Menu Expand
Evidence-Based Practice Across the Health Professions - E-pub

Evidence-Based Practice Across the Health Professions - E-pub

Tammy Hoffmann | Sally Bennett | Christopher Del Mar

(2017)

Abstract

Evidence-based Practice across the Health Professions is a contemporary guide to modern evidence-based practice. Fully revised and updated, it continues to keep the focus on the knowledge and skills that clinicians and students really need to make evidence-based informed decisions. It provides a foundation to help you to better ponder what clinical questions to ask, know ways to efficiently find research that answers those questions, know how to decide whether the results of research are believable, important and applicable and use good evidence with patients to provide healthcare as responsibly, effectively and collaboratively as possible. Featuring a multi-disciplinary approach with contributions from international and national leaders in evidence-based practice, this new edition now includes 15 health disciplines, including: - Clinical exercise physiology                                         - Optometry  - Complementary and alternative medicine                     - Paramedicine   - Human movement (exercise science)                           - Pharmacy   - Medical imaging                                                         - Physiotherapy   - Medicine                                                                   - Podiatry    - Nursing                                                                     - Radiation Therapy - Nutrition and dietetics                                                - Speech pathology  - Medicine                                                                   - Occupational Therapy

Visit evolve.elsevier.com for your additional resources

Instructor resources:

  • Image collection
  • PowerPoint slides
  • Short answer and tutorial questions
  • Clinical Scenarios
  • Test bank

Student and instructor resources:

  • Interactive quiz
  • Worksheets
  • Updated and additional content on shared decision making
  • Additional case studies on community pharmacy and optometry
  • Expanded and updated content on evidence implementation
  • New content on diagnostic clinical prediction rules
  • Revised and expanded evolve assets to support teaching and learning

