EBP IS A PROBLEM SOLVING APPROACH TO CLINICAL PRACTICE THAT

INTEGRATES THE BEST USE OF EVIDENCE IN COMBINATION WITH

CLINICAL EXPERTISE AND PATIENTS PREFERENCES AND VALUE IN
MAKING DECISIONS ABOUT PATIENT CARE
EBP – trying to make the best decision using the best evidenced. Like
for example when you go to buy a car or a house or any other
purchases,or make a major decision in life. Same thing in evidenced
based practice except what you’re talking about here is the patient…..
what is the best for your patient.
In making the best evidence practice imagine this three legged stool.
First part of the chair or one part of the EBP IS THE CLINICAL DATA OR
KNOWLEDGE. WHICH SIMPLY PUTS WHAT DOES YOUR EXPERIENCE
TELLS YOU? AND WHAT DOES YOUR COLLEAGUE TELL YOU ABOUT
WHAT ROUTE OR WHAT IS THE BEST THING TO DO IN ORDER TO CARE
FOR A PATIENT WITH A PARTICULAR CONDITION. SECOND STEP IS THE
RESEARCH EVIDENCED WHAT DOES THE RESEARCH SAY IS THE BEST
THING TO DO HERE. AND LASTLY ARE THE PATIENTS VALUES AND
PREFERENCE OR EXPECTATIONS. AS YOU KNOW NO CARE CAN BE
CARRIED FORWARD UNLESS A PATIENT IS WILLING OR WANTS TO GO
ALONG WITH IT. WHEN THESE THREE THINGS ARE COMBINED THEY
COME TO GIVE US TOGETHER TO GIVE US AN OPTIMAL DECISION.

NOW WHEN IT COMES TO EBP I SAID THE MAJOR FOCUS IS TRYING TO

PROVIDE THE BEST CARE FOR THE PATIENTS. IN DOING THAT YOURE
GOING TO HAVE TO GO THROUGH AN INQUIRY PROCESS. IT IS THE
SEARCH STRATEGY OR THE STEPS OF GOOD SEARCH FOR
INFORMATION EXCEPT FOR IT COULD TAKE A COUPLE ROUTES. WHAT
YOU’LL NOTICE IN THE SLIDE IS ONE WAY OF LOOKING AT IT. THIS IS
ACTUALLY BASED UPON THE JOHNS HOPKINS MODEL OF EVIDENCE
BASED PRACTICE. AND OF COURSE THE FIRST THING THAT YOURE
GOING TO DO IS TO HAVE QUESTIONS. WHEN YOU GET THERE KEEP IN
MIND THAT YOU ARE NOT ALONE. FIND SOME RESOURCES ON YOUR
UNIT AND CARRY IT FORWARD. WHEN IT COMES TO LITERATURE
SEARCH DON’T HESITATE TO ASK A LIBRARIAN OR SOMEONE WITH
LOTS OF SKILLS IN DOING SEARCHES TO HELP BECAUSE THE RESEARCH
EVIDENCE IS GOING TO BE VERY IMPORTANT IN INFORMING WHAT
YOURE ABLE TO DO. AND THEN AS YOU APPRAISE THE LITERATURE
YOURE GOING TO HAVE TO MAKE A DETERMINATION AS TO WHETHER
OR NOT THERE’S ADEQUATE EVIDENCE.
IF YOU FEEL BASED ON YOUR SEARCHING AND YOUR INQUIRY THAT
THERE IS ENOUGH EVIDENCED THEN IT WILL BECOME EBP PROJECT
PERO KAPAG AYYY BUT IF NOT, IT BECOMES MORE OF A RESEARCH
PROJECT IN WHICH YOURE GOING THROUGH AND YOURE TRYING TO
ANSWER A NEW QUESTIONS AND COME TO SOME SORT OF
DETERMINATION. IN ANY CASE THE MAIN THING TO DO AT THE VERY
END IS BE ABLE TO DISSEMINATE THE INFORMATION AND GET IT OUT
THERE TO IMPROVE PATIENT CARE.

NOW AS YOURE DOING THAT ONE OF THE MAJOR THINGS THAT YOURE
GOING TO HAVE TO DO IS LOOK AT EVIDENCE: WHAT IS THE EVIDENCE
TELLING YOU.AND WHILE LOOKING YOURE GOING TO COME TO CROSS
SOMETHING THAT LOOKS LIKE A PYRAMID THIS IS CALLED THE
EVIDENCED PYRAMID. WHAT IT SHOWS YOU IS THE LEVEL OF
EVIDENCED WHEN IT COMES TO LEVEL OF EVIDENCE IT STARTS AT THE
BOTTOM WITH BACKGROUND INFORMATION OR EXPERTS OPINION
AND IT WORKS ITS WAY UP. AS IT GOES UP UP YOU’LL NOTICE IS YOU
GET A LOT OF PRIMARY STUDY LIKE RCT’S OR RANDOMIZED CONTROL
TRIALS, COHORT STUDIES AND CASED CONTROL STUDIES. AND IT
CONTINUES TO GO UP TILL YOU GET TO THINGS LIKE SYSTEMATIC
REVIEWS META ANALYSES, AND EVIDENCED BASED PRACTICE
GUIDELINES.

