Research + EBP Chapter 1

What is EBP

Application of research to a profession

Goals of EBP

Reduce errors, improve outcomes, advance practice, reduce unnecessary costs, self govern

Role of evidence in practitioner’s decision making process

1. Identify best treatment

2. Identify best use of resources

3. Identify tests that are appropriate

Two negative forms of procedures with false evidence are…

-Lobotomy

-Blood pleeding

Primary implications

Familiar with research process, evaluate merits of research findings, determine applicability to practice

Level 5 research

Fundamental principles, expert opinion and bench research

Fundamental principles

Do no harm

Expert opinion

Single or group of experts form an opinion

Bench research

Basic science

Level 4 research

Case studies

Case studies

One group, everyone gets the same treatment

Level 3B research

Individual case control

Individual case control

Comparing two groups of people. One of which has a disease and while the other does not

Level 3A research

Systematic review of case control

Systematic review of case control

Taking multiple other people’s research and writing your own review

Level 2C research

Outcomes research/ecological studies

Outcomes research/ecological studies

Using patient outcomes to improve, population verses individuals

Level 2B research

Individual cohort study or low quality RCT

Individual cohort or low quality RCT

Fails to clearly define comparison groups

Protestive cohort

To happen in the future

Retropective cohort

Happened in the past

Level 2A research

Systematic review of cohort studies

Systematic review of cohort studies

GET DEF

Level 1C research

All or none

All or none

Requires large number of subjects, every in study shows a benefit, drastic outcome, rare

Level 1B research

Individualized RCT

Individualized RCT

2 Groups, to prove differences of groups are not by chance

Level 1A research

Systematic review of RCT

Systematic review of RTC

Comprehensive review of all relevant studies

Which researches are secondary?

All the systematic ones

Which research has the highest strength?

SR of RCT

Which research has the lowest strength?

Expert opinion and bench research

Rogers Adoption/Innovation Curve

A model that illustrates how innovations spread through a population. It categorizes adopters into five segments

5 Levels of Rogers

Innovators, early adaptors, early majority, late majority, laggards

Strength of recommendation taxonomy

A systematic process that assigns a letter grade to a group of studies

What does the letter grade do?

Determines emphasis to place on the overall evidence.

SORT focuses more on _____

patient-oriented measures
versus disease-oriented measures

3 Criteria of SORT

Quality, quantity, and consistency

The 5 step approach

1. Ask

2. Acquire

3. Appraise

4. Act

5. Adjust and analyze

Ask

Using P.I.C.O.

P

Patient

I

Intervention

C

Comparison

O

Outcome

Acquire

Electronic databases

Search strategies

Subject, author, refining

3 Booleans

And, or, not

Appraise

Validity, clinical relevance, applicability

Act