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Nursing

This research guide is created specifically for Nursing Courses and topics such as Evidence Based Practice and PICO Formatting. It will help with library resources like finding articles, using databases, and much more!

Evidence Based Practice Stages and Pyramid

 

WHAT IS EVIDENCE BASED PRACTICE?

The most common definition of EBP is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematicresearch." (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002) 

The difference between Meta-Analysis and Systematic Review

A meta-analysis and a systematic review are both methods used to synthesize research findings, but they differ in their scope and methodology.

  1. Systematic Review:

    • Purpose: A systematic review aims to comprehensively collect, evaluate, and synthesize all relevant studies on a specific research question or topic.
    • Process: It follows a structured and predefined protocol that includes a thorough search of the literature, selection of studies based on strict criteria, assessment of the quality of included studies, and a qualitative or quantitative synthesis of the findings.
    • Outcome: The result is a detailed, unbiased summary of the evidence on the topic, often highlighting gaps in research and providing recommendations for practice or further study.
  2. Meta-Analysis:

    • Purpose: A meta-analysis is a subset of a systematic review that quantitatively combines the results of multiple studies to arrive at a single conclusion about the effect of a treatment or intervention.
    • Process: After identifying and selecting studies through a systematic review, a meta-analysis statistically aggregates the data from these studies, typically using effect sizes, to produce an overall estimate of the effect.
    • Outcome: The result is a more precise estimate of the effect size or association, often presented in the form of a pooled average with confidence intervals.

In summary, a systematic review can exist without a meta-analysis, but a meta-analysis is always part of a systematic review if the data allows for quantitative synthesis.

Common Articvle Types in EBP

Here are the basic types of scientific articles commonly used in evidence-based practice:

  1. Original Research Article (Empirical Study):

    • Purpose: Presents new research findings from original experiments, clinical trials, or observational studies.
    • Structure: Typically follows the IMRaD format—Introduction, Methods, Results, and Discussion.
    • Significance: Provides primary evidence on the effectiveness of interventions, diagnostic accuracy, or risk factors, contributing directly to evidence-based practice.
  2. Systematic Review:

    • Purpose: Synthesizes all relevant studies on a specific research question using a systematic and transparent method.
    • Structure: Includes a comprehensive literature search, selection criteria, quality assessment, and summary of findings.
    • Significance: Provides a high level of evidence by integrating results from multiple studies, often used to guide clinical practice guidelines.
  3. Meta-Analysis:

    • Purpose: Combines data from multiple studies (usually included in a systematic review) to produce a single, quantitative estimate of an intervention's effect.
    • Structure: Uses statistical techniques to aggregate results, typically presented with pooled effect sizes and confidence intervals.
    • Significance: Offers a more precise estimate of the effect size, often considered the highest level of evidence when available.
  4. Clinical Practice Guidelines:

    • Purpose: Provides evidence-based recommendations for clinicians on the diagnosis, management, and treatment of specific conditions.
    • Structure: Developed by expert panels, usually based on systematic reviews and meta-analyses, with graded recommendations.
    • Significance: Guides healthcare professionals in making informed decisions, ensuring that patient care is based on the best available evidence.
  5. Case Report/Case Series:

    • Purpose: Describes the clinical presentation, diagnosis, treatment, and outcomes of a single patient (case report) or a small group of patients (case series).
    • Structure: Detailed account of individual cases, often highlighting unusual or novel aspects.
    • Significance: Provides evidence that may lead to the generation of new hypotheses or contribute to the body of knowledge on rare conditions.
  6. Cohort Studies:

    • Purpose: Observes a group of individuals over time to study the outcomes associated with specific exposures or interventions.
    • Structure: Follows participants prospectively or retrospectively, comparing outcomes between exposed and unexposed groups.
    • Significance: Provides evidence on the association between risk factors and outcomes, helping to inform clinical decision-making.
  7. Randomized Controlled Trial (RCT):

    • Purpose: Tests the effectiveness of an intervention by randomly assigning participants to an experimental group or a control group.
    • Structure: Includes randomization, blinding, and controlled conditions to reduce bias.
    • Significance: Considered the gold standard in clinical research for establishing causality and guiding evidence-based practice.

