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Push Technology For How to find EBP resources easily! Methods for personalizing easy access of pertinent clinical evidence online Meghan Warren, PT, MPH, PhD Associate Professor Department of Physical Therapy and Athletic Training What is EBP? • Well EBP = Evidence Based Practice • But really…what does that mean? Evidence based practice Best Patient research preferences evidence Clinical experience EBP And why is EBP important? Sources of evidence Decision maker Purpose Patient values Patient/Caregivers Communication Education Negotiation Best research evidence Shared-informed decisions & OPTIMZED OUTCOMES Clinical expertise Evidence-based clinician If EBP is used to optimize clinical outcomes… • …then it is a GOOD thing, right? • …and important to use? • …and important to ‘keep up with?’ ▫ …which PTs do well? https://www.fsbpt.org PTs seem to think it is important However… Why not using EBP? Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83:786 – 805 Why not using EBP? Lack of time EBP skills USE OF EBP Access to evidence To address all 3….. …technology! A story...Once upon a time • PT working in a busy outpatient PT practice ▫ Treats primarily patients after TKA and other knee surgeries ▫ But every once in a while gets a patient with a different diagnosis…. A case • 74 y/o man; relatively healthy ▫ TKA in 1/11: rehabbed by you and patient was very pleased Able to get back to hiking and gardening without pain ▫ Gets diagnosed with COPD (chronic bronchitis) Long history of smoking, although quit in 2011 Pulmonologist tells him to ‘exercise’ • The patient and his wife remember how much you spoke about exercise and the importance ▫ So he calls to make an appointment with you… Uh Oh! • You remember learning something about exercise in pulmonary rehab ▫ But that was 6 years ago! ▫ But it was something about treadmill walking • Coincidentally, you were flipping through your colleague’s CSM program while waiting for a patient 1 day ▫ Noticed there were a bunch of titles about strength training in pulmonary disease You do not remember learning about this????? What do you do? A way to organize your ideas? Patient/Proble In patients with P chronic bronchitis m is strength training Intervention as effective as (Exposure)/Comparison I C aerobic exercise to improve functional Outcome capacity and quality of O life? And back to how technology fits into this… Developing a Technology Profile “select combination of technology resources used to support EBP” Fetters L, Tilson J. Evidence Based Physical Therapy. Philadelphia: FA Davis & Company; 2012. Components of an EBP Technology Profile 1. Pull information technology 1. Push information technology Ideally 1. Reference management system …but not too hard to achieve the ideal! What is push? What is pull? Pull PUSH • Retrieve information for a • Information that comes to you specific need on demand automatically • Actively search for information ▫ On a regular basis ▫ Using Google, Google Scholar, • May be a prompt for pull PubMed, etc technology • "pulling" the information to you Pull technology • PubMed: search engine for Medline ▫ http://www.ncbi.nlm.nih.gov/pubmed/ • Saved search with updates ▫ Turn a pull technology to a push technology! TRIP database: a pull technology • http://www.tripdatabase.com/ • Searches Medline, National Guidelines Clearinghouse, and many other EBP databases National Guidelines Clearinghouse (NGC) • http://guideline.gov/ • Initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services • Mission: provide health care providers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines ▫ Further dissemination, implementation, and use • Provides structured, standardized summaries containing information derived from guidelines Example of push set up • Using Yahoo… ▫ APTA: www.apta.org PT Journal: http://ptjournal.apta.org/?navID=10737423605 Examples • Journal Table of Contents: emailed automatically ▫ Can be set up easily with pretty much any journal you subscribe ▫ Podcasts downloaded automatically • Collection of journal articles ▫ Subscribe to an external organization • Google alert Examples of push technology • Journal Table of Contents: emailed automatically ▫ Can be set up easily with pretty much any journal you subscribe ▫ Podcasts downloaded automatically iTunes • Collection of journal articles ▫ Subscribe to an external organization http://www.evidenceinmotion.com/EvidenceExpress/EvidenceExpre ss.aspx • Google alert ▫ http://www.google.com/intl/en/about/products/index.html Differences between pull and push technologies Push Pull Objective Information capture Navigation User Passive Active Technology Always active Active only when used Best for Continuing knowledge One-time knowledge needed Urgent or time-dependent Conducting research information Detailed information Creating awareness of what can be pulled (notification) Main advantage Brings important issues to the Allows users to access user’s attention information at the point of need Main disadvantage Can overload users since they Requires time on the part of the do not control it user (to both master the technology and to deploy it) Got lots of research information… …what do you do with it? Reference management software Some options (although none free ) • Ref Works: http://refworks.com/ ▫ $100 for a single user • EndNote: http://endnote.com/ ▫ $250 for a single user • Bookends: http://sonnysoftware.com/ (Mac only) ▫ $99 for a single user ▫ $250 for up to 5 users • Reference Manager: http://www.refman.com/rmbuy.asp (Windows only) ▫ $250 for a single user …But talk to your ACCEs! Components of an EBP Technology Profile 1. Pull information technology 1. Push information technology Ideally 1. Reference management system …so we talked about each of these What about lack of time for EBP?!?! If you only have…. • 1 minute ▫ Write a clinical (PICO) question • 5 minutes ▫ Set up an RSS feed ▫ Conduct a search • 1 hour ▫ Read a study in depth ▫ Discuss a study with a colleague ▫ Watch an online tutorial about a new EBP technology ▫ Explore a new database Thank you! Questions? [email protected] .
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