While evidence-based practice (EBP) has become an essential component of training in a wide range of healthcare professions, a textbook for beginning practitioners was largely missing. Howlett, Rogo, and Shelton authored Evidence-Based Practice for Health Professionals: An Interprofessional Approach to engage student audiences from rehabilitation, medicine, dentistry, nursing, pharmacy, and public health programs. The text was designed to help readers achieve two objectives: (1) to locate, interpret, evaluate, and apply research to the care of individual patients/consumers; and (2) to effectively communicate research results to consumers, colleagues, and other professionals. The authors’ emphasis is on the knowledge and skills needed to facilitate informed, evidence-based, and patient-centered healthcare decisions.
The text has two parts and 11 chapters. Part I, “Foundations of Evidence-Based Practice,” consists of six chapters. Chapter 1 defines and explains EBP; Chapter 2 provides an overview of research methods; Chapter 3 examines health communication; Chapter 4 illustrates the process of locating relevant evidence; and to conclude, Chapters 5 and 6 review basic descriptive and inferential statistics, respectively. Part II, “Applications of Evidence-Based Practice,” explores how EBP is implemented in different contexts. Chapter 7 introduces readers to epidemiology as it relates to EBP; subsequent chapters depict EBP in assessment and diagnosis (Chapter 8), treatment, examination of harm, and prevention (Chapter 9), and working with the pharmaceutical industry (Chapter 10). Finally, Chapter 11 synthesizes the process of implementation of EBP including detailed simulation of critical appraisal of examples from research studies.
In this text, the process of EBP is broken down into concrete steps, and a variety of tools to work through these steps are presented. For example, evaluation of research evidence to clinical questions is daunting for beginners. To guide this process, the authors present a systematic method in a chart to compare components of the clinical question with components as addressed in the study. Similarly, critical appraisal of trustworthiness of research may appear to be a formidable process to novices. The authors provide worksheets to use for appraising quantitative and qualitative studies composed of questions on various dimensions of research reports that contribute to their overall credibility. These focused steps can guide beginners in EBP in simulating the process of critical analysis of an experienced practitioner. Tools like these can play a vital role in the development of skills and judgment needed for evidence-based clinical decision making.
Due to the rapid pace of scientific and technological advancement, healthcare professionals are increasingly required to locate, appraise, and synthesize most up-to-date information in their daily practice, rather than solely rely on the previously acquired knowledge base. In addition to deciphering the procedure of EBP, this text introduces beginning clinicians to processes of healthcare provision that is based on critical thinking. The versatile tools, in combination with ample case studies dealing with an array of clinical conditions, render this text particularly suitable for experiential approach to training interprofessional teams composed of early career professionals. In conclusion, the text is a unique contribution to the clinical training in healthcare disciplines on multiple dimensions, including EBP and interprofessional care.
Review by: Naoko Yura Yasui, PhD, CRC; Assistant Professor, Department of Rehabilitation Studies, Alabama State University
Evidence-Based Practice for Health Professionals: An Interprofessional Approach
Howlett, B., Rogo, E. J., and Shelton, T. G.
Burlington, MA: Jones & Bartlett; 2014
394 pages; US$86.95
ISBN 9781449652777
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Friday, July 24, 2015
Book Review: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
Anne Fadiman, the author and narrator of The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Culture, shares the story of Lia Lee, a young Hmong girl with severe epilepsy, to demonstrate the detrimental impact of cultural misunderstanding between families and their doctors. This book alternates with one chapter focusing on Lia’s story and the next educating the reader on Hmong traditions and culture. Fadiman supports her argument by countlessly comparing traditional Hmong healing practices with American medicine, emphasizing the gap between the two and the need for improvement.
