EVIDENCE BASED PRACTICE;
Clinical effectiveness measures outcomes on an individual patient level. Clinical effectiveness studies help us
to understand how to design treatments based on patient variation rather than cost.
Clinical effectiveness is about “the right persons, doing the right thing, the right way, in the right place, at the
right time with the right result “(Graham 1996).
In the context of my practice as a Podiatrist, The right person would primarily be a well trained and member
of HCPC.With the new advancements in Podiatry, such as Local Anaesthesia, Nail Surgery, Diabetic feet,
Gait analysis and etc. All above specialities need extended training such as C.P.D.(s).
Clinical effectiveness doing the right thing is aimed making clinical practice more specifically based on the
use of investigations that have been proven to be effective relative to specific patient needs.
In the right way it is necessary to have well trained and competent work force, having clear responsibilities ,
and working together in this new era of Podiatry, to deliver best value health care.
The Right result refers to the maximization of health effects, which can be expressed in terms of improvement
in the health related quality of life.
Developing appraisal skills should be central to continuing professional development program for
appraisal is a systematic process used to identify the strengths and weakness of a research article
in order to assess the usefulness and validity of research findings.
The most important components of a critical appraisal are an evaluation of appropriateness of the study
design for the research question and careful assessment of the key methodological features of the design.
Other factors that also should be considered include the suitability of the statistical methods,and their
interpretation,potential conflicts of interest and the relevace of the research.
Evidence based practice ,is another tool we can used to make sure that our patients get the best
RCT are a critical component of the evidence base for contemporary medical practice,this design is not feasible
or appropriate for all questions .Depending on the question posed, especially in situations in which RCT
is either not feasible or impractical ,other study designs may be superior .
RCT(s) are considered the criterion standard for the assessment of whether a treatment or intervention
is efficacious,whether treatment works under ideal conditions.
There are four interrelated components that influence the conclusions that we might reach from a statistical test
in a research project.
The four components are:
A. Sample size ,or the number of units (eg. people accessible to the study).
B.Effective size ,or salience of the treatment relative to the noise in measurement.
C. Alpha -level (a,or significance level),or the odds.
D. Power ,or the odds,that we will observe or treatment effect when it occurs.
The hierarchy is based on the premise that the study designs differ in their ability to predict what will happen
to patients in real life.The studies at the top of hierarchy carry more wieght than sudies lower down ,
because their evidence is of higher grade.
Guidelines are systematically developed statements to assist us as practioners to make decisions
about appropriate health care for specific clinical circumstances.
Clinical guidelines affect our own practice all the time where different protocols or therapy guidelines
can be applied in particular circumstances.
Purpose of guidelines in our practice is to make evidence based standards explicit and accessible.
To provide a yarstick for assessing professional performace.To educate patients and professionals
about current best practice.To improve cost effectiveness of health services.Clinical guidelines aim
to improve clinical effectiveness and efficiency.They assist us as clinicians and patients by using a
combination of research evidence ,clinical experience and expert opinion to recommend assessment
and management srategies for patients in specific clinical situations.
Many local ,national and international organisations produce clical guidelines.However,guidelines vary
in quality.They need to be critically appraised just like individual research studies.
Clinical guidelines are not designed to replace knowledge,skills and cliniclal judgement of clinicians.
Guidelines need to be interpreted sensibly and applied with discretion.
Guidelines are systematically developed statements to assist practioners decisions about appropriate
health care for specific clinical circumstances.
The future of clinical guidelines aims to support the development, implementation and evaluation
of guidelines,orientated patient and puplic involvement.
Some autonomy is essential, but too much can negatively affect efficiency.
Podiatrists and other health care providers are now implementing guidelines for assessment and
management of foot ulcers for people with diabetes.Ensuring high quality care,to the level of scientific
rigour with accessibility and usability need to spread the guidelines to practioners and health care
professionals.Podiatrists and other health care providers, will find guidelines invaluable for the development
of policies, procedures,protocols,educational programs and assessments,to assist individuals and
organizations to implement best practice.
SWOT is a useful technique for understanding our strengths and weakness ,and for identifying both the
opportunities open to us and the threats we face.What makes SWOT powerful is that ,with little thought,
it can help you uncover opportunities that we can exploit.Understanding the weakness of our work as
clinicians, we can manage to eliminate threats that otherwise catch us unawares.
By looking at ourselfs and our competitors using SWOT framework, we can start a strategy that can helps us to distinguish ourselfs from our competitors,so we can complete successfully in our field of practice.
SWOT analysis was originated by Alberts Humphrey in 1960.
Strengths and weakness are often internal to our clinics,while opportunities and threats generally relate to external factors.
1. Using the definition of clinical effectiveness from Graham (1996), we would like you to explore what clinical effectiveness means to you within your own clinical practice. This term may be new to some of you so consider this first activity carefully, reflect on your own practice and share your thoughts with the group.
It is always beneficial to take an active role in the discussions as it helps you develop your knowledge and understanding of the topic.
2. the implications of evidence being identified by a research method only as suggested in the hierarchy of strength of evidence. Ask yourself:
• what do you think about using appraisal as the process to identify evidence for patient care?
• are there limitations in RCTs and should the method alone influence the value of the research?
• are there any other components of the research that may equally influence confidence in the research findings?
• if recommendations for patient care are to be based on the outcome of the appraisal, what would you need to be aware of in order to rely on the appraisal process?
3. Please consider:
• what do you think is the future for clinical guidelines?
• how do clinical guidelines affect your own practice? (think how they affect your clinical autonomy)
• what has your experience been on the implementation of clinical guidelines? (did you meet any barriers..how did you overcome them?)
4. clinical effectiveness and evidence based practice:
• what are the drivers that would support the process?
• can you identify any barriers which would prevent change in practice?
• in your clinical setting are there just generic issues, or specific issues related to your own particular healthcare setting?
• discuss how you would deal with the issues you have highlighted.
5. to carry out a SWOT analysis on the future developments for clinical effectiveness. The analysis requires you to provide no more than 5 suggestions for each of the following:
You can reflect on your own area of working practice.
HOW DO I APPROACH THE ASSIGNMENT?
The assignment is asking you to consider your own practice and how you/the service promotes clinical effectiveness – think of the ways that you/the service are continuously improving the quality of services and safeguarding the high standards set.
Although there is not a single definitive approach to this assignment – you should use the question when constructing your assignment and make sure that you have addressed all the elements of Graham’s definition.
Don’t worry about the conclusion and the title until the very end – just concentrate on looking at possible areas to discuss. What I would suggest, is have a good think through possible topics for the assignment and then do a rough outline with subheadings of the Graham’s definition and see which topic can be elaborated under each area and see if each area can be easily linked in a logical flow.
Discussion (discussing and applying Graham’s clinical effectiveness definition)
The title is a broad overview of what your essay is about. It should be short and concise and inform the reader of the content of the essay.
You can construct this essay with or without sub headings – whichever way you decide you are looking for a logical flow to your writing.
If you did decide to use sub headings you need to paragraph your work under each heading and each heading would have to link/flow onto the following heading to ensure a logical flow.
Arial font – size 11 or 12
Main Section – DOUBLED SPACED
References – SINGLE SPACED
Page numbers – in the footer & aligned centrally
Remember to put in the reference list only the work you have read.
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