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Samenvatting methoden en onderzoek 3: Evidence based practice
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Samenvatting methoden en onderzoek deel 3. Samengevat aan de hand van de cursus en powerpoints. Soms met aanvulling uit het handboek.
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1 DE ACHTERGROND VAN EVIDENCE BASED PRACTICE...................................................................................31.1 AANZET EN INTRODUCTIE TOT EVIDENCE BASED HANDELEN........................................................................................3
1.2 HIËRARCHIE IN STUDIEDESIGNS EN VERSCHILLENDE TYPES EVIDENCE............................................................................3
1.2.1 RCT...........................................................................................................................................................4
1.2.2 Cohort onderzoek....................................................................................................................................4
1.2.3 Patiënt (case)-control onderzoek............................................................................................................5
1.2.4 Dwars-doorsnede onderzoek..................................................................................................................6
1.2.5 Case reports.............................................................................................................................................6
1.2.6 Ecologische studies (staat niet in de piramide).......................................................................................6
1.3 WAT ZIJN REVIEWS – SYSTEMATISCHE REVIEWS – META-ANALYSES.............................................................................6
1.3.1 Definitie review.......................................................................................................................................6
1.3.2 De opbouw..............................................................................................................................................8
1.4 COCHRANE COLLABORATION..............................................................................................................................10
1.5 WAT ZIJN RICHTLIJNEN.....................................................................................................................................11
1.5.1 Definitie.................................................................................................................................................11
1.5.1.1 Richtlijn.......................................................................................................................................................... 11
1.5.1.2 Zorgstandaard................................................................................................................................................11
1.5.1.3 Protocol......................................................................................................................................................... 12
1.5.1.4 Zorgpad..........................................................................................................................................................12
1.5.2 Ontwikkelen richtlijn.............................................................................................................................13
1.5.3 Niveaus bewijskracht............................................................................................................................13
1.6 BASISKENNIS STATISTIEK BIJ MEDISCH ONDERZOEK.................................................................................................14
1.6.1 Descriptieve statistiek...........................................................................................................................14
1.6.1.1 CATEGORISCH................................................................................................................................................14
1.6.1.2 CONTINUE......................................................................................................................................................15
1.6.2 Descriptieve statistiek met 2 variabelen...............................................................................................16
1.6.3 Inferentiële statistiek.............................................................................................................................17
1.6.4 Statistische testen binnen inferentiële statistiek..................................................................................17
2 EVIDENCE BASED PRACTICE....................................................................................................................... 18
2.1 INLEIDING......................................................................................................................................................18
2.2 DE JUISTE VRAGEN STELLEN...............................................................................................................................18
2.3 ZOEKEN EN SELECTEREN VAN LITERATUUR............................................................................................................20
2.3.1 Databanken...........................................................................................................................................20
2.3.2 Van PICO naar zoekactie.......................................................................................................................21
2.3.3 Gebruik van Boolean operators en truncations....................................................................................21
2.3.4 Filters of limits toepassen......................................................................................................................22
2.3.5 Tips, details en zoekgeschiedenis..........................................................................................................22
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, 2.4 KRITISCH BEOORDELEN.....................................................................................................................................22
2.4.1 Beoordelen kwantitatief onderzoek......................................................................................................22
2.4.1.1 Validiteit en betrouwbaarheid.......................................................................................................................22
2.4.1.2 Belang van resultaten....................................................................................................................................23
2.4.1.3 Generaliseerbaarheid of toepasbaarheid bevindingen..................................................................................23
2.4.1.4 Diagnose........................................................................................................................................................23
2.4.1.5 Herhaling methoden en onderzoek 2............................................................................................................24
2.4.1.6 Bijwerkingen en etiologie, risico en prognose...............................................................................................25
1.1.1.1.1. Validiteit................................................................................................................................................26
1.1.1.1.2. Belang...................................................................................................................................................26
1.1.1.1.3. Toepasbaarheid....................................................................................................................................26
2.4.1.7 Interventie onderzoek...................................................................................................................................27
2.4.2 Beoordelen kwalitatief onderzoek........................................................................................................27
2.4.3 Beoordelen systematische reviews.......................................................................................................27
2.4.4 Beoordelen richtlijnen...........................................................................................................................28
2.5 CONCLUSIES OPSTELLEN....................................................................................................................................29
2.5.1 Conclusie diagnostische onderzoeksvraag............................................................................................29
2.5.2 Conclusie onderzoeksvraag naar bijwerkingen en etiologie (prognostisch onderzoek).......................29
2.5.3 Conclusie therapeutische onderzoeksvraag..........................................................................................29
2.6 TOEPASSEN OP INDIVIDUELE PATIËNT: SHARED DECISION MAKING.............................................................................29
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, 1 De achtergrond van Evidence based practice
1.1 Aanzet en introductie tot evidence based handelen
Integreren individuele klinische expertise met beste externe bewijsmateriaal dat vanuit
systematisch onderzoek beschikbaar is. Voorkeuren, wensen en verwachtingen patiënt
spelen rol bij besluitvorming
3 pijlers:
o Informatie uit bewijsmateriaal uit onderzoek
Kan steeds nieuwe evidence opduiken met nieuwe inzichten
o Klinische ervaring, inzicht en kennis zorgprofessional
Identificeren unieke gezondheidstoestand patiënt
o Toestand, voorkeur, ervaringen en verwachtingen patiënt
Essentieel om mee te integreren in klinische beslissing
EBP model = multidisciplinair overleg (shared decision making process)
o Onderzoek
o Afweging
o Adviseren
o Partnership
o Regie bij patiënt
EBP drempels
o Vaardigheden en bewustzijn
o Tijd
o Ondersteuning
o Werkplek
1.2 Hiërarchie in studiedesigns en verschillende types evidence
Mogelijke typen van informatie geordend naar mate van evidence:
1. Meta-analyses en systematische reviews
2. RCT
3. Cohort studie
4. Case-control studie
5. Case reports
6. Ideeën en opinies
7. Dier onderzoek
8. In vitro onderzoek
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