Fadiman’s story is targeted at culturally uninformed interdisciplinary members. She foils Lia’s doctors Neil Ernst and Peggy Philp with Jeanine Hilt, Lia’s social worker who is an “incredible patient advocate” (p. 114) for the Lee’s. When the Lee’s first bring Lia to the emergency room for her seizures, the hospital staff is unable to communicate with Foua and Nao Kao about their daughter’s illness. This miscommunication continues with each hospital visit. The lack of translators and individuals educated on Hmong traditions force the American doctors, hospital staff, and social services to view the Lee’s as uncooperative and noncompliant. With the growing Hmong community in Merced, California, the American doctors and hospital staff would have benefitted from learning about the Hmong culture, as this would allow them to understand how and why the Lee’s made some of their questionable decisions regarding Lia’s treatment. The tone expressed by Fadiman is objective and solemn; this allows both the Lee’s and the health professionals involved in Lia’s treatment to rationalize their annoyance, irritation, and frustration with each other to the reader. When Lia experiences her most severe seizure, she suffers brain damage. This tragedy ultimately brings the two parties closer, although it is too late. The closing of the book, aspiringly, fills the reader with hope.
Lia’s brain damage could have been preventable by removing cultural barriers and improving collaboration between families and interdisciplinary teams. Fadiman clearly argues that a mix of traditional healing with western medicine is ideal. She mentions a program called “Bridging the Gap,” which is a cross-cultural education program to train hospital staff to be culturally mindful of patients. The television segment on the Hmong cable channel regarding American hospitals and treatment was another attempt to reduce the cultural miscommunication in Merced. The Nationalities Service of Central California received a grant to integrate western mental health with traditional Hmong practices, and this was an outstanding success. The interaction between doctors and spiritual healers indicated that the interaction between these fields boosted patient morale.
Doctors alone are not enough to cure a patient, especially when culture is the barrier. Fadiman countlessly brings up the sad fact that Lia’s brain damage could have been prevented by communication and strengthened interactions between the doctors and hospital workers, social workers, translators, spiritual healers, and patients. This emotionally captivating book will motivate the reader from any background for advocating cultural awareness among interdisciplinary teams.
Review by: Shannon Sim, Concordia University of Edmonton
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
Anne Fadiman
New York: Noonday Press, 1998
341 pages, CA$12.29
ISBN 0374525641 9780374525644
Fadiman’s story is targeted at culturally uninformed interdisciplinary members. She foils Lia’s doctors Neil Ernst and Peggy Philp with Jeanine Hilt, Lia’s social worker who is an “incredible patient advocate” (p. 114) for the Lee’s. When the Lee’s first bring Lia to the emergency room for her seizures, the hospital staff is unable to communicate with Foua and Nao Kao about their daughter’s illness. This miscommunication continues with each hospital visit. The lack of translators and individuals educated on Hmong traditions force the American doctors, hospital staff, and social services to view the Lee’s as uncooperative and noncompliant. With the growing Hmong community in Merced, California, the American doctors and hospital staff would have benefitted from learning about the Hmong culture, as this would allow them to understand how and why the Lee’s made some of their questionable decisions regarding Lia’s treatment. The tone expressed by Fadiman is objective and solemn; this allows both the Lee’s and the health professionals involved in Lia’s treatment to rationalize their annoyance, irritation, and frustration with each other to the reader. When Lia experiences her most severe seizure, she suffers brain damage. This tragedy ultimately brings the two parties closer, although it is too late. The closing of the book, aspiringly, fills the reader with hope.
Lia’s brain damage could have been preventable by removing cultural barriers and improving collaboration between families and interdisciplinary teams. Fadiman clearly argues that a mix of traditional healing with western medicine is ideal. She mentions a program called “Bridging the Gap,” which is a cross-cultural education program to train hospital staff to be culturally mindful of patients. The television segment on the Hmong cable channel regarding American hospitals and treatment was another attempt to reduce the cultural miscommunication in Merced. The Nationalities Service of Central California received a grant to integrate western mental health with traditional Hmong practices, and this was an outstanding success. The interaction between doctors and spiritual healers indicated that the interaction between these fields boosted patient morale.
Doctors alone are not enough to cure a patient, especially when culture is the barrier. Fadiman countlessly brings up the sad fact that Lia’s brain damage could have been prevented by communication and strengthened interactions between the doctors and hospital workers, social workers, translators, spiritual healers, and patients. This emotionally captivating book will motivate the reader from any background for advocating cultural awareness among interdisciplinary teams.
