Scribd Logo
Upload

Welcome to Scribd!

  • 22 views

    Evidence-Based Practice (1) - 2013-A

    Uploaded by

    Melda Amalia Sikumbang
    This document discusses evidence-based practice (EBP) and the EBP process. It describes the steps in the EBP process as assessing the patient, asking a question, acquiring evidence through a literature search, appraising the evidence, applying the evidence in practice by discussing it with the patient, and evaluating one's performance. It emphasizes starting with the patient's problem or question and constructing a well-built clinical question using the PICO (patient, intervention, comparison, outcome) format to guide an effective literature search. Different types of clinical questions and studies are discussed, including randomized controlled trials being the best evidence for questions about therapy, prognosis, or harm/etiology.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Evidence-Based Practice (1) - 2013-A

    Uploaded by

    Melda Amalia Sikumbang
    22 views24 pages
    This document discusses evidence-based practice (EBP) and the EBP process. It describes the steps in the EBP process as assessing the patient, asking a question, acquiring evidence through a literature search, appraising the evidence, applying the evidence in practice by discussing it with the patient, and evaluating one's performance. It emphasizes starting with the patient's problem or question and constructing a well-built clinical question using the PICO (patient, intervention, comparison, outcome) format to guide an effective literature search. Different types of clinical questions and studies are discussed, including randomized controlled trials being the best evidence for questions about therapy, prognosis, or harm/etiology.

    Original Description:

    materi kuliah s2 kebidanan pak darwin

    Original Title

    Evidence-based Practice (1) - 2013-A

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses evidence-based practice (EBP) and the EBP process. It describes the steps in the EBP process as assessing the patient, asking a question, acquiring evidence through a literature search, appraising the evidence, applying the evidence in practice by discussing it with the patient, and evaluating one's performance. It emphasizes starting with the patient's problem or question and constructing a well-built clinical question using the PICO (patient, intervention, comparison, outcome) format to guide an effective literature search. Different types of clinical questions and studies are discussed, including randomized controlled trials being the best evidence for questions about therapy, prognosis, or harm/etiology.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    22 views24 pages

    Evidence-Based Practice (1) - 2013-A

    Uploaded by

    Melda Amalia Sikumbang
    This document discusses evidence-based practice (EBP) and the EBP process. It describes the steps in the EBP process as assessing the patient, asking a question, acquiring evidence through a literature search, appraising the evidence, applying the evidence in practice by discussing it with the patient, and evaluating one's performance. It emphasizes starting with the patient's problem or question and constructing a well-built clinical question using the PICO (patient, intervention, comparison, outcome) format to guide an effective literature search. Different types of clinical questions and studies are discussed, including randomized controlled trials being the best evidence for questions about therapy, prognosis, or harm/etiology.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    EVIDENCE-BASED

    PRACTICE (EBP)
    (1)
    Darwin Amir
    Bgn Ilmu Penyakit Saraf
    FK-Unand / RS Dr. M. Djamil
    PADANG

    The EBP Process

    Best
    Researc
    h
    Evidenc
    e

    Clinical
    Expertis
    e

    EB
    P

    Patient
    Values &
    Preferen
    ce

    Select the approproiate resource (s)


    and conduct a search
    Construct a well built clinical
    question derived from the case
    Start with the patient a clinical
    problem or question arises from the
    care of the patient

    ACQUIR
    E the
    evidenc
    e
    ASK
    the
    questio
    n
    Assess
    the
    patient

    The Steps in the EBP


    Process

    Evaluate your performance with this patient

    Return to the patient integrate that evidence


    with clinical expertise, patient preferences and
    apply it to practice
    Appraise that evidence for its validity
    (closensess to the truth) and applicability
    (usefulness in clinical practice)

    SELF
    EVALUATI
    ON

    APPLY:
    talk with
    the
    patient

    APPRAISE
    the
    Evidence

    The Steps in the EBP


    Process

    The Built Clinical Question


    ASSESS
    the
    patient
    ASK the
    question

    Start with the


    patient: a clinical
    problem/question
    arises from the care
    of the patient
    Construct a well-built
    question derived
    from the case

    Anatomy of a good clinical


    question: PICO

    PICO:
    The mnemonic that helps one remember the key
    components of a well focused question
    The question needs to identify the key problem of
    the patient,
    - what treatment you are considering for the
    patient,
    - What alternative treatment is being considered (if
    any) and
    - What is the outcome you want to avoid or
    promote

    Anatomy of a good clinical


    question: PICO
    What are the most
    P = Patient or important characteristic of
    the patient. This may
    Problem
    include the primary
    problem, disease or coexisting conditions

    I=
    Which main intervention,
    Intervention, What do you want to do for
    prognostic
    the patient ? (drugs, order
    a test, what factor may
    factor or
    influence the prognosis ?.
    exposure

    Anatomy of a good clinical


    question: PICO

    C=
    Comparison

    O=
    Outcome

    What is the main alternative


    to compare with the
    intervention ?.
    Are you trying to decide
    between two drugs or two
    diagnostic tests ?.
    What can you hope to
    accomplish, measure,
    improve or effect ?.
    What are you trying to do for
    the patient ? (relieve or
    eleminate the symptoms,
    improve function ?)

