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Evidence-based Practice and Knowledge Translation in the Era of Health Care Reform: Opportunities for Occupational Therapy

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Title: Evidence-based Practice and Knowledge Translation in the Era of Health Care Reform: Opportunities for Occupational Therapy


1
Evidence-based Practice and Knowledge Translation
in the Era of Health Care Reform Opportunities
for Occupational Therapy
Click to edit Master title style
AOTA Living Life to its Fullest
Kenneth J. Ottenbacher University of Texas
Medical Branch
2
AJOT 1986 (40) p.112-116
3
Center for Evidence-based Medicine
http//www.cebm.net/
4
The Evolution of Evidence-based Practice
Medical Outcomes
Quality Assurance
Evidence-based health care
5
What I would like to talk about
1. What is Evidence-based practice (EBP)?
2. Its impact and does it work?
3. How can we make it better?
4. Opportunities related to Health Care Reform.
6
The desire to connect research findings to
changes in health care practice is not new.
1940-50s
7
But, the evidence has been indirect.
8
The Challenge has been
How to make the connection between research and
practice more obvious and explicit.
Evidence-based Practice
Better Health Care
Research
9
1992 268 2420-2425
10
Original Definition Evidence-based clinical
medicine is the conscientious and judicious use
of current best evidence from clinical care
research in the management of individual
patients.
Evidence Based Medicine Working Group, 1992
11
Evidence-based MedicineHow to Practice and
Teach EBM By Sackett DL, Straus SE, Richardson
WS, Rosenberg W, Haynes RBSecond
Edition.Churchill Livingstone Edinburgh, 2000.
12
Components of EBP
Haynes, et al., 1996
Individual Clinical Experience
Patient Values Expectations
Improved Patient Outcomes
Best Available Evidence
13
Steps in Evidence-based Practice
(Tickle-Degnen, 2000)
14
Steps in Evidence-based Practice
Step 1. Write a question related to a specific
clinical task or problem.
Step 2. Gather current published evidence
that might answer the question.
15
OTseeker
OTseeker is a database that contains abstracts of
systematic reviews and randomized controlled
trials relevant to occupational therapy.
http//www.otseeker.com/
16
Steps in Evidence-based Practice
Step 3. Evaluate the gathered evidence to
determine what is the best evidence for
answering the question.
Levels of Evidence
17
Levels of Evidence
A hierarchy of evidence was developed based on
research design.
Randomized Controlled Trials (RCT) are the gold
standard and provide the best evidence.
18
Randomized Clinical Trial
Random Sampling
Random Assignment
Treatment
Control
Blinding
Pre/post-test outcome measures
19
Hierarchy of Evidence
I II III IV V
A B C D
20
Steps in Evidence-based Practice
Step 4. Interpret the evidence to determine a
possible answer to the question.
Step 5. Communicate with clients and colleagues
about the evidence as intervention decisions are
made.
Step 6. Document clinical decisions and record
assessments, progress and outcomes.
21
  1. Its impact and does it work?

22
The New York Times Magazine Year in Review
identified EBM as one of the five most
influential ideas of the past five years.
The New York Times Magazine
December 23, 2001
23
The British Medical Journal (BMJ) listed
Evidence-based Medicine as one of the 15 most
important developments in medicine in the last
150 years.
January, 2005
24
Evidence-based medicine web sites
13.6
million
1.24
25
  • EBP has contributed to an increase in Randomized
    Clinical Trials

The average number of randomized clinical trials
increased from 5,000 per year during 1980-1990
to 20,000 per year during 1994-2001.
26
National Guideline Clearinghouse
The National Guideline Clearinghouse includes
over 2,500 Clinical Practice Guidelines.
http//www.guideline.gov/
Supported by Agency for Healthcare Research
Quality (AHRQ)
27
So what is the evidence for evidence-based
practice?
Has the increase in research and practice
guidelines improved healthcare decision making
and outcomes?
28
American Academy of Pediatric Guidelines
EBP success Frequency of prone sleeping
decreased from 70 to 20. Sudden infant death
rate reduced 40.
29
Surveys and systematic reviews indicate that
30-45 of patients are not receiving care
according to scientific evidence and that 20-25
of the care provided is not needed or is
potentially harmful.
(2003)
30
McGlynn, et al. examined quality of care scores
based on evidence-based reviews to evaluate
performance on 439 indicators for quality of
care for 30 acute and chronic conditions.

