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Respiratory Care: Evidence-Based Practice: EBP

Defining EBP

Evidence-Based Practice (EBP) is the framework for your clinical decision-making process. It is the integration of

  • your knowledge, skills, and past experience (Clinical Expertise);
  • the unique preferences, concerns and expectations of your patient (Patient Characteristics); and
  • valid and clinically relevant research (Best Evidence).

 

      

 

Types of Clinical Questions

Therapy - What is the treatment for a disease?

Diagnosis - power of a test to differentiate between those with and without a disease?

Prognosis - a patient’s likely course over time due to factors other than interventions?

Etiology/Harm - effects of potentially harmful agents on the patient?

Rating Evidence

Strength of the Recommendation and Grade of Quality of the Evidence

Restrepo, R. D. (2010). AARC Clinical Practice Guidelines: from “reference-based” to “evidence-based”.

5 A's - Steps for Acquiring Information

                    

               - Review the Situation (Assess)

             - Define the clinical problem as a question (Ask)

             - Select resources, design a strategy, and search for the

               answer (Acquire)

             - Summarize the evidence yield (Appraise)

             - Apply the evidence (Apply)

Levels of Evidence

                A hierarchy of the likely best evidence.

Systematic Review: High-level overview of primary research on a focused clinical question using a systematic search strategy, eliminating bias. One of the highest levels of infomation. Not a literature review, which summarizes evidence on a topic. Cochrane (Systematic) Reviews are recognized as having the highest level of evidence.

Meta-analysis: The use of quantitative/statistical methods to summarize data from studies included in a systematic review. Not all systematic reviews include a meta-analysis.

                     Overview of other study designs

  Illustration of Evidence to Evidence-Based Resources

Study Design

Type of Question Suggested Best Type of Study
Therapy RCT > prospective cohort
Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis cohort study > case control > case series
Prevention RCT > cohort study > case control > case series
Clinical Exam prospective, blind comparison to gold standard
Cost economic analysis