Good Literature Review On Evidence-Based Practice:

Is there sufficient research to produce reliable diagnosis?

Abstract
This paper explores published articles and analysis from the internet that focuses on the use of evidence based practice. The purpose of this paper is determine through research if there is a practical amount of reliable evidence supported through studies to determine the dependability of a diagnosis using evidence-based practice (EBP) by clinicians today. Specifically this paper will take a in depth look at the (1)needs for a change,(2) comparison with old practices,(3)pros and cons associated with evidence-based practice,(4) the reliability of existing research and (5)physicians outlook on using this approach to determine what illness is plaguing there patients using this method would help or complicate diagnosing patients. The methods that will determine the reliability will be research from physicians who have or still use this type of research when determining illness and prescribing evidence based medicine (EBM) in comparisons studies. EBP research shows some amount of unreliability in the past however with advances in technology there may be a use for this method now and it may prove to be extremely reliable.
Keywords: Evidence-based medicine, Evidence-based practice

Practice Based Evidence

Is there sufficient evidence to produce a reliable diagnosis?
There have been numerous opinions about how practice based evidence may or may not be helpful. To the people that are in the academic field the research suggests an exciting new way of being able to employ the best medical advice and techniques to each patient ensuring a sound and reliable diagnosis and route of treatment. To the people that are operating in the medical field this type of practice seems farfetched, time consuming and overall impractical. However the opinions may vary research indicates not only a need for this change but a positive and realistic application to put this fairly new idea into productive use for both medical professionals and the patients that rely on them. This paper examines multiple outlooks and research studies in order to determine if there is a use and appropriate place for PBE in the medical field.

Literature Review

A need for change. Through ought time medical practices have been mostly experience based practices (EBP) or they would determine a person’s illness and treatment based on the physicians experience in the area that the physician has developed their own expertise in. When faced with the changes in medical and a strong demand for reliable diagnosis that doctors are held accountable there is a new demand for strong research that encompasses the specific person’s illness. To make a decision that is reliable for each individual patient there is an agreement raging that suggests practice based evidence becomes more reliable on the most recent research and studies when providing the best possible treatment for their consumers. This process is described as a difficult approach that requires more than research but also comparison of this research to the patients records, needs and data. The words that are commonly used when describing practice based evidence are “integration, and creativity” because it requires not only relying on a stockpile of research that supports the physicians decision but also the physicians best medical opinion on how the research specifically defines an approach for treatment for each unique diagnosis (Schlosser, 2006).
Comparison with old practice. Evidence based practice was first recognized in the 90’s but has faced criticism and skepticism ever since. People who were in the medical field and handled the academic perspective found this new way of thinking exciting and interesting however the doctors and medical practitioners that faced the new concept were unsure of how this was a good idea. The medical field is a constant and moving industry so this of course raised some concerns when considering the amount of time it would take to incorporate research into diagnosis when faced with patients that are waiting for a solution to their issue as soon as possible. However impossible the idea might seem to incorporate there is a lot of new technology that allows a vast amount of information to be accessed in a matter of seconds making this research a real possibility. David Sacket MD describes this approach best stating that, EBM is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical experience with the best available external clinical evidence from systematic research” (White, 2015). When determining a patient’s diagnosis and treatment based on EBP there is a certain structure that physicians follow:

An assessment is made while discussing with the patient there condition and a clinical issue takes place.

Asking questions helps to determine what concern or question arises in this particular case
Selection of the search criteria that is appropriate for the patient
Ensuring the information is valid and reliable as well as useful in medical practice
Going over the information collected with the patient, this is where “integration” comes into the process as you combine the information with your own expertise.

Last is a self-performance evaluation with the patient to ensure quality service.