NEJM, 2003
31
They found that less than half of patients
received care based on best evidence currently
available.
The gap between what we know works and what is
actually done is substantial
NEJM, 2003, p. 2644
32
Hand Washing
A large body of research evidence (including
RCTs) demonstrate that hand washing
prevents disease and improves health. Hand
washing is supported by Level A evidence.
33
Hand Washing
Despite Level A evidence, and other
incentives, compliance at the national level
remains poor.
34
The Ideal
Evidence-based Promise
Evidence-based Paradigm
The Reality
Evidence-based Paradox
35
3. How can we make it better?
36
Areas for improvement
  • Levels of Evidence Hierarchy
  • Strategies for Implementation / Application
    (e.g., knowledge translation)
  • The role of theory in EBP

37
Levels of Evidence
The standard hierarchy focuses on research design
(RCT) regardless of the question or context.
38
Concato J., et al. Randomized, controlled
trials, observational studies, and the hierarchy
of research designs. N Eng J Med
20003421887-92.
Examined 99 studies from five major medical
journals. Designs were either RCTs or cohort and
case-control. They found that well-designed
observational studies did not overestimate the
magnitude of treatment effects compared to RCTs.
39
McGlynn, et al. (2003) estimate that
approximately 50 or less of the research
questions in clinical medicine can be addressed
by RCTs.
For the broader area of health care, the
percentage is lt 30.
40
Lee J. Cronbach, Ph.D.
Convincing reasoning about causation may be
possible using many types of design. Once
more we see the limitation of a classification
system that leads to appraisal, in the abstract,
of some types of designs as excellent and others
as defective. (Cronbach, 1983)
41
Where is the wisdom we have lost in
knowledge Where is the knowledge we have lost in
information?
The Rock T.S. Eliot
42
Knowledge Application
  • The process of knowledge translation, transfer
    and application involve system factors and
    behavior change that are complex.

M.C. Escher
43
Changing peoples behavior is difficult. There is
no simple solution.
44
Knowledge to Action Process
Monitor Knowledge Use
Select, Tailor, Implement Interventions
  • KNOWLEDGE CREATION

Evaluate Outcomes
Knowledge Inquiry Knowledge Synthesis Knowledge
Tools / Products
Assess Barriers to Knowledge Use
Sustain Knowledge Use
Adapt Knowledge to Local Context
ACTION CYCLE (Application)
Identify Problem ------------------------------ Id
entify, Review, Select Knowledge
Graham 2006
45
Scholars in occupational therapy have made
important contributions to struggling with the
knowledge translation and application challenge.
Law MacDermid, 2008
46
What is the Role of Theory in Evidence-based
Practice?
Two methods of translating research into practice
  • Empirical method
  • Theoretical method

47
Clinical Practice
Clinical Problem
Theory
3
1
2
Research Studies
48
Patient-Centered Outcomes Research Institute
Arête ??et?, Excellence. The notion of the
fulfillment of purpose or function the act of
living up to one's full potential.
Being the best you can be.
 
49
4. Opportunities related to Health Care Reform
50
Patient Center Outcomes Research Institute
Created by the Affordable Care Act, the Institute
will
  • Identify research priorities and outcome measures
    for Comparative Effectiveness Research
  • Fund research (500 million per year)

51
Patient Center Outcomes Research Institute
www.pcori.org
www.pcori.org


 
52
National Quality Forum
A nonprofit organization with a mission to
improve American healthcare by endorsing national
consensus standards for measuring and publicly
reporting on performance
http//www.qualityforum.org/Home.aspx
 
53
http//www.qualityforum.org/Home.aspx
Patient-Centered Outcomes Research Institute
 
54
Think strategically, Compete collaboratively
Patient-Centered Outcomes Research Institute
have FUN
Competing collaboratively with my daughters
 
55
The End
Patient-Centered Outcomes Research Institute
K. Ottenbacher Division of Rehabilitation
Science UTMB at Galveston kottenba_at_utmb.edu
Old Red at UTMB
PPT slides including references available at
www.shp.utmb.edu/download/AOTA.ppt
 
