Requirements: 800

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P r o j e c t 1
Steps for practice. Use acronym P I C O (Cluett, 2002).
P – Patient, population, problem
I – Intervention
C – Comparison , control
O – Outcome
Step 1.
Choose your search terms in each section
Population Intervention Comparison Outcome
OR
Problem Intervention Comparison Outcome
OR
Patient Intervention Comparison Outcome
Use these steps on the following information.
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Is min Now secectoall
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3,548 patients
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1. What population/ problem / patient do you want to study?
2. What sub-group from this would you like to study?
Example:
• If the problem you want to study is depression, what part of the population
would you like to study, which demographic group?
• Also, which type of depression do you want to study?
T A S K: In small groups find a problem you want to study. Then think about the subgroups
in that population. Present this to the group. Be prepared to say why?
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P R O J E C T 2
E v i d e n c e b a s e d p r a c t i c e i n T h e K i n g d o m o f S a u d i A r a b i a .
Your task is to review two articles below using principles from Evidence
Based Practice.
1. The effectiveness of Narrative Exposure Therapy with traumatized firefighters
in Saudi Arabia: A randomized controlled study, by Mohammed Al Ghamdi, Nigel
Hunt and Shirley Thomas. In B e h a vigor Re s e a ch and T h e r a p y, ( 2 0 1 5 ), 6 6, 6 4 –
7 1 .
2. In-patient treatment for resistant obsessive-compulsive disorder, by
Mohammed Al Sughayir (2000). In Neurosciences, 5 (2), 128-130.
a. Can you identify the – Problem/ population/ patient
– Intervention
– Control group
– Outcome?
Box 1. Sources of evidence
Sources of evidence
Evidence can be sourced from experts and literature. The latter includes original research and
compilations of research evidence used to analyze and inform choices in clinical decision-making.
This is often categorized as a hierarchy of evidence. This includes:
i. Primary sources of evidence: These draw on original research findings. These sources will
include reports and articles about research that has been gathered from research subjects or
participants.
ii. Secondary sources of evidence: These draw on a range of sources informing the topic of
concern including:
• Systematic reviews;
• Meta analyses;
• Clinical guidelines or protocols;
iii. Expert opinion.
Levels of Evidence
Decide on the level of evidence you are reading. You need to know the strength and
weaknesses of the evidence being presented in research or other sources of information.
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“Many different rating systems of varying complexity and clinical relevance are described in the
medical literature. Recently, the third U.S. Preventive Services Task Force (USPSTF)
emphasized the importance of rating not only the study type (RCT, cohort study, case-control
the study, etc.), but also the study quality as measured by internal validity and the quality of the entire
body of evidence on a topic”.
• Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial
(RCT) that considers all-important outcomes. A high-quality meta-analysis (quantitative
systematic review) using comprehensive search strategies.
• Level B (other evidence): A well-designed, nonrandomized clinical trial. A non-quantitative
systematic review with appropriate search strategies and well-substantiated conclusions.
Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased
selection of study participants and consistent findings. Other evidence, such as high-quality,
historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings,
is also included.
• Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.
Each rating is applied to a single reference in the article, not to the entire body of evidence that
exists on a topic. Each label should include the letter rating (A, B, C), followed by the specific type
of study for that reference. For example, following a level B rating, include one of these
descriptors: (1) nonrandomized clinical trial; (2) non-quantitative systematic review; (3) lower
quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study;
(7) epidemiologic study.
b. Now decide how you would evaluate this study if you were assessing the
quality of the evidence it is detailing. What level of evidence is it?
c. Use the rapid style of critical evaluation of research material and studies.
Once you have selected studies for review you should be able to assess their
relevance quickly because you can find yourself with many studies to evaluate.
At this stage of review you are just collecting evidence so there is no need to
check every article in depth. You will need to select out weaker studies from
stronger studies. The studies you decide to include in your review are called “
keeper studies”.
“Ra pid Critic al Appr ais al” involves three questions used to evaluate the
usefulness of the study you are considering:
1 . Ar e th e r esults of th e stud y v alid? Ar e th e r es e a rch me thods rigourous
e nou g h to e nsur e t h a t th e r esults prop e rly r e pr es e nt t h e t rut h of th e ma t t e r?
• Random assignment to control/ treatment groups?
• Characteristics of groups?
• Validity and reliability of outcome measures?
2. Wh a t a r e t h e results and a r e t h e y important?
• In interventions did it work? Impact on outcomes?
• Replicability for other clinicians?
3. Will the results help me can r e for my patients?
• Are the subjects and participants in the study similar to your own
patients?
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• Do the benefits of the intervention outweigh any risks?
• How feasible and cost-effective would it be to carry out the same
intervention?
• Consider how your patient’s preferences and values fit with this style of
intervention.

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