From evidence-based to wisdom based creating value with justice

1. Evidence-Based Practice (EBP)
in Hand Surgery
Vaikunthan Rajaratnam

2. What is EBP?
• clinical expert opinion
• scientific evidence
• patient perspectives
WISDOM BASED PRACTICE
VALUE

3. Why bother?
• make informed evidence-based decisions
• provide high-quality services
• reflecting the interests, values, needs, and choices of individuals
• Provide value in health care

4. The EBP Process

6. Frame the clinical question
(PICO) approach
Population
Intervention
Comparison
Outcome

7. Search and Find Evidence
• Plan your search
• Decide on type of evidence needed
• Chose database to search
• Alternate source of evidence
• making your search broader
• search from similar or related populations, interventions, or outcomes
• alternative assessment, treatment, or service delivery option

8. Searching
• Develop a list of search terms
• using elements from PICO question
(If searching for traumatic brain injury, include "traumatic brain
injury", "TBI", and "acquired brain injury".)
• Set parameters for your search
• Boolean search , “AND” , “OR” etc
• What type of evidence
• Systematic reviews
• RCT
• clinical practice guidelines
• evidence-based or consensus-based.

9. Finding
• PubMed, MEDLINE, EMBASE
• Google Scholar
• The Cochrane Library – Cochrane Central Register of Controlled Trials,
ARCHIE
• PSYCHInfo - behavioural science and mental health
• CINAHL - Nursing and Allied Health Literature
• Web of Science Core Collection
• Open Grey

10. Assess the Evidence
• determine the relevance to your question
• appraise the validity and trustworthiness
• review the results and conclusions
• Synthesized research such as systematic reviews, meta-analyses, and
guidelines usually include quality and/or bias assessment of the included
studies
• statistical information about the outcomes such as confidence intervals or
effect sizes
• information (strong) enough to help me make a clinical decision
• generalize the results to your practice

11. Make Clinical Decision
• critical judgment to evaluate the
strength and methodological rigor
of the evidence
• interpret it in consideration of the
patients concerns and
preferences
Define your
clinical
question
Extrapolate
applicable
information
Consider
your clinical
expertise
and of others
Incorporate
your patients
needs
Develop an
assessment
or treatment
plan
Evaluate
your clinical
decision
D.E.C.I.D.E.