Using this list in order helps the physician to support their decision showing that it is evidence based however it is not solely the evidence that produces results but also the physicians evaluation of the situation in comparison with the patients’ health records and needs (Sackett, 2015) .
Pros and Cons. It is important to address both the benefits of EBP as well as the reasons it would be an issue to implement such a change. One of the main concerns with EBP is the process of conversion which is required as one of the crucial steps. Physicians are expected to not only address the needs of the patient but to convert these needs in to a question thus allowing them to use research to find an appropriate answer or solution. Another disadvantage is having the resources that are needed to accurately find the answers to this question through approved and reliable research. This requires the physicians to be versed in the capability of performing time efficient research which is an added skill to the long list of requirements that it takes to become a practicing doctor. Information technology skills are equally important as the research that is conducted has to produce facts for results that show supporting evidence as opposed to the usual practice of the doctor providing there professional opinion about the issue. Excessive workloads present another serious concern for health professionals as conducting all of the research that is needed to form a good opinion in each case while the patient is waiting for results so in a matter of time it takes a doctor to usual look at something and use their vast amount of knowledge to form an opinion. When it comes to integrating the technology the only way to make this approach work properly would be to equip the staff with handheld devices and constant access to the internet and that brings another issue to the table the issue of cost.
The issues that arise with the introduction to EBP can be seemingly overwhelming considering that even the top issues create such a large region of concern. With all of these issues in mind it is just as important to consider why EBP might have a positive impact if incorporated into the existing system. For instance when a doctor has to rely on only his/her area of expertise in a diagnosis there is often the chance that the patient will have to be referred out to another physician who specializes in the specific area of the issue before they can even receive some sort of relief for the health concern that is plaguing them. By incorporating the research of many physicians during one visit this will not eliminate the need for the patient to need to see the other physician for further treatment but it will allow the immediate physician to prescribe an acceptable form of treatment catered to the individual concerns and care that will help with the condition until the patient can seek a more long term treatment option. Another benefit of EBP is that having this sort of database to assist in first hand diagnosis doctors will be able to educate the patient on what their needs for care are and why this is important. This establishes a relationship built on trust as the doctor has an instantaneous way to share the actual data with the patient making patients more likely to entrust the physician with their health concerns and follow instructions on taking medications that may be concerning to some (Ammend & Golden, 2011). Some research studies have even shown that the education that is provided to the patient that discusses there discharge instructions can have a significant impact on helping to reduce readmission and emergency room visits. A contrasting pro is that although physicians and medical staff showed concern for the fact that they have a large amount of patients and only a certain amount of time to effectively provide a solution, medical staff that has incorporating this new system has reported that they are more prone to use it because it is effective and time saving to be able to look the information up on their handheld portable devices.
Reliability of existing research. Normally research studies are focused on recognizing issues with the safety of patients and to show records indicating that incorporating EBP will result in improvements within the quality of patient care. This research was conducted then analyzing data that had been collected through studies of how EBP would cause a significant change for the better. When it comes to how practitioners will actually implement these changes there has been a lot less studies making it difficult for researchers to show people in the medical field the benefits of this change. To really see the difference evidence based practice can make in the lives of both patients and physician actual evidence can be produced by looking closer at nursing. Using research in medical practice was first seen by the work of Florence Nightingale in the 1900s. Though many of the nurses at the time did not follow her influence recently there have been changes in the medical field as the nurses of today have successfully put this practice into use in their profession. The evidence and research that the medical professionals use to make decisions based on this practice is gathered from studies that conducted research in each field of medical study to find the results needed. For instance the most helpful evidence to these physicians is gathered from random control trials usually on medications and there effects on the study group that is being tested. There is also evidence available through case reports, scientific research as well as expert opinions in each area of studies (Titler, 2015). When a doctor needs specifics about something that is rarely seen this useful research can mean the difference in finding a cure before it is too late for treatment. This can be especially useful in busy places like the emergency room that do not have a lot of time or resources to spend making a diagnosis. In Taiwan one study in particular was conducted which consisted of a survey that was sent out to eleven hospitals that were selected at random. The study used Linear and Logistic regression models to look for the different variables necessary for implementation of EBP. There were just over six thousand questionnaires collected at the end of the study for the researchers to form their opinion of the overall situation. In general the medical professionals who were the most familiar with EBP were doctors and pharmacy staff. The results of the study showed that the variables associated most with implementing EBP were training to understand it, college degree, the profession i.e. doctors and pharmacist as well as a positive understanding of the working model in practice (Weng et al., 2013)
Another study that was conducted included a survey for analysis as well and included questions about “awareness, attitudes, and beliefs, knowledge of, skills in, barriers to and implementation of EBP. Both the content and the validity of the people who were participants were monitored and approved by a research panel with many years of experience. When the study was completed the results indicated that doctors had the most experience with EBP and understanding of it and nurses fell dead last at 79.7 percent having some sort of understanding of EBP with the other entire medical professional in between. This study showed a strong need for nurses to have more encouragement and education concerning EBP for a successful process of integration into this part of the medical profession. All of the studies in the research (Weng et al., 2013) produced similar results showing a strong need for more education to the physicians and medical staff that are expected to adopt this new way of diagnosing patients for EBP to show the same success when put into use in the real world as it did in trials and research studies.
Physician’s outlook on implementing this approach: Physicians and medical professionals alike have contradicting opinions on implementing EBP into their current practices and procedures. This is understandable considering that changing things is difficult in any circumstance as we become comfortable with the norm. Although there is a lot of academic research suggesting that the change is necessary and even complimentary to the physicians, there are a lot of valid reasons that doctors bring to the table suggesting that the change would be extremely difficult for some and worries have surfaced that EBP could even be counterproductive if it is too time consuming. With the results indicating that moving this research into actual practice by physicians would produce a better environment for doctors and patients, there is only one solution to swaying the doctors and medical staff’s opinions in favor of this change. That is for there to be a plan that shows them how this will effectively be put into place so research is needed for implementation based more on evidence than just suggestions. To do this it is proposed that many different views are looked at and possibilities suggested that contain multiple solutions as what works for one doctor’s office may not be the same thing that is needed for the other. Another thing that research has identified as essential for implementation is that this will only be incorporated successfully if very sequential steps are followed that will act as a guideline for successful EBP in general.