Table of Contents

Section Title Page Action Price
Front Cover cover
Evidence-Based Practice Across the Health Professions i
Copyright Page iv
Table Of Contents v
Foreword vii
Authors viii
Contributors ix
Reviewers xiii
Preface xiv
1 Introduction to evidence-based practice 1
Learning Objectives 1
What is evidence-based practice? 2
A simple definition of evidence-based practice 3
Where did evidence-based practice come from? 4
What happened before evidence-based practice? 5
Is evidence-based practice the same as ‘guidelines’? 5
Is evidence-based practice the same as randomised controlled trials? 5
Can anyone practise evidence-based practice? 5
Do health professionals have time for an activity such as evidence-based practice? 6
Why is evidence-based practice important? 6
Scope of evidence-based health care 6
Common criticisms of evidence-based practice 7
The process of evidence-based practice 7
Step 1: Convert your information needs into an answerable clinical question 7
Step 2: Find the best evidence to answer your clinical question 9
Step 3: Critically appraise the evidence for its validity, impact and applicability 9
Why do I need to critically appraise the evidence? Surely all published research is good quality? 9
What is involved in critically appraising evidence? 10
Step 4: Integrate the evidence with clinical expertise; the patient’s values, preferences and circumstances; and information from the practice context 11
Step 5: Evaluate the effectiveness and efficiency with which steps 1–4 were carried out, and think about ways to improve your performance of them next time 11
How this book is structured 12
Summary Points of this Chapter 14
References 14
2 Information needs, asking questions, and some basics of research studies 16
Learning Objectives 16
Clinical information needs 17
Dealing effectively with information needs 17
The size of the problem 17
Noting down your clinical question 18
Different ways of obtaining information: push or pull? just-in-case or just-in-time? 19
Push: ‘just-in-case’ information 19
Pull: ‘just-in-time’ information 21
How to convert your information needs into an answerable clinical question 22
Patient or problem (or population or person) 23
Intervention (or diagnostic test or prognostic factor or issue) 23
Comparison 23
Outcome(s) 23
Now that the question is formulated, what types of information should be looked for? 24
Relevant information 24
Believable information: validity 24
What are the different study types? 24
Hierarchies of evidence for each question type 28
Hierarchy of evidence for questions about experiences and concerns 31
Internal validity: what are bias and confounding? 31
Internal validity and external validity 31
Chance 32
Bias 32
Confounding 32
Statistical significance, clinical significance and power 35
Statistical significance 35
The p value 35
Confidence intervals 35
Clinical versus statistical significance 37
Outcome measures—what do we need to know about them? 38
Putting it all together: thinking about power 38
Summary points of this chapter 39
References 40
3 Finding the evidence 41
Learning objectives 41
The basics of searching 42
Carefully define your clinical question 42
Choose your key search terms 42
Broaden your search if necessary 42
Use Boolean operators 43
Basics of searching: an example 44
How to navigate evidence-based information services 46
Systems—first layer (top) of the pyramid 47
Summaries—second layer of the pyramid 47
Synopses of syntheses—third layer of the pyramid 48
Syntheses (systematic reviews)—fourth layer of the pyramid 49
Synopses of studies—fifth layer of the pyramid 51
Studies—sixth layer (bottom) of the pyramid 51
Cochrane central register of controlled trials 54
Medline 55
Other large databases 57
Some tips for locating qualitative research 57
Alerting or updating services 58
Other resources 59
Search examples 60
Clinical question about the effects of intervention 60
Clinical question about diagnosis 60
Clinical question about prognosis 61
Clinical question about patients’ experiences and motivations 61
Summary points of this chapter 62
Acknowledgments 62
References 62
4 Evidence about effects of interventions 64
Learning objectives 64
Study designs that can be used for answering questions about the effects of interventions 65
Studies that do not use control groups 66
Controlled studies 67
Non-randomised controlled studies 67
Randomised controlled trials 68
How to structure a question about the effect of an intervention 69
How to find evidence to answer questions about the effects of an intervention 70
Is this evidence likely to be biased? 71
Was the assignment of participants to groups randomised? 72
Was the allocation sequence concealed? 73
Were the groups similar at the baseline or start of the trial? 74
Were participants, health professionals and study personnel ‘blind’ to group allocation? 75
Were all participants who entered the trial properly accounted for at its conclusion, and how complete was follow-up? 77
Were participants analysed in the groups to which they were randomised using intention-to-treat analysis? 79
The role of chance 81
Completeness of reporting of randomised controlled trials 81
Understanding results 81
Continuous outcomes—size of the intervention effect 82
Clinical significance 83
Continuous outcomes—precision of the intervention effect 84
How are confidence intervals useful? 84
How do I calculate a confidence interval? 85