    The Literature Search

    Type of Question and Types of


    Studies
    Types of Questions:
    Diagnosis

    how to select and interpret diagnostic tests

    Therapy
    how to select treatments to offer patients
    that do more good than harm and that are
    worth the efforts and costs of using them
    Prognosis

    Harm/Etiology

    how to estimate the patient's likely clinical


    course over time and anticipate likely
    complications of disease
    how to identify causes for disease (including
    iatrogenic forms)

    The Literature Search


    Types of Studies
    Type of Question:
    Diagnosis
    Therapy
    Prognosis
    Harm/Etiology

    Suggested best type of study:


    prospective, blind comparison to a gold
    standard
    RCT > cohort > case control > case series
    cohort study > case control > case series
    RCT > cohort > case control > case series

    Prevention

    RCT > cohort study > case control > case


    series

    Clinical Exam

    prospective, blind comparison to gold


    standard

    Cost Benefit

    economic analysis

    The Literature Search


    Types of Studies

    Clinical Trial
    Clinical Trial (report pre-planned clinical study of
    the)
    - safety,
    - efficacy, or
    - optimum dosage schedule of one or more
    diagnostic, therapeutic, or prophylactic
    drugs,
    devices, or technique in humans selected
    according criteria of eligibility and evidence
    of
    favorable and unfavourable effects)

    Clinical Trial
    Clinical Trial, Phase I (for small number of
    healthy persons and conducted over the
    period of about a year)
    Clinical Trial, Phase II (for several hundreds
    volunteers, including a limited number of
    patients, and conducted of about two years)
    Clinical Trial, Phase III (a large enough group
    of patients is studied and closely monitored
    by physicians for adverse respons to long
    term exposures, over a period of about three
    years)

    Clinical Trial
    Clinical Trial, Phase IV (the study conducted in
    many countries for general safe after clinical
    trials phases I, II, III and efficacy of a product).
    Launching for marketing
    Surveilance post marketing

    Other types of Clinical Trial


    Cross sectional studies: describes the relationship
    between diseases and other factors at one point in time
    (usually) in a defined population.
    Lack any information or timing of exposure and outcome
    relationship and prevalences cases

    Other types of Clinical Trial


    Qualitative Research answers: a wide
    variety of questions related to human responses
    to actual or potential health problems. The
    purpose of this research is to describe, explore
    and explain the phenomena being studied

    Cross sectional studies: describes the


    relationship between diseases and other factors at
    one point in time (usually) in a defined population.
    Lack any information or timing of exposure and
    outcome relationship and prevalences cases

    Other types of Clinical Trial


    Studies that show the efficacy of a
    diagnostic test are called
    prospective, blind comparison to a
    gold standard study

    Retrospective cohort (historical cohort).

    Begin with the presence or absence of an


    exposure or risk factor and are followed until
    outcoma of interest in observed. However this
    study design uses information that has been
    collected in the past and kept in files or databases

    The Literature Search


    ACQUIRE
    the
    Evidence

    Select the appropriate resource (s) and


    conduct a search

    For our patient, the clinical


    question is:

    In elderly patients with heart failure and an


    ejection fraction of 40%, is Ibesartan
    effective in reducing the need for
    rehospitalization ?
    It is a therapy question and the best
    evidence would be a randomized controlled
    trial (RCT). If we found numerous RCTs, then
    we might want to look for a systematic

    The Literature Search


    PICO

    Clinical Question

    Search
    Strategy

    Patient /
    Problem

    Heart failure, Elderly,


    Ejection fraction 40%

    Heart Failure
    Limit to aged

    Intervention

    Irbesartan or

    Irbesartan or

    Comparison (if
    any)

    None, Placebo, Standard


    Care

    Outcome

    Reduce need for


    hospitalization
    Reduce mortality

    Hospitalization

    Type of question

    Therapy

    (see below)

    Type of study

    RCT

    Clinical Query
    Therapy / narrow or
    Limit to randomized
    controlled trial as
    publication type

    The Literature Search


    research in PubMed)

    (conduct the

    Step 1: Use PICO to formulate the search strategy; start


    with Patient problem
    and Intervention

    The Literature Search


    research in PubMed)

    (conduct the

    tep 2. Look at Details to verify MeSH terms

    The Literature Search


    research in PubMed)

    (conduct the

    tep 3. Limit to appropriate study design

    The Literature Search


    research in PubMed)

    (conduct the

    tep 3. Limit to appropriate study design

    The Literature Search


    research in PubMed)

    Step 4. Review the results

    (conduct the

    The end for temporary

    You might also like