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PDPT-56800 Research II Evidence Based Practice II

PDPT-56800 Research II Evidence Based Practice II. Laura Kuo lkuo@ithaca.edu March 10, 2011. Outline – Class 1. What is evidence-based practice? How do you build a good clinical question? What are the bibliographic databases to search? MEDLINE CINAHL Search strategies

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PDPT-56800 Research II Evidence Based Practice II

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  1. PDPT-56800 Research IIEvidence Based Practice II Laura Kuo lkuo@ithaca.edu March 10, 2011

  2. Outline – Class 1 • What is evidence-based practice? • How do you build a good clinical question? • What are the bibliographic databases to search? • MEDLINE • CINAHL • Search strategies • Keyword vs Subject Heading • Boolean • Limits • Search History • Appraising the evidence

  3. Outline – Class 2 • Brief review of Class 2 • How do you build a good clinical question? • Search strategies • What are the EBP databases to search • Cochrane • PEDro • Hooked on Evidence • Other resources: EBP Research Guide

  4. Clinical Clinical Expertise Research Evidence Resources Patients’ Preferences What is Evidence-based Practice?

  5. What do we mean by “evidence”? The evidence pyramid is used to illustrate the evolution of the literature. As you move up the pyramid the amount of available literature decreases, but … increases in its relevance for application in clinical settings. Image: http://library.downstate.edu/EBM2/2100.htm

  6. Evidence-based Practice: The Process

  7. A well-built clinical question • Patient, population, or problem • Intervention, prognostic factor, or exposure • Comparison or intervention • Outcomes to measure or be achieved

  8. Types of Clinical Questions Once the basic parameters of the clinical question are established, what type of question is it? • THERAPY/INTERVENION • DIAGNOSIS • PROGNOSIS • HARM / ETIOLOGY -- ???? • OUTCOME -- ???

  9. Types of Studies What is the best study design to answer the type of question? • Therapy: RCT; systematic review, meta analysis, cohort; case control • Diagnosis: blind comparison to gold standard • Prognosis: cohort; case control • Harm/Etiology: cohort; case control • Outcome:

  10. Clinical Scenario • George is an active 83 year old male. He used to swim three times a week for 45 minutes, garden, and walk to church. But for the last several months, he has had trouble walking and bending his knees. It has made gardening difficult and restricted his daily activities. • He is referred to physical therapy by his family physician with a diagnosis of osteoarthritis and prescribed Voltaren (diclofenac), a nonsteroidal anti-inflammatory drug.  He has been using the medication for two weeks, but is still in pain and wants to know if acupuncture would help.  He says he would like to stay away from more medication.  You are not sure about the effectiveness of acupuncture for this patient and need to do a little research before you can address his question.

  11. Example (cont.) P I C O Clinical Question: Type of Question: Type of Study:

  12. Searching the Literature - Strategies Before going online, PREPARE! • Identify the relevant database(s) to search • Formulate a clear research or clinical question • Identify the key concept(s) of the question, relevant synonym and alternate terms or spelling • Use Boolean operators to show concept relationships • Apply limits (date, language, age, human…)

  13. Demo Class 1 • Medline • PubMed Clinical Queries • CINAHL Class 2 • Cochrane • PEDro • Hooked on Evidence • Other Resources: • http://www.ithacalibrary.com/sp/subjects/evidence

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