Introduction to evidence based health care and the systematic review of evidence
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Introduction to Evidence-Based Health Care and the Systematic Review of Evidence. Over view. Evidence Based Health Care The Joanna Briggs Institute (JBI) The JBI Model of Evidence Based Practice The Systematic Review Process. Introduction to Evidence Based Health Care.

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Over view Systematic Review of Evidence

  • Evidence Based Health Care

  • The Joanna Briggs Institute (JBI)

  • The JBI Model of Evidence Based Practice

  • The Systematic Review Process


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Introduction to Evidence Based Health Care Systematic Review of Evidence


Evidence based health care ebhc l.jpg
Evidence-based Health Care (EBHC) Systematic Review of Evidence

  • ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources’(Guyatt et al., 2008:783).


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Evidence-based Health Care (EBHC) Systematic Review of Evidence

  • Evidence based health care takes place when decisions that affect the care of patients are taken with due weight accorded to all valid, relevant information (Hicks, 1997)


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Evidence-based Practice (EBP) Systematic Review of Evidence

  • ‘EBP is clinical practice in which patient management decisions are consistent with the principles of evidence-based health care. This means that decisions will be, first of all, consistent with the best evidence about the benefits and downsides of the alternative management strategies. Second, decisions will be consistent with the values and preferences of the individual patient’ (Guyatt et al., 2008:783).


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Evidence-based Health Care (EBHC) Systematic Review of Evidence

Needs and preferences of patients & clients

EBHC

Professional expertise, skills & judgment

Best available research   evidence


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Evidence Systematic Review of Evidence

=

knowledge arising :

Reconceptualising Evidence

  • From experience

  • From acknowledged experts

  • From learned/official bodies

  • From experimental research

  • From any rigorous research studies


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Evidence is… Systematic Review of Evidence

  • ‘…the available facts, circumstances etc supporting or otherwise a belief, proposition etc or indicating whether a thing is true or valid…’

    (Pearsall and Trumble, 1995)

  • “…any statement, record, testimony which tends to prove the existence of a fact in issue”

    (Nygh and Butt 1997, p435)


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Introduction to the Joanna Briggs Institute Systematic Review of Evidence


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The Joanna Briggs Institute Systematic Review of Evidence

  • Evidence Based Practice

  • Research Institute since 1996

  • Royal Adelaide Hospital and the University of Adelaide

  • Not-for-profit

  • 60+ Centres and Groups, >5000 members in over 47 countries

  • Global Leader


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The Joanna Briggs Institute Systematic Review of Evidence

  • International collaboration of health scientists, health professionals and health researchers

  • To improve global health through providing point-of-care access to:

    • Evidence databases

    • Decision support systems

    • Implementation, evaluation and continuous improvement tools


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Home of: Systematic Review of Evidence


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Europe Systematic Review of Evidence


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Middle East Systematic Review of Evidence


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The Americas Systematic Review of Evidence


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Africa Systematic Review of Evidence


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Asia Systematic Review of Evidence


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Australasia Systematic Review of Evidence


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How our Global Collaboration Gets Evidence into Action Systematic Review of Evidence

JBI Members


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The Joanna Briggs Institute 2010 Systematic Review of Evidence


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JBI Systematic Review of EvidenceCOnNECT 

  • Clinical Online Network for Care and Therapeutics


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…at the point of care Systematic Review of Evidence


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The JBI Model of Evidence-based Healthcare Systematic Review of Evidence


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The Systematic Review of Evidence Systematic Review of Evidence


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The Systematic Review Systematic Review of Evidence

  • Also called research synthesis: has some characteristics of literature review

  • Is an ‘attempt to integrate empirical research for the purpose of creating generalisations’ to:

    • ‘produce statements about evidence that are neutral in perspective’

    • ‘uncover all the evidence’

  • Explicit and exhaustive reporting of the methods used in syntheses

    (Cooper & Hedges, 2009:6-7)


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Systematic Review Systematic Review of Evidence

  • ‘a review that has been prepared using a systematic approach to minimising biases and random errors’

    (Egger et al., 2001:5)

  • ‘is an attempt to minimise the element of arbitrariness … by making explicit the review process, so that, in principle, another reviewer with access to the same resources could undertake the review and reach broadly the same conclusions’

    (Dixon et al., 1997:157 quoted by Seers, 2005:102).