56
  • References
  • Alderson, P. (1998) The importance of theories in
    healthcare. British Medical Journal, 317,
    10071010.
  • Atkins, D., Briss, P. A., Eccles, M., et al.
    (2005) System for grading the quality of evidence
    and the strength of recommendations II pilot
    study of a new system. BMC Health Services
    Research, 5, 25.
  • Berwick, D. (2005) Broadening the view of
    evidence-based medicine. Quality and Safety in
    Healthcare, 14, 315316.
  • Biswas, R., Martin, C. M., Sturmberg, J.,
    Shanker, R., Umakanth, S., Shanker, S. Kasturi,
    A. S. (2008) User-driven healthcare answering
    multidimensional information needs in individual
    patients utilizing post-EBM approaches a
    conceptual model. Journal of Evaluation in
    Clinical Practice, 14, 742749.
  • Borry, P., Schotsmans, P. Dierickx, K. (2006)
    Evidence-based medicine and its role in ethical
    decision making. Journal of Evaluation in
    Clinical Practice, 12, 312318.
  • Brownson, R. C., Baker, E. A., Leet, T. L.
    Gillespie, K. N. (2003) Evidence Based Public
    Health. New York Oxford University Press.

57
  • References cont.
  • Brownson, R. C., Gerney, J. G. Land, G. H.
    (1999) Evidence-based decision making in public
    health. Journal of Public Health Management and
    Practice, 5, 8697.
  • Chochinav, H. (2007) Dignity and the essence of
    medicine the A, B, C and D of dignity conserving
    care. British Medical Journal, 335, 184187.
  • Coffey, R. J., Richards, J. S., Remmert, C. S.,
    LeRoy, S. S., Schoville, R. R. Baldwin, P. J.
    (1992) An introduction to critical paths. Quality
    Management in Health Care, 1, 4554.
  • Cohen, A. M., Stavri, P. A. Hersh, W. R. (2004)
    A categorization and analysis of the criticism of
    evidence-based medicine. International Journal of
    Medical Informatics, 73, 3543.
  • Concato, J., Shah, N. Horwitz, R. (2000)
    Randomized controlled trials, observational
    studies, and the hierarchy of research designs.
    New England Journal of Medicine, 342, 1887.
  • Couto, J. (1998) Evidence-based medicine a
    Kuhnian perspective of a transvestite non-theory.
    Journal of Evaluation in Clinical Practice, 4,
    267275.

58
  • References cont.
  • Cox, J. L. (2008) Towards an evidence-based
    Medicine of the Person the contribution of
    psychiatry to health care provision. Journal of
    Evaluation in Clinical Practice, 14, 694698.
  • Cronbach, L.J. (1983) Designing evaluations of
    education and social programs. San Francisco, CA
    Jossey-Bass, 1983.
  • Dans, P. E. (1994) Credibility cookbook medicine
    and common sense guidelines and the college.
    Annals of Internal Medicine, 120, 966968.
  • Davidoff, F., Case, K. Fried, P. W. (1995)
    Evidence-based medicine why all the fuss? Annals
    of International Medicine, 122, 727.
  • Davis, D. Taylor-Vaisey, A. (1997) Translating
    guidelines into practice. A systematic review of
    theoretical concepts, practical experience and
    research evidence in the adoption of clinical
    practice guidelines. Canadian Medical Association
    Journal, 157, 408416.
  • Evans, D. (2003) Hierarchy of evidence a
    framework for ranking evidence evaluating
    healthcare interventions. Journal of Clinical
    Nursing, 12, 7784.

59
  • References cont.
  • Evidence Based Medicine Working Group (1992)
    Evidence-based medicine a new approach to
    teaching the practice of Medicine. Journal of
    the American Medical Association, 268, 24202425.
  • Goldenberg, M. J. (2006) On Evidence and
    evidence-based medicine lessons from the
    philosophy of science. Social Science and
    Medicine, 62, 26212632.
  • Goodman, K. (2003) Ethics and Evidence-based
    Medicine Fallibility and Responsibility in
    Clinical Science. Cambridge Cambridge University
    Press.
  • Grol, R. Grimshaw, J. (2003) From best evidence
    to best practice effective implementation of
    change in patients care. The Lancet, 32,
    1225-1230.
  • Guyatt, G. H. (1991) Evidence-based medicine.
    Annals of Internal Medicine 114 (Suppl.) A1A16.
  • Guyatt, G. H., Meade, M. O., Jaeschke, R. Z.,
    Cook, D. J. Haynes, R. B. (2000) Practitioners
    of evidence-based care. Not all clinicians need
    to appraise evidence from scratch but all need
    some skills. British Medical Journal, 320,
    954955.

