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Where Have You Been?

Up to this point in your educational journey, you have probably been focused on learning the scientific and clinical fundamentals of your discipline and profession. You have probably learned clinical and/or laboratory techniques, many of which are directly derived from scientific studies. It is these fundamentals and techniques derived from science that lead to what we know as the "current state of the art." You should have the sense that science evolves, and as it evolves, the methods used in the practice setting should evolve to reflect the new state of the art. Unfortunately for the busy practitioner, keeping up with the science can be a challenge. Despite this challenge, there are methods to help you stay on the cutting edge of your profession, and that is what this textbook is about.

Where Are You Going?

Assuming at this stage in your professional preparation that you may not have been introduced to evidence-based practice, your first step is to understand what constitutes evidence. Evidence is the keystone to state-of-the-art practice, and it comes in many different forms. Some forms of evidence are very good and can be trusted; other forms are less trustworthy and must be considered with less confidence. Thus, you must be able to recognize and understand the different forms of evidence and the ways in which those forms of evidence are rated in terms of strength. You must also recognize that there is no uniform system for evaluating evidence, and this realization makes your judgment an important part of the process.

To apply the available science to your profession, several steps are necessary. First, you must recognize that you have a clinical or practice question that needs answering. Second, you must ask your question properly. Third, you must find the information needed to answer the question. Fourth, you must correctly interpret the information. Fifth, you must apply what you learned to your client or patient. Finally, you must assess whether your application of what you learned (e.g., a new treatment or training technique) worked. This process may sound daunting, but it is not, as long as it is treated as a systematic process.

Learning Outcomes

After reading this chapter, you should be able to answer these questions:

  1. What is evidence-based practice?

  2. What are levels of evidence?

  3. How is evidence-based practice used in professional decision-making?

  4. What is an evidence pyramid?

  5. What types of evidence are better than others?


Key Terms

  • Critically appraised paper (CAP)

  • Critically appraised topic (CAT)

  • Disease-oriented evidence (DOE)

  • Evidence-based medicine (EBM)

  • Evidence-based practice (EBP)

  • Levels of evidence

  • Patient-oriented evidence

  • Secondary study

  • Strength of recommendation

  • Systematic review (SR)


Evidence-based practice (EBP) can be defined ...

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