BOOK
Evidence-Based Practice Across the Health Professions - E-pub
Tammy Hoffmann | Sally Bennett | Christopher Del Mar
(2017)
Additional Information
Book Details
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 |