60
  • References cont.
  • Guyatt, G., Cook, D. Haynes, B. (2004)
    Evidence-based medicine has come a long way.
    British Medical Journal, 329, 990991.
  • Guyatt, G., Montori, V., Devereaux, P.,
    Schunemann, H. Bhandari, M. (2004) Patients at
    the centre in our practice and in our use of
    language. ACP Journal Club, 140, A11A12.
  • Hart, O. (1993) Protocols or guidelines, or
    neither. British Medical Journal, 306, 816,
  • Hay, M. C., Weisner, T. S., Subramanian, S.,
    Duan, N., Niedzinski, E. J. Kravitz, R. L.
    (2008) Harnessing experience exploring the gap
    between evidence-based medicine and clinical
    practice. Journal of Evaluation in Clinical
    Practice, 14, 707713.
  • Haynes, R. B., Devereaux, P. Guyatt, G. (2002)
    Physicians and patients choices in
    evidence-based practice. British Medical Journal,
    324, 1350.
  • Haynes, R. B., Devereaux, P. J. Guyatt, G. H.
    (2002) Clinical expertise in the era of
    evidence-based medicine and patient choice. ACP
    Journal Club, 136, A11A14.

61
  • References cont.
  • Haynes, R. B., Sackett, D. L. Smith, R. (1995)
    Evidence-based medicine. British Medical Journal,
    310, 19851086.
  • Haynes, R. B., Sackett, D. L., Muir Gray, J. A.,
    Cook, D. L. Guyatt, G. H. (1997) Transferring
    evidence from research into practice 2. Getting
    the evidence straight. Evidence-based Medicine,
    2, 46.
  • Holmes, D., Murray, S. J., Perron, A. Rail, G.
    (2006) Deconstructing the evidence-based
    discourse in health sciences truth, power and
    fascism. International Journal of Evidence-Based
    Healthcare, 4, 180186.
  • Holmes, D., Perron, A. OByrne, P. (2006)
    Evidence, virulence and the disappearance of
    nursing knowledge a critique of the
    evidence-based dogma. Worldviews on
    Evidence-Based Nursing, 3, 95102.
  • Isaac, C. A. Franceschi, A. (2008) EBM
    evidence to practice and practice to evidence.
    Journal of Evaluation in Clinical Practice, 14,
    656659.
  • Isaacs, D. Fitzgerald, D. (1999) Seven
    alternatives to evidence based medicine. British
    Medical Journal, 319, 1618.

62
  • References cont.
  • Jenicek, M. (1999) Epidemiology evidence-based
    medicine and evidence-based public health.
    Journal of Public Health Management and Practice,
    5, 187197.
  • Jenicek, M. (2003) Foundations of Evidence-Based
    Medicine. Boca Raton, FL Parthenon
    Publishing/CRC Press.
  • Jenicek, M. (2006) Evidence-based medicine
    fifteen years later. Golem the good, the bad and
    the ugly in need of a review? Medical Science
    Monitor, 12, RA241RA251.
  • Jenicek, M. (2006) The hard art of soft science.
    Journal of Evaluation in Clinical Practice, 12,
    410419.
  • Kemm, J. (2006) The Limitations of
    evidence-based public health. Journal of
    Evaluation in Clinical Practice, 12, 319324.
  • Kempainen, R. R., Migeon, M. B. Wolf, F. M.
    (2003) Understanding our mistakes a primer on
    errors in clinical reasoning. Medical Teacher,
    25, 177181.
  • Kleinman, A. (2008) Catastrophe and caregiving
    the failure of medicine as an art. Lancet, 371,
    2223.