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Meta-analysis Systematic Review of Evidence

  • Quantitative evidence

  • Use of statistical methods of combining the results of various independent, similar studies

  • More precise calculation of one estimate of treatment effect than could be achieved by any of the individual, contributing studies

  • Only forms a part of the systematic review in which it appears


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Meta-synthesis Systematic Review of Evidence

  • Qualitative analysis of a number of independent qualitative research studies and text

  • Use of qualitative methods of combining the findings of individual studies

  • Only forms a part of the systematic review in which it appears


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Comprehensive/mixed method Review Systematic Review of Evidence

  • Combines both quantitative and qualitative findings and addresses both forms of evidence


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Characteristics of a Systematic Review Systematic Review of Evidence

  • a clearly stated set of objectives with pre-defined eligibility criteria for studies

  • an explicit, reproducible methodology

  • a systematic search that attempts to identify all studies that would meet the eligibility criteria

  • an assessment of the validity of the findings of the included studies

  • a systematic presentation, and synthesis, of the characteristics and findings of the included studies

    • (Green et al., 2008:6)


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Steps in a Systematic review Systematic Review of Evidence

  • Formulate review question

  • Define inclusion and exclusion criteria

  • Locate studies

  • Select studies

  • Assess study quality

  • Extract data

  • Analysis/summary and synthesis of relevant studies

  • Present results

  • Interpret results/determining the applicability of results

    (Egger & Smith, 2001:25; Glasziou et al., 2004:2)


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Systematic Review Systematic Review of Evidence

  • The notion of and methods for establishing credibility in systematic reviews has been extensively developed and debated

  • In terms of quantitative evidence:

    • Emphasis on reducing bias and increasing validity

    • degree of credibility established through critique and by applying levels of evidence

  • In terms of qualitative evidence:

    • Emphasis on rigour of research design and transferability

    • Degree of credibility established through critique and by applying levels of credibility


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Standard format for protocols Systematic Review of Evidence

  • Background

  • Objectives

  • Review Question

  • Criteria for considering studies for this review

    • Types of participants

    • Types of interventions

    • Types of outcome measures

    • Types of studies

  • Search strategy

  • Methods of the review

    • Assessment of methodological quality

    • Data extraction

    • Data synthesis

  • References


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Review Question(s) Systematic Review of Evidence

  • Like any research project, the systematic review has a research question or hypothesis.

  • Should be specific and focused.

  • Addresses: PICO

  • Provides the basis for development of the inclusion criteria.


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“PICO” Systematic Review of Evidence

(Quantitative/causal relationships)

P - population

I - intervention

C - comparison

O - outcome

“PICo”

(Qualitative/experential)

P - participants

I - phenomena of Interest

Co - context

Review Question(s)


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Example of Review Questions Systematic Review of Evidence

  • Evidence of Effectiveness:

    • In adults aged over 65 years with a venous ulcer on the lower leg, what effect does the application of moist wound dressings compared to dry dressings have on healing rates?


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Inclusion Criteria Systematic Review of Evidence

  • Operationalises the review question.

  • Provides the details of what studies are to be included in the review.

  • Should cover:

    • Population

    • Intervention/ comparison or activity/issue

    • Outcome

    • Study design

  • May also list what is to be excluded:

    • Specific populations

    • Language

    • Setting


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    Inclusion Criteria-Example Systematic Review of Evidence

    • Participants/Population

      • adults at risk of developing mucositis resulting from chemo/radio-therapy

    • Intervention

      • those used to prevent mucositis

    • Outcome Measures

      • prevalence of mucositis

      • oral infection rates

    • Type of Studies

      • randomised controlled trials


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    Search Strategy Systematic Review of Evidence

    • Stepwise strategy to identify all relevant literature

    • Databases to be searched

    • Search terms

    • Time frames


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    Methods of the review Systematic Review of Evidence

    • Assessment of methodological quality

      • Critical Appraisal

    • Data extraction

    • Data synthesis


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    Comprehensive Review Systematic Review of Evidence Management System (CReMS)


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    • Protocol Systematic Review of Evidence

    • Reviewers

    • Search strategy

    • Bibliography - retrieved studies

    • Bibliography - non selected studies


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    Meta-analysis Systematic Review of Evidence


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    Meta-synthesis Systematic Review of Evidence


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