Evidence based practice
In this assignment you are asked to develop an answerable clinical question for a hypothetical patient and critically appraise the relevant research literature. This includes
Describing the patient’s case in a holistic manner;
Formulating an answerable clinical question;
Selecting evidence resources and executing a search strategy;
Describing the evidence summary;
Explaining how you would examine the evidence for validity, importance and applicability to your patient.
You are also required to analyse the use of EBP, and its limitations, as applicable to the chosen clinical problem and your study. If the chosen clinical problem is an existing gap in the literature, you are expected to explore why that is the case and whether EBP is likely to be/was of benefit.
An example patient is given below. The type of patient you select will depend upon your clinical experience and questions of relevance to your setting.
Betty is a 74 year old woman with a history of hypertension since the age of 40. She weighs 162 kg and stands at 170 cm tall. Betty has struggled with attempts to lose weight all her life and has long since given up on her attempts. She has remained active and relatively fit until the last 2 years.
Her hypertension was previously well controlled with metoprolol 100 mg bd but in the past 2 years has frequently been raised to over 160/90 on several occasions. In the last year she has had recurrent chest and left arm pain with no evidence of ischaemia found as each time she has had normal ECGs and troponin levels. In the past year she has also noticed more shortness of breath and wheezing. This has partially improved with inhaled beclomethasone diproprionate. On review you note that she is in atrial fibrillation. Recent blood tests show that her cholesterol is normal but her fasting blood sugar is 6.1. Her full blood picture, urea & electrolytes and liver function tests are normal.
Betty also has a history of pernicious anaemia and osteoarthritis. Betty is divorced and has a daughter aged 51 who also has hypertension. She is independent and has recently felt somewhat depressed because of her inability to do everything she would like to do at home without feeling tired and short of breath.
In this case an answerable question might relate to the role of warfarin in improving cardiovascular outcomes or the efficacy of various therapies in producing weight loss in a person who has failed previous attempts.
Your approach to the assignment will depend upon your role in the health team. Please consider the questions from this perspective. Note that you are not required to develop a management plan for all of the health issues in your selected patient, but to seek an answerable question to be answered in the context of your patient.

One of the overall aims of this unit is that you develop your understanding of EBP and what it involves. These first few modules have focused on discussing what Evidence Based Practice (EBP) actually is and why it is important that we use EBP to support clinical practice. Depending on your professional background and experience, these concepts may be completely new to you or you may have existing experience with them. There will no doubt be some of you who feel a little removed from the whole thing – particularly those whose work is very clinically orientated may find it more challenging to relate the theory to practice. Not everyone will be involved in developing answerable clinical questions, or appraising literature etc as part of their everyday work, but nonetheless it is important that as health care professionals, you can make a sound judgement on what is best for your patient/client based upon sound evidence rather than tradition and hearsay.

Those of you who have had research or clinical audit experience may be more familiar with EBP and also the challenges in supporting clinical practice when ‘the evidence’ is not strong. Is it that the evidence is fundamentally weak or is it just that not enough research has been carried out to provide a good evidence base? Consider for example pain management in the last days of life – it is very difficult to obtain ethics approval for studies with the dying and also difficult to recruit and follow up such patients – how then do we acquire a good evidence base for areas that are difficult to research? Either way hopefully you will have learned something new about EBP or the ways in which it can be utilised.

Some general advice regarding Assignment 1: the key to the first assignment is that you clearly articulate an answerable clinical question from your scenario, describe and execute an appropriate search strategy and show understanding of the process involved in searching for evidence, critically evaluate the evidence (ie don’t just describe it) and comment back to your scenario, and also include an exploration of the strengths and challenges in using EBP.
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