article
Go back to Ovid, search Upper extremity. Use it to explain explode
Then come back to powerpoint
Explode: Must explode upper extremity, easy way to get all parts; keyword would need to search each word
Go back to Ovid, search Splints; Show that it doesn’t explode
Importance of subject headings: If you searched “splint” or “splints” as keyword, you would not have gotten this article. Subject heading allows you to get all of the spellings or ways of writing an idea
examples of when keywords are useful. Need to be able to use both SH and keywords
Summarize the ideas that you already discussed (don’t spend long here)
Ask them to search Medline to find articles to help this patient.
Discuss their findings
Let at least 3 students share their findings, so that we can see diversity of results. Discuss why they found different information and whether this is important.
http://www.flickr.com/photos/32595872@N02/4195880838/
Now we are moving to the second part of the the workshop: practical. Looking at how to formulate a question and how to use this question.
Importance of clinical question
Go back to the cycle and explain to find the best evidence to answer our question, we need to better formulate questions to search! Start with the question!
What is a clinical question and why do we use it?
Focus on the importance of clinical questions for their own professional practice. It is not a theoretical exercise; it is rather a very practical issue.
The clinical question has two parts, here are examples of those two parts
Emphasize that phrasing it precisely will enhance the chances of getting relevant information.
Explain that the “evidence” is in a pyramid, with the best, but less available, evidence is at the top of the pyramid. All of these study designs are in Medline, but we have to search through them to find them.
There are different types of questions and best evidence to answer these questions.
Link to resource for refresher on this idea.
Introduce a framework for clinical question
Explain each element
Introduce a framework for clinical question.
Ask them whether they are familiar with it, and whether they use it during their studies. Also, explain each element with the help of the students, if possible.
Patient/family stakeholder: spouse, parent of a child, caregiver and how it impacts them
Professional Stakeholder: Is this a referral from another professional? Do you need to consider referral to another professional (social worker? OT?)
Context: Live alone? Want to get back to work?
Time: Any time factors
Read the scenario
Find each element in the example – use the framework to identify the main parts of the question.
As the students to ID the element before you reveal it.
Find each element in the example
As the students identify the elements in this framework, write them either on the slides or on the board.
Connect back to ideas, and how using the framework helps you find these ideas.
Now time to search, since we have the question
Verify if all students found the same article
Mention that we don’t always search on outcome
Demonstrate the search in Ovid.
Discuss: we were lucky to find a review. What if we didn’t find one?
We would need to expand our search.
Ask them possible ways to expand the search, and how it would look like in the database search. If time allows, let them do a new search and discuss the results.
Here they could add keywords or just search tens AND stroke AND spasticity separately from combined modality therapy AND stroke AND spaticity and do the comparison themselves.
What if we had a lot of results? Then use limits. Most useful for question formulation is AGE (only for pediatrics or elderly) or publication type (RCT or SysRev)
Discuss the PICO elements in the scenario
Emphasize the idea that the example contains much information that are not relevant for the PICO framework.
Have them tell you the elements. Mention that there is lots of information in this scenario and the framework helps you ID it.
and have them do the search by themselves. Leave this slide up for them to do the search.
Mention l
Show the framework elements and have them do the search by themselves. Lots of information in the scenario; framework helps you find the elements.
Discuss the results, and check which elements they used to their search.
(I don’t usually show this slide, but we’ll see if it is useful this time)
Discuss how you did the search using this slide (I don’t go back into the database here unless someone has a specific question). Emphasize how I searched the keyword for energy conservation since the SH isn’t the same
Discuss comparing exercise therapy and energy conservation (line 5): One 12 year old review and one trial with no results yet
so I looked at just energy conservation alone, and found this review. Mention that I used the limit, but you don’t have to.
These databases all have subject headings, or controlled vocab
Have to look for them in some databases—but some databases are very helpful and suggest subject headings to you!