christopher manacci, msn, acnp, ccrn acute care nurse practitioner critical care transport services...
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Christopher Manacci, MSN, ACNP, CCRNAcute Care Nurse Practitioner
Critical Care Transport ServicesThe Cleveland Clinic
Director, ACNP Flight Nursing ProgramThe National Flight Nurse Academy
Case Western Reserve University
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Define EBP Discuss the process for developing EBP Identify levels of evidence Discuss how to evaluate evidence List strategies for making EBP changes
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Integration of best research evidence with clinical expertise and patient values
◦ Identify a clinical problem◦ Asking an answerable question◦ Searching for evidence◦ Evaluating evidence
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Clinical practice – high volume, high cost patient populations
Quality assurance indicators Regulatory requirements, accreditation
standards
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Strong questions have 4 components:• Problem of interest• Main intervention• Comparison intervention, if relevant• Outcome of interest
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Searching for evidence Start with Systematic Reviews Clinical trials Experimental studies Quasi experimental studies Descriptive or Qualitative Case Studies
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Systematic review is a summary of research literature that uses explicit methods to systematically search, critically appraise, and synthesize the literature on a specific issue.
◦ Meta-analysis – a type of systematic review that uses quantitative methods to summarize the results.
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Clinical Trial:◦ random assignment of subjects◦ double blinded◦ prospective ◦ one or more interventions are tested in an
experimental group and compared to a control group
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Experimental study has:◦ Random assignment of subjects to an
experimental and control group◦ An independent variable that the investigator
manipulates (intervention)◦ A dependent (outcome) variable
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Quasi-experimental has:◦No Random assignment of subjects to an
experimental and control group◦ An independent variable that the investigator
manipulates (intervention)◦ A dependent (outcome) variable
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Descriptive, Correlational, Survey:◦ Main objective is to understand the characteristics
of persons, situations, or groups; and/or the frequency with which certain phenomena occur.
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Qualitative:◦ Main objective is to describe a phenomenon or
understand an experience◦ Data is collected in narrative (nonnumeric) form
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Case Study:◦ An in-depth analysis of an individual, group,
institution or other social unit
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National Guideline Clearinghouse◦ www.ngc.gov
The Cochrane Library◦ www.chchrane.de
Evidence Based Journals◦ e.g. www.evidencebasednursing.com
Professional Organization Guidelines PubMed
◦ www.ncbi.nlm.nih.gov/PubMed
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Systematic Reviews (SR): Are the results of the SR valid? Are the results important? Can you apply this evidence in caring for
your patients? What is the clinical bottom line?
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The Association of Air Medical Services Research Committee developed several surveys
Identify the restraining forces related to the lack of research
Identify the priorities in air medical research Develop a cohort of member programs to
create, encourage and promote research
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Auto Launch Early Activation Appropriate use of air medical services Criteria for waiting on scene for air
medical services Relationship of number and type of
missions and patient outcomes Is there a difference in outcome utilizing
different team configurations, e.g. Advanced Practice v. Traditional
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What is auto launch and do we all define it the same way?
Is auto launch different than early activation?
Is auto launch cost effective? Does auto launch improve outcomes in the
trauma population?
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