These types of articles form the backbone of evidence-based practice, helping to inform clinical decisions and policy-making with the best available scientific evidence.

Evidence Based Practice Resources

Books about EBP

British Medical Journal- Recent Issues

  • Insights on the German College of General Practitioners and Family Physicians (DEGAM) guideline addressing medical overuseThis link opens in a new windowNov 22, 2024

    Overdiagnosis is a common phenomenon. It is defined as the identification of an abnormality that would not have harmed the patient if it had not been detected. However, once detected, the knowledge of such an abnormality alone has the potential to harm the patient, both psychologically and physically.1 Next to problems for individuals, ‘too much medicine’ also contributes to problems in our healthcare systems: continuously rising healthcare costs, a shortage of healthcare workers, increasing burnout rates among them and increasing greenhouse gas emissions by the healthcare sector.2 Due to limited human, financial and environmental capacities, solutions must be found to better allocate the available resources. The international Preventing Overdiagnosis Conference (PODC) has been dedicated to this topic for 10 years now.3 In August 2023, the conference was held in Copenhagen. The aim of the PODC is the international scientific exchange on the topic...

  • Reporting health and medical researchThis link opens in a new windowNov 22, 2024

    The use of the best available evidence to inform patient care in evidence-based medicine is reliant on the accurate, complete and transparent reporting of health and medical research. Without a complete and transparent account of what was done and what was found during a research study, findings cannot be fully understood, replicated, assessed for validity and applicability, and used to inform clinical and policy decisions.

    For over 50 years, problems of incomplete and poor reporting of research have been widely documented across health and medical research.1–3 Unusable research reports contribute to avoidable research waste4 through the inability to appraise and synthesise research and can detrimentally impact patient care through incorrect implementation of research findings.5 Because of this, complete and transparent reporting of research is a researcher’s moral and ethical responsibility to maximise the usefulness and positive impact of their...

  • Guidelines for the development and validation of patient-reported outcome measures: a scoping reviewThis link opens in a new windowNov 22, 2024
    Objective

    The objectives of this scoping review were to provide an overview of existing guidelines for the development and validation of patient-reported outcome measures (PROMs), review them for comprehensiveness and clarity and provide recommendations for their use based on the goals of the instrument developers.

    Design

    Scoping review.

    Methods

    A literature search was performed in PubMed, Scopus, PsycInfo and Google Scholar up to 2 June 2023 to identify guidelines for the development and validation of PROMs. Screening of records and reports as well as data extraction were performed by two reviewers. To assess the comprehensiveness of the included guidelines, a mapping synthesis was performed and steps to develop and validate a measurement instrument outlined in the included guidelines were mapped to an a priori framework including 20 steps, which was based on the guideline by de Vet et al.

    Results

    A total of 40 guidelines were included. Statistical advice (at least partially) was provided in 98% of the guidelines (39/40) and 88% (35/40) of the guidelines included examples for steps required to develop and validate PROMs. However, 78% (31/40) of the guidelines were not comprehensive and two essential steps in PROM development (‘consideration and elaboration of the measurement model’ and ‘responsiveness’) were not included in 80% and 72% of the guidelines, respectively. Three guidelines included all 20 steps and six included almost all steps (≥90% of steps) for developing and validating a PROM.

    Discussion

    Most guidelines on PROM development and validation do not appear to be comprehensive, and some crucial steps are missing in most guidelines. Nevertheless, for some purposes of PROMs, many guidelines provide helpful advice and support.

    Conclusion

    At least 15 guidelines may be recommended, including three comprehensive guidelines that can be recommended for the development and validation of PROMs for most purposes (eg, to discriminate between subjects with a particular condition and subjects without that condition, to evaluate the effects of treatments (between a pre and post time-points) or to evaluate a status quo).

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