Confidence intervals and statistical significance 85
Confidence intervals and clinical significance 86
Dichotomous outcomes—size of the treatment effect 90
Risk and relative risk (or relative benefit) 90
Relative risk reduction (or relative benefit increase) 91
Absolute risk reduction (or absolute benefit increase) 93
Number needed to treat 93
Applying results to your clinical situation 94
Dichotomous outcomes—precision of the treatment effect 94
How can we use this evidence to inform practice? 96
Do the results apply to your patient or situation? 97
Do the benefits found outweigh any harm, costs and/or inconveniences that are involved with the intervention? 97
What other factors might need to be considered when applying this evidence? 97
Summary points of this chapter 99
References 99
5 Questions about the effects of interventions 102
6 Evidence about diagnosis 136
Learning objectives 136
Study designs that can be used for answering questions about diagnosis 137
How to structure a diagnotic question 138
Patient/population 138
Intervention 138
Comparison 139
Is this evidence likely to be biased? 140
Was there a clear question for the study to address? 140
Is the comparison with an appropriate reference standard? 141
Did all participants get the diagnostic test and the reference standard? 141
Could the results of the test of interest have been influenced by the results of the reference standard, or vice versa? 142
Was there a clear description of the disease/condition status of the tested population? 143
Was there sufficient description of the methods for performing the test? 143
What are the results? 144
Sensitivity and specificity 144
Post-test probabilities of a positive and a negative test 145
Positive and negative likelihood ratios 148
How changes in the cut-off affect test performance 149
How can we use this evidence to inform practice? 150
Other types of test studies 152
Diagnostic clinical prediction rules 153
Summary points of this chapter 157
References 157
7 Questions about diagnosis 159
References 184
8 Evidence about prognosis 185
Learning objectives 185
How to structure a prognostic question 186
Patient/problem 187
Intervention/issue 187
Outcomes 187
Time 188
Is this evidence likely to be biased? 189
Did the study address a clearly focused issue? 190
Was an appropriate study type used? 190
Was the cohort recruited in an acceptable way? 191
Was there a representative and well-defined sample of participants? 191
The weaknesses of retrospective studies 191
Were participants recruited at a common point in the disease or condition? 192
Was the exposure determined accurately? 192
Were the outcomes measured accurately? 193
Were important confounding factors considered? 194
Was the follow-up of participants sufficiently long and complete? 195
What are the results? 195
Likelihood of the outcomes over time 195
Precision of the estimates of likelihood 196
Calculating a confidence interval for continuous outcomes 197
Calculating a confidence interval for dichotomous outcomes 197
Identification and analysis of prognostic factors 198
How can we use this evidence to inform practice? 198
Summary points of this chapter 200
Acknowledgments 200
References 200
9 Questions about prognosis 202
References 225
10 Understanding evidence from qualitative research 226
Learning objectives 226
Qualitative research: the value of different philosophical perspectives and methodologies in researching people’s experiences and behaviours 228
Qualitative methodologies used in health research 229
Interpretive approaches to research 229
Phenomenology 229
Grounded theory 230
Ethnography 230
Critical approaches to research 231
Action research 231
Discourse analysis 231
Using qualitative evidence: a stepwise approach 232
Structuring a qualitative question 232
Searching for qualitative evidence 232
Critically appraising qualitative evidence 234
Further comments comparing the QARI and CASP approaches to critical appraisal 244
Applying qualitative evidence 245
Summary points of this chapter 246
References 246
11 Understanding evidence from qualitative research 248
References 291
12 Appraising and interpreting systematic reviews 292
Learning objectives 292
What are systematic reviews? 293
Advantages and disadvantages of systematic reviews 295
Systematic reviews for different types of clinical questions 295
Locating systematic reviews 296
How are systematic reviews conducted? 296
Quantitative systematic reviews 297
Define the research question and plan the methods for undertaking the review 297
Determine the eligibility criteria for studies to be included 297
Search for potentially eligible studies 298
Apply eligibility criteria to select studies 298
Assess the risk of bias in the included studies 299
Extract data from the included studies 299
Synthesise the data 299
Interpret and report the results 301
How do you interpret a forest plot? 302
Critical appraisal of quantitative systematic reviews 303
Critical appraisal of systematic reviews—a worked example 304
Qualitative evidence syntheses 311
Define the research question and plan the methods for undertaking the review 311
Determine the eligibility criteria for studies to be included 311
Search for potentially eligible studies 312
Apply eligibility criteria to select studies 312
Assess the quality of the included studies 312
Extract data from the included studies 312
Synthesise the data 312
Interpret and report the results 313
Assessing the quality of qualitative evidence syntheses 315
