Evidence Based Practice Professional and Clinical Judgment

Question: Discuss about theEvidence Based Practicefor Professional and Clinical Judgment. Answer: It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014). There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanners model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016). Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013). The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013). The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013). The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014). The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference bet ween the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013). Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected. The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors. Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training t o the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014). Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19. Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group. It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received. Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016). My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research. References Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice.Willard and Spackmans occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412. Hall, H.R. and Roussel, L.A., 2016.Evidence-based practice. Jones Bartlett Publishers. Matthews, B. and Ross, L., 2014.Research methods. Pearson Higher Ed. McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial.BMj,346, p.f3030. Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors evaluation and development of new nurses clinical judgment.Nurse Education in Practice,19, pp.84-90. Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis.Journal of Marital and Family Therapy,39(1), pp.17-27. Panneerselvam, R., 2014.Research methodology. PHI Learning Pvt. Ltd..