NOW WHEN YOURE AIMING TO DO A GOOD LITERATURE SEARCH.

WHAT YOU WANT TO DO IS YOU WANT TO TO AIM FOR THE TOP OF
THE PYRAMID BUT THE PROBLEM IS AS YOU MOVE TOWARD THE TOP
OF THE PYRAMID THE LEVEL OF EVIDENCED GETS BETTER OR
STRONGER BUT THE NUMBER OF ARTICLES OR STUDIES DECREASES.
THEREFORE MANY TIMES YOUR SEARCH WILL START ON A TRAJECTORY
AIMINF FOR THE TOP BUT YOU’LL USUALLY FALL SHORT OF THAT AND
BE LOOKING FOR PRIMARY STUDIES. I JUST LIKE TO MAKE SURE THAT
PEOPLE UNDERSTAND THAT BECAUSE EVERYBODY WOULD LOVE TO
HAVE A SYSTEMATIC REVIEW OR EVIDENCED BASED PRACTICE
GUIDELINE BUT MANY TIMES WHAT YOURE LOOKING AT ARE ----
YOURE LOOKING AT SERIES OF PRIMARY STUDIES IN ORDER TO MAKE
DECISION WHICH MEANS THAT ITS VERY IMPORTANT THAT YOU KNOW
HOW TO APPRAISE THEM.

NOW AS IT COMES TO THAT THERE ARE COUPLE THINGS THAT YOU

NEED TO KNOW WHEN IT COMES TO THESE DIFF. TYPES OF EVIDENCE
WITH PRACTICE GUIDELINES THE ADVANTAGES OF PRACTICE
GUIDELINES
1. IT IS CREATED BY PANEL OF EXPERTS AND IS BASED UPON
PROFESSIONAL PUBLISHED LITERATURE AND THAT’S VERY
IMPORTANT WHEREAS AN EXPERTS OPINION IS MANY TIMES IT
MAY HAVE SOME LITERATURE BASE BUT MAINLY ITS BASED UPON
THAT PERSONS EXPERIENCE.
AND OFCOURSE IF THERE IS ADVANTAGES THERE IS DISADVANTAGES
ONCE THEY ARE DONE THEY SLOW TO CHANGE OR TO BE UPDATED
AND THEY ARE NOT ALWAYS AVAILABLE ESPECIALLY ON
CONTROVERSIAL TOPIC. SO THERES NOT MANY OF THEM AND MANY
HAVE DRAWBACKS BUT SOME HAVE ADVANTAGES