Review by: Shannon Sim, Concordia University of Edmonton
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
Anne Fadiman
New York: Noonday Press, 1998
341 pages, CA$12.29
ISBN 0374525641 9780374525644
Sunday, July 12, 2015
Summary: Adherence to clinical guidelines in heart failure (HF)outpatients: Impact of an interprofessional HF team on evidence-basedmedication use
Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated.
Crissinger and colleagues sought to determine which provider type, between an interprofessional HF team, non-HF cardiologists and primary care physicians (PCP), most optimally manages HF medications and doses. A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist or PCP) at least twice within a 12-month period.
Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33% and 25% for the HF team, cardiologists and PCPs, respectively (p < 0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses.
The findings of this study support the use of specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.
Summary: E-Learning with virtual teammates: A novel approach tointerprofessional education
The Institute of Medicine identified interprofessional education (IPE) as a key innovation for achieving the triple aim of better care, better outcomes and reduced health care costs. Yet, a shortage of qualified faculty and difficulty with aligning learners’ schedules often prevent sustainable and scalable IPE.
A virtual IPE intervention was developed to circumvent these barriers and compared to a blended-learning IPE intervention. Djukic and colleagues recently used a pre-test and post-test design with two comparison interventions to test the effects of these IPE interventions on changes in teamwork knowledge, skills and attitudes. The interventions were delivered to pre-licensure learners at a large, metropolitan medical and a nursing school. The study used one-sample and independent-sample t-tests to analyze data from 220 learners who received the blended-learning intervention in 2011 and 540 learners who received the virtual learning intervention in 2012.
Interestingly, study results suggested the students in the blended-learning intervention did not significantly (p < 0.05) outperform the students in the virtual learning intervention for any of the measured outcomes, except for medical students’ attitudes around team value.
These findings support virtual IPE learning as an effective, scalable, and sustainable solution for imparting foundational teamwork knowledge in health profession students.
For more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1030068
Wednesday, July 8, 2015
Summary: Partnership to promote interprofessional education and practicefor population and public health informatics: A case study
Team-based healthcare delivery models, which emphasize care coordination, patient engagement, and utilization of health information technology, are emerging. To achieve these models, expertise in interprofessional education, collaborative practice across professions, and informatics is essential.
A recent case study by Rajamani and colleagues from informatics programs in the Academic Health Center (AHC) at the University of Minnesota and the Office of Health Information Technology (OHIT) at the Minnesota Department of Health presents an academic–practice partnership, which focuses on both interprofessionalism and informatics. Outcomes include the Minnesota Framework for Interprofessional Biomedical Health Informatics, comprising collaborative curriculum development, teaching and research, practicums to promote competencies, service to advance biomedical health informatics, and collaborative environments to facilitate a learning health system. Partnership success is due to interprofessional connections created with emphasis on informatics and to committed leadership across partners. A limitation of this collaboration is the need for formal agreements outlining resources and roles, which are vital for sustainability.
This partnership addresses a recommendation on the future of interprofessionalism: that both education and practice sectors be attuned to each other’s expectations and evolving trends. Success strategies and lessons learned from collaborations, such as that of the AHC-OHIT that promote both interprofessionalism and informatics, need to be shared.
Summary: Increasing medical students’ understanding of the role ofoccupational therapists
Understanding the roles and responsibilities of different healthcare professionals allows for collaborative care to occur.
A recent study by Roberts and Shamus evaluated a student-designed, case-based educational module about the roles and responsibilities of occupational therapists (OTs) designed to increase the knowledge of occupational therapy among medical students. The study used a quasi-experimental, pre-/post-test design.
Independent paired t-tests showed medical students’ mean score on the OT Awareness Education Module at post-test was significantly greater than their mean score at pre-test. Results demonstrated how using an evidence-based approach to design an educational strategy can increase the knowledge of one member of the healthcare team about the role of another within a short period.
This study documented an effective approach for educating future physicians about the roles and responsibilities of occupational therapy as they prepare to make decisions affecting patient care outcomes.
For more: http://informahealthcare.com/doi/abs/10.3109/13561820.2015.1034848
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