63
  • References cont.
  • Kohatsu, N. D., Robinson, J. G. Turner, J. C.
    (2004) Evidencebased public health an evolving
    concept. American Journal of Preventive Medicine,
    27, 417421.
  • Korenstein, D., Dunn, A. McGinn, T. (2002)
    Mixing it up integrating evidence-based medicine
    and patient care. Academic Medicine, 77, 741742.
  • Kravitz, R. L., Duan, N. Braslow, J. (2004)
    Evidence-based medicine, heterogeneity of
    treatment effects and the trouble with averages.
    The Millbank Quarterly 82, 661687.
  • Lancet (1995) Evidence-based medicine, in its
    place. Lancet, 346, 785
  • Lau, J., Ioannidis, J. P. A. Schmid, C. H.
    (1998) Summing up evidence one answer is not
    always enough. Lancet, 351, 123127.
  • Law, M. MacDonald, J. (ed.). Evidence-based
    rehabilitation. A guide to practice. 2nd Ed.
    Thorofare, NJ Slack, Inc., 2008.
  • Lin, V. Gibson, B. eds. (2003) Evidence-based
    Health Policy Problems and Possibilities. New
    York Oxford University Press.

64
  • References cont.
  • Loughlin, M. (2003) Essay review of Kenneth
    Goodmans ethics and evidence-based medicine
    fallibility and responsibility in clinical
    science. Journal of Evaluation in Clinical
    Practice, 9, 141144.
  • Loughlin, M. (2008) Inside Intuition. Journal of
    Evaluation in Clinical Practice, 14, 690692.
  • Maier, T. (2006) Evidence-based psychiatry
    understanding the limitations of a method.
    Journal of Evaluation in Clinical Practice, 12,
    325329.
  • McGlynn, E., Asch, S.M., Adams, J., Keesey, J.,
    Hicks, J., DeCristofaro, A., Kerr, E.A. (2003).
    The quality of health care delivered to adults in
    the United States. New England Journal of
    Medicine, 348, 2635-2645.
  • McIntyre, N. (1995) Evaluation in clinical
    practice problems, precedents and principles.
    Journal of Evaluation in Clinical Practice, 1,
    513.
  • Miettinen, O., Bachmann, L. M. Steurer, J.
    (2008) Towards scientific medicine an
    information-age outlook. Journal of Evaluation in
    Clinical Practice, 14, 771774.

65
  • References cont.
  • Milbrandt, E. B. Vincent, J. (2004)
    Evidence-based medicine journal club. Critical
    Care, 8, 401402.
  • Miles, A. Loughlin, M. (2006) The progress and
    price of EBM. Journal of Evaluation in Clinical
    Practice, 12, 385398.
  • Miles, A. (2007) Science a limited source of
    knowledge and authority in the care of patients.
    Journal of Evaluation in Clinical Practice, 13,
    545563.
  • Miles, A., Bentley, D. P., Polychronis, A.
    Grey, J. E. (1997) Evidence-based medicine why
    all the fuss? This is why. Journal of Evaluation
    in Clinical Practice, 3, 8386.
  • Miles, A., Bentley, D. P., Polychronis, A.
    Grey, J. E. (1997) The limits of evidence-based
    medicine. Journal of Evaluation in Clinical
    Practice, 3, 8386.
  • Miles, A., Bentley, D. P., Polychronis, A., Grey,
    J. E. Price, N. (1998) Recent progress in
    health services research on the need for
    evidence-based debate. Journal of Evaluation in
    Clinical Practice, 4, 257265.

66
  • References cont.
  • Miles, A., Bentley, D. P., Polychronis, A., Grey,
    J. E. Price, N. (1999) Advancing the
    evidence-based healthcare debate. Journal of
    Evaluation in Clinical Practice, 5, 97101.
  • Miles, A., Charlton, B. G., Bentley, D. P.,
    Polychronis, A., Grey, J. E. Melchiorri, C.
    (2001) Recent developments in the evidence-based
    healthcare debate. Journal of Evaluation in
    Clinical Practice, 7, 8589.
  • Miles, A., Charlton, R. G., Bentley, D. P.,
    Polychronis, A. Grey, J. E. (2000) New
    perspectives in the evidence-based healthcare
    debate. Journal of Evaluation in Clinical
    Practice, 6, 7784.
  • Miles, A., Loughlin, M. Polychronis, A. (2007)
    Medicine and evidence knowledge and action in
    clinical practice. Journal of Evaluation in
    Clinical Practice, 13, 481503.
  • Miur Gray, J. A., Haynes, R. B., Sackett, D. L.,
    Cook, D. J. Guyatt, G. H. (1997) Transferring
    evidence from research into practice developing
    evidence-based clinical policy. Evidence-based
    Medicine, 2, 3638.

