This series of articles illustrates many considerations relevant to the application of clinical practice guidelines (CPGs). This particular column describes the actions of a nurse practitioner (NP) striving to understand the foundations of recommendations that are based largely on expert opinion. Although application of CPGs does not generally require this degree of investigation, it is essential that providers understand the processes used to interpret the basis of recommendations, including the application of the basic statistical concepts, when making decisions about how recommendations apply to individual patient scenarios. Utilizing evidence-based practice when providing patient care requires a range of skills that allows the NP to locate appropriate research evidence, to develop an understanding of the statistics used in interpreting and reporting research, and to evaluate the effects of interventions on patient outcomes. The application of the key concepts of evidenced-based practice within the primary care setting is explored through a hypothetical patient scenario, which was created as the focal point for three articles that illustrate principles of evidence-based practice. The goal of this series of articles is to provide a basic understanding of evidence-based practice and its application in clinical practice. This article explores the use of interventions selected from CPGs and investigates the potential effects of recommended interventions on patient outcomes. Commonly encountered statistical concepts are reviewed, and examples of their application in interpreting and reporting research are demonstrated. The principles of relative risk, relative risk reduction, absolute risk reduction, and numbers needed to treat are described. This review provides the NP with some basic skills to determine both the quality and usefulness of research.
Current health care trends and pressures have strained clinical decision making and practice patterns of practitioners. Evidence-based practice has evolved in response to these trends. Evidence-based practice requires providers to be proficient in statistical analysis and critique of the evidence. This article uses a hypothetical patient's prognostic concerns to depict a practitioner's integration of the principles of evidence-based practice as she considers clinical practice guidelines, expert opinion, and a prognostic study relative to her patient's prognosis. Statistical measures evident in a prognostic study, such as absolute risk, baseline risk, relative risk, survival curves, and hazard ratios are defined.
The intention of the clinical practice guideline (CPG) column has included increasing readers' familiarity with the range of available evidence-based recommendations, while stimulating dialogue regarding application of those recommendations in practice. This column introduces the first article in a series of three written to describe a framework in which the principles of evidence-based practice can be applied. This article uses a clinical scenario to illustrate considerations relevant to the selection and application of a CPG in practice.
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