Evidence-Based Medicine: Physician Experience Scenario

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

Most of the literature is made up of low quality retrospective non-randomised cohort studies with small sample sizes. Ultimately, large multi-centred, adequately powered, well-designed randomised trials are needed to establish clearer guidelines for the management of these patients.

Practicing evidence-based medicine is imperative in today’s healthcare upbringing for the reason that this sculpts of care offers clinicians a line of attack to accomplish objectives of enhanced eminence, better patient contentment, and reduced expenditure. To understand how, this works, consider the prostate cancer example. With evidence-based medicine, a contributor can gauge the potency of the confirmation as well as the risks and reimbursement of ordering indicative tests and treatments for each cancer patient. Such an approach, united with the provider’s clinical understanding makes the provider to healthier envisage if a treatment will do more harm than good. It establishes a systematic move towards to considerate for patients with specific

Over the past decades, there has been a shift in medicine from traditional reasoning towards evidence-based medicine (EBM).1 Practicing evidence-based medicine has been shown to improve quality of care.2 The providers are trained to assess the strengths and weaknesses of the evidence and use their clinical judgment to predict whether a treatment will be beneficial for a particular patient. One can argue that evidence-based practice is very guideline-driven and does not take into account patient’s preferences. However, evidence-based medicine is not just about using data from clinical trials to design treatment plans for patients. It encourages a patient to be an active participant in a decision-making, which promotes improved patient satisfaction.

In their research, Cohen, et al. (2001) and colleagues suggest that randomized controlled trials conducted in research settings, may not provide the whole picture about the most

As a provider of care, the nurse has a more personal relationship with the patient and can get more information. The provider of care can identify barriers in nursing care and can use this as a foundation to develop a plan, or theory. Evidence-based practice is incorporated in everyday nursing care, because many policies and procedures are the result of this practice. Before a policy is implemented, there is research that is done to provide a positive result. Nursing research has helped in the improvement and prevention of diseases. “Nurses may play a variety of roles in research, including the following: informed consumer of research; participant in research-related activity; contributor to a systematic review process; data collector for a research project; and principal investigator for a research study” (Houser, 2015,p.9).

The concept of evidence based medicine (EBM) emerged in the early 1990s led to the development of evidence based practice (EBP) in physical therapy later in the decade1. The aim of EBP is to increase the quality of care and decrease the needless variation in practice. EBP can be defined as, making clinical decision about the patient care plan using the latest evidence from research2,3. Applying the EBP may reduce medical errors, challenge beliefs based views and help balance risks and benefits in patient care2. The important of EBP arose from the fact that nearly 30-40% of patients do not receive treatment according to the current research evidence. Surprisingly, 20-25% of provided care is harmful or not needed4. For example, despite the

The effect of evidence-based practice (EBP) within the healthcare industry has greatly advanced the need for quality improvement that is efficiently safe and valid. Evidence-based research data are increasing utilized in clinical practice and program education; hence, it is imperative that the research scholar understands that a factual experiment does have an affinity for high ranking of internal validity related to exploitation and random assignment to exclude utmost justification for the research results (Polit & Beck, 2017). The purpose of this week discussion is to examine the key issues related to quantitative research that a research scholar must address to certify a quality research study

The original conceptualization of evidence based medicine was the integration of clinical experience with conscientious, explicit, and judicious use of current research. However, there are differences in opinion regarding the value of evidence based medicine. An article written by Hermann W. Borg entitled “The Evidence Based Transformation of American Medicine” indicated that the ideal originally presented with evidence based medicine reflected a process of decision making by individual physicians in treating individual patients. This author notes that the ranking of evidence using randomized controlled trials as the highest level of evidence has devalued the role of intuition, clinical experience and theory derived conclusions in practice. Part of the concern addressed is the distorted use of evidence based practice by administrators, pharmaceutical companies and payers. Instead of an individualized approach to care

For clinical research to be considered ethical, the question it poses must be equipoise: in other words, it must be in a state of genuine uncertainty (Freedman, 1987, p. 141). In the case of this study, the question was definitely uncertain. Although the benefits of COX-2 inhibitors could be very real, the question as to its affects on cardiovascular health was worth exploring. Thus, the study is equipoise in it’s seeking an answer to the very valid question: are COX-2 inhibitors worth using?

I agree with you that evidence based medicine is dictating how we treat patients today. I believe it is important to rely on evidence-based medicine, as it can help you make an informed decision. EBM integrates clinical experience and patient values with the best available research information.1 Even though EBM is based on the analysis of large, well-designed trials, doctors still use their experiences and education to make an informed medical decision based on the research, at the same time making sure a patient is an active participant in the decision making.

Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.

The fourth step ascertained if the evidence supported the patient’s values and situation. The evidence such as treatment, costs, and facility locations must be discussed amongst the physicians, patients and parents if applicable to allow them the opportunity to reach an informed decision. “This approach allows a “therapeutic alliance” to be formed with the patient and the parents and is consistent with the fundamental principle of EBM: the integration of good evidence with clinical expertise and patient values” (Akobeng, 2005a).

The involvement of professional medical writers in developing peer-reviewed publications reporting clinical trials has been a matter of debate in the last decade. It has been criticised by some (1 Sismondo S. (2009),2) but defended by others (3,4).

There are skills necessary for evidence based practice which include the ability to define a patient’s problem precisely and ascertain what information is required to resolve the problem, to conduct an efficient search of literature, to select the best of the relevant studies, to apply rules of evidence to determine their validity, to extract the clinical message to determine how the patient’s values affect the balance between advantages and disadvantages of available management options, to involve the patient appropriately in the decision and to implement and evaluate the management plan. This is all essential for the treatment and prevention methods for a patient and even a community also to educate and bring awareness to them as