Role In Evidence-based Practice Research Articles

Demystifying Research and Evidence-Based Practice for Consumers and Carers: Development and Evaluation of an Educational Package

Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted and its role in evidence-based practice. Information regarding participants' attitudes towards research, knowledge about research practice and participation was also examined. The findings provide evidence that workshop attendance increases knowledge and encourages participation in future research projects, particularly when participants have confidence in the researcher.

Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke

The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. A cross-sectional mail survey was conducted. Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.

Social Work Education and Clinical Learning: Yesterday, Today, and Tomorrow

Social Work Education and Clinical Learning by Simpson, Williams, and Segall is a welcome and timely statement about the nature of clinical social work and its implications for educational curricula. The authors took on an awesome task. Educating students for clinical practice is increasingly more daunting than it has been previously and is in considerable disarray, if not a state of crisis. In addition to amplifying and expanding some of the major points the authors make, this discussion considers where we have been, where we are, and where we are going. It describes the educational landscape today, which the author views as bleak with respect to its preparation of students for clinical social work practice. In keeping with clinical social work’s inclusive definition that encompasses a broad knowledge base, diverse practice roles, and a wide range of interventions, this discussion emphasizes the importance of numerous unifying themes that help to distinguish clinical social work from other approaches or from the use of a fragmented assemblage of techniques. The paper considers the role of evidence-based practice and makes some suggestions about future emphases in clinical social work. It concludes with a call to alter the educational landscape.

The integrative review: updated methodology

The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process. Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated. A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review. An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

Chapter 6.

The role of Evidence-Based Practice (EBP) is increasing in importance for professional psychologists working in university counseling center contexts. As a result, providing training and supervision in EBP will be essential to the ability of college-based counselors to meet minimal standards of care. The focus of this paper is to provide a framework to foster critical thinking, to discuss the pedagogical assumptions of supervisors, and to provide suggestions for college counseling center supervisors to incorporate training in EBP into the expected competencies to be gained by interns and other trainees.

A call for systematic reviews

A call for systematic reviews

Crossing the Quality Chasm in Behavioral Health Care: The Role of Evidence-Based Practice.

The concept of evidence-based practice (EBP) is one receiving increasing attention from providers, managers, payers, and regulators of care, yet practical guidelines for professional psychologists who may be interested in incorporating EBPs into their own work settings are not available. The author explores the pragmatics of EBP adoption within the broad context of quality problems in American health care, particularly as described in a heralded 2001 publication by the Institute of Medicine. Concrete suggestions are offered to help practitioners locate EBP resources for specific clinical problems, use an evidence hierarchy to infer “best practices,” address the science-to-service management challenge, and generate outcomes data and feedback loops to continuously improve clinical effectiveness. Increasingly, clinical practitioners working in professional psychology, as well as in other areas of behavioral health care, are encountering the concept of evidence-based practice (EBP) along with implicit responsibility for assessing the applicability of EBPs for their own clinical setting. The context for these considerations is a health system with profound quality defects and a professional environment with little consensus about what role EBPs realistically might serve in overcoming quality problems.

Quality of Primary Care Guidelines for Acute Low Back Pain

Systematic review of clinical guidelines. To assess the methodologic quality of existing guidelines for the management of acute low back pain. Guidelines are playing an increasingly important role in evidence-based practice. After publication of the Quebec Task Force in Canada in 1987 and the Agency for Health Care Policy and Research guidelines in the United States in 1994, guidelines for acute low back pain were developed in many other countries. However, little is known about the methodologic quality of these guidelines. Guidelines were selected by electronically searching MEDLINE and the Internet and through personal communication with experts in the field of low back pain research in primary care. The methodologic quality of the guidelines was assessed by two authors independently using the AGREE instrument. A total of 17 guidelines were included. Overall, the quality of reporting of guidelines was disappointing. Most guidelines clearly described the aim of the guideline and its target population, and most guideline development committees were multiprofessional. However, many other methodologic flaws were identified. More than half of the guidelines did not take patients' preferences into account, did not perform a pilot test among target users, did not clearly describe the methods of study identification and selection, did not include an external review, did not provide a procedure for updating, were not supported with tools for application, did not consider potential organizational barriers and cost implications, did not provide criteria for monitoring and audit, did not include recommendations for implementation strategies, and did not adequately record editorial independence and conflict of interest of the members. The diagnostic and therapeutic recommendations of the guidelines were largely similar. The quality and transparency of the development process and the consistency in the reporting of primary care guidelines for low back pain need to be improved.

Overview of clinical trials in medical rehabilitation: impetuses, challenges, and needed future directions.

The goal of clinical trials is to provide the strongest possible basis for inferring that the observed results of a health-oriented intervention are attributable to that intervention and not to other factors. Particularly strong causal inferences can be drawn from the randomized clinical trial in which participants are assigned on a random basis to either the intervention of interest or to a comparison condition. This article explains the reasons for that contention and explores its implications for medical rehabilitation research. Among the topics discussed are: the role of evidence-based practice in fostering interest in randomized clinical trials; a contextual view of randomized clinical trials that emphasizes strategies of investigation and the goals of particular studies; two key distinctions, efficacy-oriented vs. effectiveness-oriented clinical trials and pragmatic vs. explanatory clinical trials; the sequencing of different study designs, including randomized clinical trials; and needed advances in treatment theory, treatment fidelity, and adherence.

Evidence-Based Radiology: Requirements for Electronic Access

Rationale and Objectives The purpose of this study was to determine the electronic requirements for supporting evidence-based radiology in today's medical environment. Materials and Methods A software engineering technique, use case modeling, was performed for several clinical settings to determine the use of imaging and its role in evidence-based practice, with particular attention to issues relating to data access and the usage of clinical information. From this basic understanding, the analysis was extended to encompass evidence-based radiologic research and teaching. Results The analysis showed that a system supporting evidence-based radiology must ( a) provide a single point of access to multiple clinical data sources so that patient data can be readily used and incorporated into comprehensive radiologic consults and ( b) provide quick access to external evidence in the way of similar patient cases and published medical literature, thus supporting evidence-based practice. Conclusion Information infrastructures that aim to support evidence-based radiology not only must address issues related to the integration of clinical data from heterogeneous databases, but must facilitate access and filtering of patient data in order to improve radiologic consultation.

Quality Care Outcomes in Cardiac Surgery: The Role of Evidence-based Practice

Quality Care Outcomes in Cardiac Surgery: The Role of Evidence-based Practice

Quality care outcomes in cardiac surgery: the role of evidence-based practice.

An internal database and research methods were used to evaluate the impact of clopidogrel on cardiac surgical bleeding. This quality improvement initiative, led by the clinical nurse specialist, showed that preoperative exposure to clopidogrel was associated with significant increases in chest tube output, blood product use, and reoperation for bleeding rates that were 10-fold higher than for control patients (0.85% versus 8.3%, P = 0.027). Acute care costs averaged $2,680 more for patients who received clopidogrel (P = 0.1936). After implementation of an interdepartmental clinical practice guideline, preoperative exposure to clopidogrel dropped from 39% to 6.3% (P = 0.0000). This drop was accompanied by reductions in chest tube output, blood product use, and bleeding complications, with improved achievement of clinical benchmarks. The availability of internal evidence to support achievement of best practices was an essential factor in the implementation of this interdepartmental change. Comprehensive database systems and advanced practice nurses are highlighted as essential components of evidence-based programs.