WHAT IS EVIDENCE BASED PRACTICE?
Patient Values/ Preferences Or Expectations
Clinical Data/
Knowledge
Research Evidence
Optimal Decision
What does the patient want?
What are they willing to do?
What does your experience tell you?
What has been the experience of your colleagues?
What does the research say?
Evidence Based Practice Inquiry Process
Focus the
question
Adequate evidence?
Assign / Find
mentor
IRBProposal
& Approval
Datacollection
Data analysis
Disseminate
Impactand/or
outcome
Initialquestion
Unit or
department resource
Assess translation of evidence
into practicesetting
Create action plan and
implement change
Evaluate outcome
and/or impact
Finalize team membership
and schedule conferences
Report results
to decision-makers
Adoptchange
and identify
next steps
Contact Research Advisory Council
or Group (If Applicable)
Appraisalof
literature
Assembleinitial
project team
If answer is yes, proceed to EBP
Project.
If answer is no, proceed to research
project
Consult Librarian &
Do Lit. Search
Adapted from VCUHS Nursing Inquiry Process Diagram
Levels of Evidence Evidence
Based Practice
Guidelines
Meta- Analysis / Systematic
Review
Critically Appraised Topics
[Evidence Syntheses]
Critically Appraised Individual Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered Information
Qua
lity
of E
vide
nce
Start of
Search
(Idea
l)
Rea
lity
EBP Objective:Clinical Knowledge Bedside
Practice Guideline
Advantages Created by panels of experts Based on professional published
literature
http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html
Statement produced by a panel of experts that outlines current best practice to inform health care professionals and patients in making clinical decisions.
Where Can They Be Found? o PubMedo CINAHLo National Guidelines Clearinghouse
Disadvantages Slow to change or be updated Not always available, espeically
on controversial topics Recommendations might be
affected by the type of organization creating the guideline
Review Articles Review Articles
• Provide Overview of a field or subject• Synthesize Previous Research • Useful when you need background information and additional references
Systematic Review • Evidence based search and review of the literature on a topic by an
established method.
Meta-Analysis • A systematic method that takes data from a number of independent studies
and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health Consumers)
Primary Research Articles • Present new and original scientific findings • Explain research methodology and provide data
Randomized Controlled Trials (RCT’s)
Cohort Studies
Case-Controlled Studies
Studies that randomly assign individuals to an intervention group or to a control group,
in order to measure the effects of the intervention.
Study in which a particular outcome, such as death from a heart attack, is compared in groups of people who are alike in most ways but differ
by a certain characteristic
Study that compares patients who have a disease or outcome of interest (cases) with
patients who do not have the disease or outcome (controls), and looks back
retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk
factor and the disease.
Types of Research Articles
Cause & Effect
Type of Question/ Best Type of Study
Type of Question
Best Type of Study
TherapyHow to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using
them
Randomized Control Trial (RCT)
PreventionHow to prevent a disease or condition
RCT/ Cohort Study / Case Control
PrognosisHow to estimate the patient's likely clinical course over
time and anticipate likely complications of disease
Cohort Study/ Case Control/ Case Series or Case Report
DiagnosisHow to select and interpret diagnostic tests
Blind RCT Compared to the Gold Standard (best treatment/test for diagnosis)
Etiology/HarmHow to identify causes for disease
RCT/ Cohort Study /Case Control
Cost analysisEconomic costs of all facets of a intervention or disease
treatment
Economic Analysis
Search Process Checklist
Top of Pyramid:
Met. Analysis, Sys. Rev. ,
Prac. Guideline
Selecting the Right Resource
• Research Guides • Nursing Research Guide
• Important Databases• PubMed/Medline (Free) • CINAHL• APA PsycNet/PsychInfo• Cochrane Library • TRIP Database (Free)• National Guidelines
Clearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)
http://guides.library.vcu.edu/nursing
Evidence Based
Practice Guidelines
Meta- Analysis / Systematic
Review
Critically Appraised Topics
[Evidence Syntheses]
Critically Appraised Individual Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered Information
Qua
lity
of E
vide
nce
Evidence Based
Practice Guidelines
Meta- Analysis / Systematic
Review
Critically Appraised Topics
[Evidence Syntheses]
Critically Appraised Individual Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered Information
Qua
lity
of E
vide
nce
Objectives: By the end of this presentation you will :
• Have an understanding of how evidence based practice is defined.
• Understand the quality of the different types of literature that are assessed when making decisions based on evidence.
• Be aware of the different types of EBP questions and what studies best answer each type.
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