67
  • References cont.
  • Montgomery, K. (2006) How Doctors Think. Clinical
    Judgment and the Practice of Medicine. Oxford
    Oxford University Press.
  • Morgan, W. K. C. (1995) Evidence-based medicine.
    Lancet, 346, 1172
  • Murray, S. J., Holmes, D. Rail, G. (2008) On
    the constitution and status of evidence in the
    health sciences. Journal of Nursing Research, 13,
    272280.
  • Murray, S. J., Holmes, D., Perron, A. Rail, G.
    (2007) No exit? Intellectual integrity under the
    regime of evidence and best practices. Journal
    of Evaluation in Clinical Practice, 13, 512516.
  • Murray, S. J., Holmes, D., Perron, A. Rail, G.
    (2008) Towards an ethics of authentic practice.
    Journal of Evaluation in Clinical Practice, 14,
    682689.
  • Nunn, R. (2008) Evidence-based medicine and
    limits to the literature search. Journal of
    Evaluation in Clinical Practice, 14, 672678.
  • Onion, C. W. R. Walley, T. (1995) Clinical
    guidelines development, implementation and
    effectiveness. Postgraduate Medical Journal, 71,
    39.

68
  • References cont.
  • Ottenbacher, K. (1985). The Foundation --
    Ritual, rigor and relevance The design of
    clinical research. American Journal of
    Occupational Therapy, 39, 202-203.
  • Ottenbacher, K., Barris, R., Van Deusen, J.
    (1986) Some issues related to research
    utilization in occupational therapy. American
    Journal of Occupational Therapy, 40, 111-116.
  • Ottenbacher, K. (1987) Nationally Speaking
    Research Its importance to clinical practice in
    occupational therapy. American Journal of
    Occupational Therapy, 41, 213-215.
  • Ottenbacher, K., Hasselkus, B. (1988)
    Editorial Research and practice An evolving
    synthesis. The Occupational Therapy Journal of
    Research, 8, 67-74.
  • Ottenbacher, K. (1990) Editorial Occupational
    therapy curricula and practice Skill based or
    knowledge based. The Occupational Therapy
    Journal of Research, 10, 7-12.
  • Ottenbacher, K. (1992) Nationally Speaking --
    Confusion in occupational therapy research Does
    the end justify the method. American Journal of
    Occupational Therapy, 46, 871-874.

69
  • References cont.
  • Ottenbacher, K.J., Degnen, L.T., Hasselkus, B.R.
    (2002). Therapists Awake! The challenge of
    evidence-based occupational therapy. American
    Journal of Occupational Therapy, 56, 247-249.
  • Panella, M., Marchisio, S. Di, S. F. (2003)
    Reducing clinical variations with clinical
    pathways do pathways work? International Journal
    of Quality in Health Care, 15, 509521.
  • Parmley, W. W. (1994) Clinical practice
    guidelines. Does the cookbook have enough
    recipes? Journal of the American Medical
    Association, 272, 13741375.
  • Pearson, S. D., Goulart-Fisher, D. Lee, T. H.
    (1995) Critical pathways as a strategy for
    improving care problems and potential. Annals
    of International Medicine, 123, 941948.
  • Petticrew, M. Roberts, H. (2003) Evidence,
    hierarchies and typologies horses for courses.
    Journal of Epidemiology and Community Health, 57,
    527529.
  • Polychronis, A., Bentley, D. P. Miles, A.
    (1996) Evidence-based medicine Reference? Dogma?
    Neologism? New Orthodoxy? Journal of Evaluation
    in Clinical Practice, 2, 13.

70
  • References cont.
  • Polychronis, A., Bentley, D. P. Miles, A.
    (1996) The protagonists of EBM arrogant,
    seductive and controversial. Journal of
    Evaluation in Clinical Practice, 2, 912.
  • Porzsolt, F., Ohletz, A., Gardner, D., Ruatti,
    H., Meier, H., Schlotz-Gorton, N. Schrott, L.
    (2003) Evidence-based decision making the 6-step
    approach. ACP Journal Club, 139, A11A12.
  • Prior, M., Guerin, M. Grimmer-Somers, K. (2008)
    The effectiveness of clinical guideline
    implementation strategies a synthesis of
    systematic review findings. Journal of Evaluation
    in Clinical Practice, 14, 888897.
  • Reilly, B. M. (2004) The essence of EBM. British
    Medical Journal, 329, 911912.
  • Roddy, E., Zhang, W., Doherty, M., et al. (2006)
    Evidence-based clinical guidelines a new system
    to better determine true strength of
    recommendation. Journal of Evaluation in Clinical
    Practice, 12, 347352.

