Recording-2025-03-10T10_59_24.808Z

Cycle of Inquiry in Evidence Based Practice

• Evidence based practice revolves around the cycle of inquiry, which consists of five key steps:

  • Identify the Clinical Concern: Start with a clinical problem or patient dilemma, leading to the formulation of a clinical question.

  • Acquire Evidence: Gather relevant evidence related to the clinical problem at hand.

  • Appraise Evidence: Evaluate the evidence according to established principles of evidence based medicine.

  • Apply Evidence: Utilize the assessed evidence in the context of patient care, considering individual patient needs or patient group conditions.

  • Assess Outcomes: Evaluate the outcomes of the intervention or the efficacy of the applied clinical guidelines on the targeted patient population.

Significance of the Cycle of Inquiry

• Recognizing the importance of the inquiry cycle helps prevent outdated practices that may not align with current evidence and standards.

• It emphasizes the continuous need for:

  • Asking clinical questions

  • Acquiring and appraising evidence

  • Applying findings to improve patient outcomes

The Philosophy of Evidence Based Practice

• Information Needs: The demand for literature searching skills is growing rapidly due to the information explosion—an overwhelming increase in publications across fields.

• Integration of Evidence: Evidence based practice offers a framework to combine:

  • The best research evidence

  • Clinical expertise

  • Patient and family preferences in decision-making.

Challenges in Evidence Based Practice

• Mismatch Between Evidence and Expectations: Evidence based medicine sometimes contradicts established beliefs, leading to unexpected outcomes from interventions. Examples involve cardiology studies where medications did not perform as anticipated.

• Complex Patient Scenarios: Patients often present multiple comorbidities, complicating the application of findings from controlled studies that usually involve homogenous populations.

Statistical Understanding in Evidence Based Practice

• A solid grasp of statistics and biostatistics is crucial to interpreting evidence:

  • Understanding appropriate statistical tests and their application is vital, rather than trying to master every technical detail of biostatistics.

• Critical appraisal skills are necessary to assess the validity and relevance of study outcomes.

Ethical Considerations

• Conflicts of Interest: Transparency regarding financial ties influencing research is critical. Researchers must disclose funding sources, and undisclosed conflicts can undermine the credibility of studies.

• Sham Surgical Studies: These studies highlight the unexpected results of surgical interventions, raising ethical dilemmas about their implementation.

Terminology Distinction

• The terms evidence based medicine, evidence based practice, and evidence based surgery (EBS), though often used interchangeably, have specific meanings:

  • Evidence Based Medicine: Primarily focused on clinical practice in medicine.

  • Evidence Based Practice: A broader term that can apply to various fields, including allied health, library services, and business strategies.

  • Evidence Based Surgery: A specific application of evidence based principles in surgical contexts.

• Evidence based practice emphasizes a philosophical approach to improving practices based on research evidence, making it applicable beyond conventional medicine.

Cycle of Inquiry in Evidence Based Practice:

1. Identify the Clinical Concern: Begin with a clinical problem or patient dilemma and develop a related clinical question.

2. Acquire Evidence: Collect relevant evidence pertaining to the identified clinical issue.

3. Appraise Evidence: Evaluate the gathered evidence based on established principles of evidence-based medicine.

4. Apply Evidence: Implement the assessed evidence within patient care contexts, considering individual or group needs.

5. Assess Outcomes: Evaluate the results of the intervention or the effectiveness of the applied clinical guidelines.

Significance: Highlights the continuous necessity for asking questions, acquiring, appraising, and applying the findings to enhance patient outcomes.

Challenges: Differences between evidence and expectations, handling complex patient scenarios, and the need for strong statistical understanding for evidence interpretation are critical to practice.

Ethical Considerations: Includes managing conflicts of interest in research transparency and addressing ethical dilemmas from sham surgical studies.

Terminology Distinction:

• Evidence Based Medicine: Focuses on clinical practice in medicine.

• Evidence Based Practice: Broader term including fields like allied health and business.

• Evidence Based Surgery: Application of evidence-based principles specifically in surgical contexts.