Please enable JavaScript.
Coggle requires JavaScript to display documents.
Evidence Based Practice: Integration with week 3 Module (Clinical Context…
Evidence Based Practice: Integration with week 3 Module
Clinical Context
#
#
#
frequency of coverage. e.g. rural?: White
consult times: White, Green
access to EPAs
white
equipment available: White, Green - need to change it? Be creative
health literacy: White - need to understand it
patient distance from the healthcare centre
White, Green - discuss it with the patient. Creativity. Telehealth?
easy access/difficult access to scans: White
GP expertise. e.g. CSI available/ USS guided??
ability to discuss with doctor: white
public vs privat
Patient Values
#
#
what the patient believes in. e.g. intervention: white, red
past experiences: white
family values: white, red
cultural beliefs: red
understanding of pain; biopsychosocial: red
what has worked before: white
what they believe the problem is: red
connection to scan results: red
Understanding of the initial problem
#
Research Evidence
#
newest research available
older research. More appropriate?
similarity/lack of similarity between research context and clinical context
understanding/interpretation of the research
tendancy to jump to diagnosis using research
#
strong vs weak evidence
#
ability for the clinician to critically appraise the research. Valid?
Confidence Intervals, p-values
#
research passed between clinicians. Leads to believe validity
Large amounts of different sources of information: computer, google, text books online databases, seminars, clinical guidelines, professional development courses, primary researchers.
What to choose? How to be time effective? Black
Must prioritise: Blue
Use of randomised control trials
Problem: RCTS expect standardisation. Physiotherapy is never standardised due to maturation and clinical reasoning. Black
Clinical decision making rules
How to use CDRs. Too rigid? Too time consuming? Black
#
Clinical Expertise
#
seen it before/never seen it before
number of times it was previously effective: red
outcomes of previous situations where the same intervention was used. White
confidence in ability: green, red
advice from supervisors: green,
bad experiences: red, black
university teachings: green
accidental discoveries - no background evidence: green, red
Can use creatively as long as have rationale as to why it worked: Green
Clinical Reasoning
combination of all four pillars
dominance of one pillar over the other
patient values takes precedence - will not achieve outcomes unless patient is on board: red
jumping to conclusions due to 1 pillar only: Black
setting up an appropriate plan using all of the pillars
reflection upon why something did not go right
Process of EBP, Sicily statement
Identify
#
Find
#
Data Hierarchies
Oxford Hierarchy
NHMRC hierarchy. NHMRC hierarchies for different kinds of research
Primary vs secondary evidence
Clinical Guidelines
Appraise
#
Critical Appraisal Tools
#
Difficult to effectively appraise; Not research orientated. How should it actually look? No alternative. Difficult to be insightful as a non research based clinician
Is the research appropriate for the situation?
Integrate
#
How do we effectively incorporate these ideas into practice: yellow
Needs to be a fluent integration; not rigid/set. black
Evaluate
PICO. Must be constructed first
Must be a relevant PICO that will find the target data in databases etc
#
Bias: Black. Difficult to always identify
Reporting bias: White
Publication bias
Language Bias
Author Publication bias
Methodological Bias: Red
selection/sampling bias
allocation bias
Maturation Bias: White. Very relevant for physios
Very relevant to physiotherapy
Attrition Bias
Measurement Bias
Quickly identifiying bias: Black, Green
#
Need to make decisions on whether to proceed or not, given bias