1. 5 steps to provide E-B Care First step
Stage of EBP How this helps you
1. Asking an answerable Focus your efforts on what • Form a clearly structured question about
question. matters your problem which you will then be able
2. Searching for the best Make the best use of your
evidence. scarce time
to search for
3. Critically-appraising the Avoid bias in research and • Four parts to a structured or focused
evidence. draw the right conclusions
from it question
4. Integrating the evidence Integrate the evidence into
with expertise and patient’s your patients unique condition
unique biology and values
5. Evaluating performance Help you to improve
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1: The Patient or the Problem 2: The intervention that you are
considering
• The clinical condition and defining • Screening tool
characteristics of the patients, population • Diagnostic test
or problem area you are interested in. • Prognostic factor
• Treatment
• Causative agent
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2. 3: The Comparison 4: The Outcome
• What you would like to compare the • What would you like to see as the
intervention with: outcome of the intervention?
• Another treatment • What would you and the patient like to
• Nothing achieve?
• Standard practice
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= PICO An example
• Patient/problem • P: Obesity
• I: Surgery/gastric bypass
• Intervention
• C: Lifestyle advice
• Comparison
• O: Weight loss
• Outcome
• Does surgical treatment improve weight
loss in obese patients compared to
lifestyle advice?
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3. 5 steps to provide E-B Care
Stage of EBP How this helps you
1. Asking an answerable Focus your efforts on what
question. matters
2. Searching for the best Make the best use of your
evidence. scarce time
3. Critically-appraising the Avoid bias in research and
evidence. draw the right conclusions
from it
4. Integrating the evidence Integrate the evidence into
with expertise and patient’s your patients unique condition
unique biology and values
5. Evaluating performance Help you to improve
M Hickson
Assessing the evidence
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4. Critical Appraisal
To weigh up the evidence
critically to assess its
validity and usefulness
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Journal Clubs
The purpose
• To practice critical appraisal
• To help keep up-to-date with new research
in a variety of areas, not just their own
specialist area.
• To evaluate whether our dietetic practice
needs to change in the light of new
research findings
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5. New Journal Club CASP tools
• ALL read the paper. • Critical Appraisal Skill Programme (Milton
Keynes Primary Care Trust 2002)
• Use the CASP tools as a guide.
• http://www.phru.nhs.uk/casp/appraisa.htm
• Think of 1-2 critical appraisal questions to ask
– systematic reviews
about the paper. – randomised controlled trials
• Someone starts the ball rolling by asking a – qualitative research studies
specific person a question. They try and answer – cohort studies
and then they ask someone else a question. – case control studies
• And so it goes round …..the paper is analysed – diagnostic test studies
by everyone and it is a lot more interactive. – economic evaluation studies
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I am getting more out of Much more
attending and see it as a constructive way of
Choosing the paper valuable process, even if spending my time. I
the paper is not in my enjoy it now!!
topic area.
• Review top medical journals for nutrition
I feel like we are
related papers: learning together
• BMJ, NEJM, Lancet, JAMA What dietitians think
as a group
• Choose a paper from these journals or any
other related. I like it. I really do feel that I I am motivated to
am learning from it. Hearing read the paper
• Paper should be fairly generally and not other dietitians opinions often because I know it will
very specialised to keep it relevant to the confirming your own, gives result in valid debate
majority. you confidence. and discussion
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6. I feel much more A lot more You can’t get away
competent in about stats, with just reading the
analysing papers but still
on a daily basis for loads to go.
abstract if you want to How to speed things up
know whether the
my own work. paper is any good!!
• Read the methods first - be critical.
That reading a paper is • Is it worth continuing?
How to skim not all that scary or
What they have learnt
read a paper - difficult. That people • If the methods are flawed the results will
it’s not always may have very different be too.
necessary to views based on the same
plough through paper.
• Ignore the abstract
all the intro and Not assuming all
discussion if
• Only skim the intro for a brief background -
studies are good
you’ve read the just because they you don’t have to read it all.
method and have been
results published! M Hickson
Practise, practise, practise Key to effectiveness
• The more you do the easier it gets.
• There are no short cuts to learning a new • Everyone MUST read the paper.
skill. • Guidance or training is provided to all.
• Keep practising - use it or lose it! • Club is supported and encouraged by
• Don’t be put off by difficult papers - keep senior staff.
going, they’re not all really complicated. • Someone chairs or facilitates the club to
• Some papers are only difficult because ensure everyone can participate.
they are badly written.
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7. Key points
• Re-evaluate your journal
club
• Use the CASP tools to help
your appraisal skills
• PRACTISE: The more you
do the easier it gets.
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