Chapter 21by Jennifer H. Bredemeyer and Ida M. Androwich

Translational Research: Generating Evidence for Practice

Objectives

• Clarify the differences between evidence based practice and translational research.

• Describe models for introducing research findings into practice.

• Identify barriers to research utilization in practice.

Key Terms Defined

• Agency for Health Care Research http://www.ahrq.gov/

• Context of Care • Evidence• Evidence Based Practice

Key Terms Defined

• IOWA Model• Meta-Analysis• National Guideline Clearinghouse

– http://www.guidelines.gov/• Open Access Initiative

Key Terms Defined

• Qualitative Study• Quantitative Study• Research Utilization• Research Validity

Key Terms Defined

• Translational Research

Introduction

• Evidential Knowledge to Clinical Practice • Evidence-Based Practice• Research Utilization• Translational Research • The Importance of Research

Introduction

• The need for evidence

• Randomized Control Trial

• What constitutes evidence?

Determining Validity• Research Must Be Valid • Evidential Hierarchy

1. Meta-analysis

2. Individual experimental studies3. Quasi-experimental studies 4. Non-experimental studies5. Program evaluations such as quality improvement projects 6. Opinions of experts

Clarification of Terms

• What is meta-analysis?• What is the benefit of qualitative

research?

Bridging the gap between research and practice

• Bridging the gap between research and practice• Barriers to the application of evidence-based

practice • An observational study performed by McKnight in

2006• How do nurses view the application of research?

The role of informatics

• The collaborative component of research• The importance of technology• The importance of an informatics

infrastructure• The integration of informatics and the

medical record

The role of informatics

• The Cochrane Collaboration – http://www.cochrane.org/

• Agency for Health Care Research– http://www.ahrq.gov/

• What is the mission of the AHRQ?

The role of informatics

• Why was the National Guideline Clearinghouse created?

• What is the NGC (http://www.guideline.gov/)

• What are the benefits of NGC website?• What resources are available for evidence-

based practices?

Developing evidence based practice guidelines

• Careful Analysis is Essential • Information Technology also Plays a Very

Important Role

Meta-analysis and Generation of knowledge

• What is the strength of the systematic review?

• What do systematic reviews achieve? • What methods do meta-analysis use?• What is meta-analysis?

Meta-analysis and Generation of knowledge

Steps of a meta-analysis are: 1. Defining the Problem 2. Establishing Study Eligibility 3. Identifying the Heterogeneity 4. Standardizing the Data 5. Sensitivity Testing

Meta-analysis and Generation of knowledge

• What is the criticism of meta-analysis?• How good is analysis?• Where is information on meta-anlaysis

available?

Meta-analysis and Generation of knowledge

• Where is open access available?• What are open access journals? • How do publishers of open access journals afford

to provide free access to readers?• What about the authors of open access journals?

Thought Provoking Questions1. Twelve hour shifts are problematic for patient and nurse

safety and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report which referred to studies as early as 1988 which discussed the negative affects of rotating shifts on intervention accuracy. Workers with 12 hour shifts realized more fatigue than workers on 8 hour shifts. In another study done in Turkey by Ilhan et al(Ilhan, Durukan, Aras, Turkcuoglu, & Aygun, 2006), factors relating to increased risk for injury were: age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units and working for more than eight hours. As a clinician reading these studies, what would your next step be?

Thought Provoking Questions2. The use of heparin versus saline to maintain the patency

of peripheral intravenous catheters has been addressed in research for many years. The American Society of Health System recently Pharmacists (ASHSP) published a position paper in January 2006 (American Journal of Health System Pharmacists, 2006) advocating their support of the use of 0.9% saline in the maintenance of peripheral catheters in non-pregnant adults. It seems surprising that their position paper references articles that advocate the use of saline over heparin dating from 1991. What do you feel are some of the barriers which would have caused this delay in implementation?