I agree that the challenge is to get people to critically appraise the
information. I do hope that preponderance of disciplinary definitions for
EBP is not driven by a desire to avoid critical appraisal of the information
that we use.
But I also suspect that the drive to redefine "evidence" stems from
misunderstanding that for different types of questions one needs different
types of study designs.
Many of the critiques of EBP in nursing (each of which then advances its own
defintion of EBP)seem to originate from the belief that the RCT (inn
whatever form e.g. n-of-1, single study or aggregate of RCTs) is the gold
standard of research design, rather than that it is the best design to
understand causal relationships where its use is ethical. Because hierarchy
of design is not accurately understood, the authors develop their own
definitions of EBP in order to "broaden the definition of evidence".
Clearly EBP recognises the place of qualitative designs to understand
patient's experience (either Giacomini & Cook 2001, or Guyatt & Rennie
2002), just as it is understood that cross-sectional studies are the design
of choice for diagnostic studies.
Andrew Jull RN MA(Applied)
HRC Foxley Fellow
Clinical Trials Research Unit
University of Auckland
New Zealand
-----Original Message-----
From: Davida Delaharpe [mailto:[log in to unmask]]
Sent: Thursday, 2 May 2002 8:19 PM
To: [log in to unmask]
Subject: Re: How do various specialities view EBM?
I think, like Susan , that this is an interesting topic. Because of the
various backgrounds, training and interests of all of us involved in health
care we each bring a unique view of the world to our work. In working with
different disciplines I find that the basic definitions of EB health care
( either Sackett or Hicks or some of the other definitions) are acceptable
to most. The change is that from a narrow focus on the quantitative we are
now moving rapidly towards a better appreciation of the value of other
kinds of research. The challenge is to ensure that people can critically
appraise such other sources . The issue really is one of developing a
questioning approach to our decision making, and also of developing ways to
use the team talents to implement and evaluate what we do. In doing that
some will like to focus on what they are most comfortable with- and in the
case of doctors that often may be the quantitative biomedical model,
whereas some other professionals and some patients may be more comfortable
with other models. It becomes interesting and productive when there is
debate and communication about the various viewpoints in a way that allows
each person to contribute and their opinion to be valued and taken into
account in the wider decision making process.
Dr Davida De La Harpe
Senior Lecturer in Evidence Based Health Care
Department of Epidemiology and Public Health
Royal College of Surgeons in Ireland
123 St Stephens Green
Dublin 2
Phone +353 1 4022739
Mobile + 353 86 2635412
Fax +353 402 2329
e-mail [log in to unmask]
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: 01 May 2002 14:41
To: [log in to unmask]
Subject: Re: How do various specialities view EBM?
This is an interesting discussion how different professions view EBP. I'm
not sure the definition of evidence is actually different, nor is the
practice of EBP. If the definition of EBP is "the conscientious, explicit
and judicious use of current best evidence in making decisions about the
care of individual patients" (Sackett et al) then then EBP involves the use
of evidence, clinical expertise and patient preferences in making decisions.
OT and PT, as well as many others, are attempting to utilize these three
sources of information in clinical decision making. I believe other
professions strive for the same goals. The inclusion of evidence doesn't
preclude the use of other sources of information.
Therefore, I do not believe that other professions are developing their own
definitions of EBP, rather trying to develop a useful way of using evidence
in daily practice. The implementation of EBP probably varies, due to
accessibiltiy of information and types of information needed by different
professions, but not the definition of EBP.
Susan Scherer, MA, PT
Assistant Professor
Department of Rehabilitation Medicine
UCHSC
4200 E. Ninth Ave C-244
Denver, CO 80262
(303) 372-9137 Phone
> -----Original Message-----
> From: Jennie Lou [mailto:[log in to unmask]]
> Sent: Wednesday, May 01, 2002 4:56 AM
> To: [log in to unmask]
> Subject: Re: How do various specialities view EBM?
>
>
> I agree with Clare that other professions are developing their unique
> definitions of EBP due the nature of their practices. For example,
> qualitative evidence is being viewed much more heavily in occupational
> therapy evidence based practice because of client centered practice
> guideline in OT.
>
> *****
> Jennie Lou, M.D., M.Sc., OTR
> Associate Professor of Public Health and Occupational Therapy
> College of Osteopathic Medicine
> Nova Southeastern University
> 3200 S. University Dr.
> Ft. Lauderdale, FL 33328
> *****
>
> ----- Original Message -----
> From: "M.C. TAYLOR" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, May 01, 2002 4:22 AM
> Subject: Re: How do various specialities view EBM?
>
>
> > Kate
> >
> > the other intersting thing is that the various professional
> groups are
> > all developing slightly different definitions of EBP, and
> the nursing
> > and OT definitions tend to draw on a wider definition of
> 'evidence' to
> > include experiential evidence and the client/patient perspective
> >
> > clare
> >
> > Kate O'Donnell wrote:
> > >
> > > Dear Aron
> > >
> > > Badri has supplied you with an excellent list of
> references (thanks
> Badri).
> > > I would add in several more:
> > >
> > > Curtin M, Jaramazovic E. Occupational therapists' views
> and perceptions
> of
> > > evidence-based practice. Br J Occup Ther 2001; 64(5): 214-222.
> > >
> > > Jacobson LD, Edwards AGK, Granier SK, Butler CC.
> Evidence-based medicine
> > > and general practice. British Journal of General Practice
> 1997;47:449-52.
> > > McColl A, Smith H, White P, Field J. General
> practitioners' perceptions
> of
> > > the route to evidence based medicine: a questionnaire survey. BMJ
> > > 1998;316:361-5.
> > > Tomlin Z, Humphrey C, Rogers S. General practitioners'
> perceptions of
> > > effective health care. BMJ 1999;318:1532-5.
> > > Greenhalgh T,.Douglas HR. Experiences of general practitioners and
> practice
> > > nurses of training courses in evidence-based health care:
> a qualitative
> > > study. British Journal of General Practice 1999;49:536-40.
> > > Allery LA, Owen PA, Robling MR. Why general practitioners and
> consultants
> > > change their clinical practice: a critical incident study. BMJ
> > > 1997;314:870-4.
> > >
> > > As someone who is involved in trying to promote
> multi-professional EBP
> > > education, I think it is vitally important that we recognise and
> > > acknowledge these differing views and perceptions of
> evidence. On our
> > > extended national course in Scotland for primary care
> professionals, we
> > > spend a lot of time on the first day getting
> participants, in small
> groups,
> > > to discuss where they are coming from and the type(s) of
> evidence that
> they
> > > regard as important. (This incorporates evidence in its
> widest sense -
> not
> > > just published research.) This allows the participants
> time to reflect
> and
> > > value the viewpoints of other professional groups
> However, I find it
> much
> > > harder to recreate that in single stand-alone workshops.
> What is the
> > > experience of others?
> > >
> > > Regards
> > >
> > > Kate.
> > >
> > > Dr Kate O'Donnell.
> > > Lecturer in Primary Care R&D.
> > > Tel: 0141 211 3378/1668.
> > > Email: [log in to unmask]
> >
> >
>
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