Discussion

This paper explored the research and studies as well as the results of this research regarding evidence based practice. A lot of the publications that exists today regarding this are based on research that has not yet been used in practical applications in the medical field. There have been studies as well on the way that the medical staff feels and perceives such an implementation into their practice but to understand this one must look at all of the current discrepancies and limits to implicating this new research into actual practice with success (Weng et al., 2013).
Limitations. There are some limitations when attempting to implicate EBP, mostly in the acceptance of the medical staff that will be making the changes. Researchers may show excitement however some medical professionals who do not know much about EBP question the actual significance this could bring. When studies conducted showed that medical staff did have a good outlook concerning implementation there was concern when they did not know much about EBP. This suggests that there needs to be more education for health professionals specifically in this area for it to show the success that researchers depicted.
Technological Limitations. Technology is the main basis for EBP as it will require the most advanced technology including a special database full of medical information and fast internet speeds to ensure that physicians and staff have immediate and accurate access to information that is needed to make proper judgment calls. In the past using EBP would have proved quite time consuming in any medical situation however there are so many technological options for staff to choose from and more developments everyday proving that technology is not such a limiting factor in recent times as it may once have been. There will have to be sufficient knowledge and skills to use the devices properly and this is a limitation as most of the studies conducted showed that this was an area that proved to be a common barrier for most (Weng et al., 2013).

Conclusions and Future Study

In an attempt to gain a true understanding and conclusive suggestion about the research done on implementing evidence based practice in the medical fields it was important to take a look at what all of the research regarding this suggests by conducting a study to examine all of the various aspects of EBP. Research shows there is significant evidence for incorporating this practice today however there are some guideline that are important if this change is to show success. Physicians and medical staff are faced with constant and changing as well as multiplying demands in the hospitals every day. These demands include patients who are in both life threating and less serious situations but all of them are expecting the same thing, quality healthcare fast. They want a diagnosis that will not only help them seek help outside of the original hospital or doctor’s office but will relieve the discomfort they are in as soon as possible. Research indicates that EBP will allow doctors and all medical staff to incorporate technology and research into a reliable way of determining this ailment not only fast but with accountability because it will allow physicians a large databases of previous medical situations right at their fingertips. This not only makes diagnosis more accurate but also faster and allows medical staff to share the information in real time with their patients educating the patients of the issue and making them more aware of what needs to be done to resolve it. Medical staff is a bit Leary about making this kind of change however it has been suggested that this is because they are not very familiar with the technology required to implement EBP. There are limitations to implementation as well however surprisingly with all of the limitations there is a suggested solution leaving nothing left to do but take a leap and see if this new system and change will work for everyone like researchers suggest. All of the research in the end does seem to conclude that there is sufficient evidence available to support a reliable diagnosis when using evidence based practice.

References

Ammend, R., & Golden, A. (2011). Evidence Based Practice at the Point of Care (7th ed., p. 306). The Journal for Nurse Practitioners- JNP. Retrieved from http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Mentoring/Section%206/Evidence-based%20practice%20at%20the%20point%20of%20care.pdf
Sackett, D. (2015). Overview - Introduction to Evidence-Based Practice - LibGuides at Duke University Medical Center. Guides.mclibrary.duke.edu. Retrieved 3 January 2015, from http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
Schlosser, R. (2006). The Role of Systematic Reviews in Evidence-Based Practice, Research, and Development (1st ed., pp. 1-3). Southwest Educational Development Labratory. Retrieved from http://www.ktdrr.org/ktlibrary/articles_pubs/ncddrwork/focus/focus15/Focus15.pdf
Titler, M. (2015). Patient Safetey and quality: An evidence based handbook for nurses: Vol 1 (1st ed., pp. 1-5). Evidence based practice implemation. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/TitlerM_EEBPI.pdf
Weng, Y., Kuo, K., Yang, C., Lo, H., Chen, C., & Chiu, Y. (2013). Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings. Implementation Sci, 8(1), 112. doi:10.1186/1748-5908-8-112
White, B. (2015). Making Evidence-Based Medicine Doable in Everyday Practice - Family Practice Management. Aafp.org. Retrieved 3 January 2015, from http://www.aafp.org/fpm/2004/0200/p51.html