71
  • References cont.
  • Rosenberg, W. M. C. Donald, A. (1995)
    Evidence-based medicine an approach to clinical
    problem solving. British Medical Journal, 310,
    11221126.
  • Rosner, A. (2000) Gilding the gold standard
    lilly the limits of evidence-based medicine.
    Dynamic Chiropractic, 18, 2324.
  • Saad, A. (2008) The evidence-based paradox and
    the question of the Tree of Knowledge. Journal of
    Evaluation in Clinical Practice, 14, 650652.
  • Saarni, S. I. Gylling, H. A. (2004)
    Evidence-based medicine guidelines a solution to
    rationing or politics disguised as science?
    Journal of Medical Ethics, 30, 171175.
  • Sackett, D. L. Rosenberg, W. M. C. (1995) On
    the need for evidence-based medicine. Journal of
    Public Health Medicine, 17, 330334.
  • Sackett, D. L., Richardson, W. S., Rosenberg, W.
    M. C. Haynes, R. B. (1997) Evidence-based
    medicine how to practice and teach EBM.
    Edinburgh Churchill Livingstone.

72
  • References cont.
  • Sackett, D. L., Rosenberg, W. M. C., Muir Gray,
    J. A., Haynes, R. B. Scot, W. (1996)
    Evidence-based medicine what it is and what it
    isnt. British Medical Journal, 312, 7172.
  • Sackett, D. L., Strauss, S., Richardson, W.,
    Rosenberg, W. Haynes, R. B. (2000)
    Evidence-Based Medicine How to Practice and
    Teach EBM. Toronto Churchill Livingstone.
  • Shahar, E. (2003) Evidence-based medicine a new
    paradigm on the Emperors new clothes? Journal of
    Evaluation in Clinical Practice, 4, 277282.
  • Shahar, E. (2008) Does anyone know the road from
    a randomized trial to personalized medicine.
    Journal of Evaluation in Clinical Practice, 14,
    726731.
  • Stewart, M., Brown, J., Weston, W., McWhinney,
    I., McWilliam, C. Freeman, T. (1995) Patient
    Centred Medicine Transforming the Clinical
    Method. London Sage.
  • Straus, S., Richardson, W., Glaziou, P. Haynes,
    R. (2005) Evidence-Based Medicine How to
    Practice and Teach EBM, 3rd ed. Edinburgh
    Elsevier, Churchill Livingstone.

73
  • References cont.
  • Sturmberg, J. P. Martin, C. M. (2008) Knowing
    in medicine. Journal of Evaluation in Clinical
    Practice, 14, 767770.
  • Tanenbaum, S. J. (2008) Perspectives on
    evidence-based practice from consumer in the US
    public mental health system. Journal of
    Evaluation in Clinical Practice, 14, 699706.
  • Tavakoli, M., Davies, M. T. Thomson, R. J.
    (2000) Decision analysis in evidence-based
    decision making. Journal of Evaluation in
    Clinical Practice, 6, 111120.
  • Tilburt, J. C. (2008) Evidence-based medicine
    beyond the bedside keeping an eye on context.
    Journal of Evaluation in Clinical Practice, 14,
    721725.
  • Tonelli, M. R. (2006) Integrating evidence into
    clinical practice an alternative to
    evidence-based approaches. Journal of Evaluation
    in Clinical Practice, 12, 248256.
  • Tunis, S. R. (2004) Economic analysis in
    healthcare decisions. American Journal of Managed
    Care, 10, 301304.

74
  • References cont.
  • Upshur, R. (2005) Looking for rules in a world of
    exceptions reflections on evidence-based
    practice. Perspectives in Biology and Medicine,
    48, 477489.
  • Vandenbrouke, J. P. (1998) Observational research
    and evidence based medicine what should we teach
    young physicians? Journal of Clinical
    Epidemiology, 51, 467472.
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