The importance of complete reporting in systematic reviews 319
Summary points of this chapter 319
Acknowledgment 319
References 319
13 Clinical practice guidelines 323
Learning objectives 323
What are clinical guidelines? 324
Why use guidelines? 324
Guidelines: the pros and cons 325
How guidelines fit with other evidence-based practice products 326
Where and how to find guidelines 326
Bibliographic databases 327
Guideline-specific databases 328
How are guidelines developed? 328
Can i trust the recommendations in a clinical guideline? 330
The AGREE II instrument for appraising guidelines 331
Grading the quality of evidence and strength of recommendations 331
Considerations for using a guideline in practice 333
Do clinical guidelines change practice and improve care? 334
Summary points of this chapter 335
References 335
14 Shared decision making 337
Learning objectives 337
Patient-centred care 338
Shared decision making 338
The connection between shared decision making and evidence-based practice 339
The importance, and benefits, of shared decision making 340
Steps in the shared decision-making process 340
Myths about shared decision making 346
Challenges in shared decision making 348
Legal implications of shared decision making 348
Tools to assess shared decision making 349
Decision support tools 349
Decision aids 349
Finding decision aids 349
Using decision aids 350
Communicating statistical information to patients 350
Types of data that health professionals use and how to present them to patients 351
Probability 351
Risk of disease or harm 352
Absolute risk: natural frequencies (incidence) versus probabilities (chance) 352
Relative risk reductions (or increases) versus absolute risk reductions (or increases) 353
Number needed to treat 353
Factors for health professionals to consider when presenting statistical information to patients 353
Words versus numbers 353
Framing 354
Using visual displays 354
Consider timeframes and social factors 355
Less is more 356
General principles regarding communication format 356
Verbal information 357
Combination of verbal and written information 357
Written information 357
Choosing a communication format 358
One final comment 359
Summary points of this chapter 359
References 360
15 Clinical reasoning and evidence-based practice 364
Learning objectives 364
The evidence-based practice movement’s concept of evidence 366
Evidence of what? 367
From the perspective of the empirico-analytical paradigm 368
From the perspective of technical rationality 368
What information helps health professionals to address the dilemmas of their practice? 369
Considering evidence from the patient’s perspective 371
Evidence of what? A summary 371
Integrating information and knowledge: the forgotten art? 372
Approaches to clinical reasoning 374
An interpretative model of clinical reasoning 375
How do I make my practice evidence-based? 378
Summary points of this chapter 380
References 380
16 Implementing evidence 384
Learning objectives 384
Implementation terminology 385
Overview of the process of implementation 385
Using theory and theoretical frameworks to inform the process of implementation 387
Normalisation Process Theory 388
Diffusion of innovations in health service organisations 389
Nature of the innovation 389
Nature of the adopter 389
Mode of communication and influence 389
Inner and outer contexts 390
Consolidated Framework for Implementation Research 390
The Behaviour Change Wheel and Capability-Opportunity-Motivation-Behaviour (COM-B) model of behaviour 391
Theoretical Domains Framework 392
The process of implementation in detail 392
Step 1: Identify the evidence–practice gap and specify the evidence-based behaviour/s to be implemented 392
Step 2: Identify which factors (that is, barriers and enablers) need to be addressed using theory and/or theoretical frameworks 394
Step 3: Select and deliver intervention components most likely to overcome the barriers and enhance enablers, informed by theory and evidence 396
Educational materials 396
Educational meetings 397
Educational outreach visits 398
Reminders 398
Audit and feedback 399
Step 4: Identify and select methods to measure implementation outcomes 401
Factors that can help sustain post-implementation practice change 402
SUMMARY POINTS OF THIS CHAPTER 403
References 404
17 Embedding evidence-based practice into routine clinical care 409
Learning objectives 409
Why is a systems approach important? 411
Why should organisations want to promote evidence-based practice? 411
1. To maintain their reputation and ‘market share’ 411
2. To improve their delivery of care through innovation 411
3. To increase their efficiency 412
Culture and characteristics of organisations that integrate evidence-based practice 413
Active senior leadership commitment and support for evidence-based practice 413
Infrastructure of clinical informatics 414
Access to evidence to answer specific questions 414
Access to clinical decision support systems 415
Access to databases for auditing current practice 415
Provision of training 415
Using evidence-based practice to improve quality and safety 416
Changing clinical processes 418
Organisational policies that embrace evidence-based practice 421
Conclusion 421
Summary points of this chapter 423
References 424
Index 428
A 428
B 428
C 428
D 430
E 430
F 432
G 432
H 432
I 432
J 433
K 433
L 433
M 433
N 434
O 434
P 434
Q 436
R 437
S 438
T 439
U 439
V 439
W 439