Evidence based practice in hand surgery
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From evidence-based to wisdom based creating value with justice
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Evidence based practice in hand surgery
- 1. Evidence-Based Practice (EBP) in Hand Surgery Vaikunthan Rajaratnam
- 2. What is EBP? • clinical expert opinion • scientific evidence • patient perspectives WISDOM BASED PRACTICE VALUE
- 3. Why bother? • make informed evidence-based decisions • provide high-quality services • reflecting the interests, values, needs, and choices of individuals • Provide value in health care
- 6. Frame the clinical question (PICO) approach Population Intervention Comparison Outcome
- 7. Search and Find Evidence • Plan your search • Decide on type of evidence needed • Chose database to search • Alternate source of evidence • making your search broader • search from similar or related populations, interventions, or outcomes • alternative assessment, treatment, or service delivery option
- 8. Searching • Develop a list of search terms • using elements from PICO question (If searching for traumatic brain injury, include "traumatic brain injury", "TBI", and "acquired brain injury".) • Set parameters for your search • Boolean search , “AND” , “OR” etc • What type of evidence • Systematic reviews • RCT • clinical practice guidelines • evidence-based or consensus-based.
- 9. Finding • PubMed, MEDLINE, EMBASE • Google Scholar • The Cochrane Library – Cochrane Central Register of Controlled Trials, ARCHIE • PSYCHInfo - behavioural science and mental health • CINAHL - Nursing and Allied Health Literature • Web of Science Core Collection • Open Grey
- 10. Assess the Evidence • determine the relevance to your question • appraise the validity and trustworthiness • review the results and conclusions • Synthesized research such as systematic reviews, meta-analyses, and guidelines usually include quality and/or bias assessment of the included studies • statistical information about the outcomes such as confidence intervals or effect sizes • information (strong) enough to help me make a clinical decision • generalize the results to your practice
- 11. Make Clinical Decision • critical judgment to evaluate the strength and methodological rigor of the evidence • interpret it in consideration of the patients concerns and preferences Define your clinical question Extrapolate applicable information Consider your clinical expertise and of others Incorporate your patients needs Develop an assessment or treatment plan Evaluate your clinical decision D.E.C.I.D.E.