AS YOURE WORKING DOWN THE PYRAMID YOU’LL ALSO COME TO THE

REVIEW ARTICLES THEY ARE VERY IMPORTANT BECAUSE WHAT THEY
WILL DO IS TO TAKE SERIES OF PRIMARY STUDIES AND PUT THEM
TOGETHER AND THEY WILL FILTER THROUGH AND MAKE THE DECISION
FOR YOU OR THEY WILL GIVE YOU SUGGESTION.
Actually theres two there systematic review and meta analysis each one
of them their intention is to be very transparent and the methods they
use are there FOR YOU TO LOOK AT BECAUSE THEY ARE THERE TO
ELIMINATE BIAS. BIAS TENDS TO SHOW UP IN MANY REVIEW ARTICLES
BECAUSE YOU CAN THINK OF THEM AS ARTICLES IN WHICH SOMEBODY
IS TRYING TO SAY “ETO NA YUNG GAGAWIN NATIN ETO MAGIGING
DECISION NATIN” AND THERE ARE TIMES WHEN THEY MAY NOT
INCLUED STUDIES THAT REFUTE WHAT THEYRE LOOKING FOR OR
WHAT THEY ARE TRYING TO ADVOCATE FOR---- BUT YOU WONT BE
AWARE OF THAT BECAUSE THEY WONT SHARE THAT TYPE OF
INFORMATION WITH YOU. AS YOU COME TO SYSTEMATIC REVIEW IT IS
VERY CLEAR AS TO HOW THEY CAME TO DECISION AND WHY THEYRE
MAKING SUGGESTIONS THEY ARE. ITLL TELL YOU WHY ARTICLES
WERENT INCLUDED AND IT WILL GIVE YOU A LIST OF THOSE ARTICLES.
METAANALYSIS IS A VERY NICE IN THAT YOU GO FROM HAVING A
QUALITITAVE TYPE OF STUDY TO MAKE A DECISION FROM, TO ONE IN
WHICH STATISTICS ARE DONE AND IT BECOMES MORE QUANTITATIVE
IN NATURE. DEPENDING OFCOURSE ON WHAT YOURE DOING YOU MAY
FIND ARTICLES THAT ADDRESS YOUR TOPIC THAT ARE REVIEW
ARTICLES SYSTEMATIC REVIEW AND META ANALYSES. YOU MAY FIND
ALL OF THEM OR ONLY SYSTEMATIC REVIEW IT JUST DEPEND UPON
WHAT OTHERS IN THEFIELD HAVE DONE AS FAR AS RESEARCH.
LASTLY IN THE BOTTOM WHAT YOU’LL NOTICE IS YOULL HAVE YOUR
PRIMARY RESEARCH HERE. MANY TIMES THIS IS THE RESEARCH THAT’S
BEING DONE THAT HELPS TO GENERATE THE INFORMATION AND TO
CREATE KNOWLEDGE.
WHEN IT COMES TO THESE STUDIES. RCT OR RANDOMIZE CONTROL
TRIAL IS VERY IMPORTANT TO YOU BECAUSE THEY ARE THE ONLY
STUDIES THAT WILL GIVE YOU CAUSE AND EFFECT.WHAT THAT MEANS
IS WHEN YOURE LOOKING AT TREATMENTS FOR A PATIENT AND YOURE
SAYING “ IF I DO THIS WILL THIS HAPPEN”. THOSE CONCLUSION CAN
ONLY BE DRAWN THROUGH CAUSE AND EFFECT THROUGH RCT. IN
OTHER CASES THERE MAY BE CORRELATIONAL EVIDENCE LIKE. LIKE
THERE MAY BE A CORRELATION IF YOU DO “THIS” THEN “THIS”
HAPPENS. BUT LARGELY YOU CANT PROVE CAUSE AND EFFECT UNLESS
YOU HAVE SOME SORT OF RCT WHERE YOU HAVE A CONTROL GROUP,
AND EXPERIMENTAL GROUP AND YOURE GOING THROUGH THE ENTIRE
PROCESS.

THE OTHER TWO TYPES OF STUDIES DEPENDING UPON WHAT YOURE

LOOKING FOR, CAN ALSO BE USEFUL. ALL OF THEM ARE TYPES OF
PRIMARY STUDIES AND THEY ARE ALL USED TO ANSWER DIFFERENT
TYPES OF QUESTIONS BECAUSE WHEN IT COMES TO RCTS, YOU CANT
ALWAYS ETHICALLY GO OUT AND DO A TRIAL LIKE THAT- LIKE SAY FOR
ACCIDENTAL FALLS, YOU CANT HAVE , SAY , A SITTER IN ONE ROOM
AND NO SITTER IN THE OTHER ROOM WHEN BOTH PATIENTS MAY BE
AT RISK AT FALLING, JUST TO WATCH ONE PATIENT FALL AND GET
HURT INORDER TO PROVE THE POINT THAT REALLY HAVING A SITTER IN
THE ROOM IS THE BEST PRACTICE IN ORDER TO ENSURE THAT NO ONE
GETS HURT. IT JUST LARGELY DEPENDS ON YOUR QUESTION.

THE REASON I BRING UP WHY IT DEPENDS UPON YOUR QUESTION IS AS

YOURE GOING THROUGH THESE STUDIES REMEMBER THAT YOURE
BIGGEST AIM IS THE TOP OF THE PYRAMID, WHEN YOU CANT FIND THE
TOP OF THE PYRAMID .THOUGH THE TYPE OF QUESTION YOU ASK IS
GOING TO BE VERY IMPORTANT BECAUSE EVERY TYPE OF QUESTIONS
IS BEST ANSWERED BY DIFFERENT TYPES OF STUDIES AS YOU CAN SEE
THE CHART ON THE LEFT IS THE TYPES OF QUESTIONS ON THE RIGHT
SIDE ARE THE TYPES OF STUDIES THAT ARE BEST USED TO ANSWER
THOSE QUESTIONS.
THIS IS IMPORTANT WHEN YOURE DOING LITERATURE SEARCHES
BECAUSE IF YOU CANNOT FIND THE TOP OF THE PYRAMID ITLL ATLEAST
ALLOW YOU TO FOCUS TO YOUR SEARCHES AS FAR AS THE LIMITS.
ALWAYS KEEP IN MIND THAT AS THE EVIDENCE GOES UP THE NUMBERS
GO DOWN.