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Evidence Based Practice for Health Professionals 1st
Edition Bernadette Howlett Digital Instant Download
Author(s): Bernadette Howlett, Ellen Rogo, Teresa Gabiola Shelton
ISBN(s): 1449652778
Edition: 1
File Details: PDF, 31.08 MB
Year: 2013
Language: english
 Bemadette Howlett
: | ae ne Ellen J.Rogo
Uitte ~ Teresa Gabiola Shelton
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EVIDENCE-BASED
PRACTICE FOR
HEALTH PROFESSIONALS
An Interprofessional Approach

parnigdete Howlett, PhD.ce

Director of Research
Bingham Memorial Hospital
Affiliate Faculty Member
Institute of Rural Health
Idaho State University

Ellen J. Rogo, RDH, PhD

Associate Professor
Department of Dental Hygiene
Idaho State University

Teresa Gabiola Shelton, MPAS, PA-C

Physician Assistant
Cache Valley, Utah
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Library of Congress Cataloging-in-Publication Data

Howlett, Bernadette
Evidence-based practice for health professionals : an interprofessional approach / by Bernadette Howlett, Ellen J.
Rogo, and Teresa Gabiola Shelton.
Qe Can
Includes bibliographical references and index.
ISBN 978-1-4496-1163-7—ISBN 1-4496-1163-X
I. Rogo, Ellen J. II. Shelton, Teresa Gabiola. Ill. Title.
[DNLM: 1. Evidence-Based Practice. 2. Health Personnel. 3. Interprofessional Relations. 4. Patient Care
Team. WB 102.5]

362.1—dc23
2012035123

6048
Printed in the United States of America
Ve MS WVSy Ns SIO) AS Tey 7 ey Sy 2
 Contents

BERANE cienca Ges sae KOR Rs ONE Le a 8y dub eto OM ORE SOD ft ARO MORMNE pi sere ek,Renee vil
ACKNOWLEDGEMENTS 22% U2FPs. PUe ere PO OVS? PLOTS 22 Me BR, oe Aes, si eens xi
BBO tTTHE AUTHORS toric ts: cece ne hee Oe oe PERE tke ene ene nee aren aren eee xiii
RN PRIBUTORS:. «cn cee re ce cc te tee boas alee 40k 1 Scns OO Ie, coe ee Be XV
BRE WE WER orion y doe hE signe en bine Sete be no meee iten Son TER A ee ee ee nce an xvii

PART | Foundations-of. Evidence-Based! Practicesx22 sui uims set Se eke MRR «0 3 one ae ee |
Chapter 1 What Evidence-Based Practice Is and Why It Matters ............... 3)
Bernadette Howlett, PhD
IfGfOGUCHON aan2). Mage as ae oe ae ae eR A eee Re eee 5
Learning Strategies for Success in Health Professional Education Programs ..... i
Tihev Case: Or MinMartinG Zio. n= sie. areqcae see eee oe ge 8
OMEN QMON IENOleMNCeleeiselel RINGS’ 5A a See Rese ae bcadoadbedsanoeasrs g
CASS UGE Witoias ROL VISSol COMNEZINOWESNONE, m2 pu wayackesaa¢soaceoaea3) 23
CNG UCR SUVA yt cna cyrdicet ochtes)dale Sek cee eee en Bil
BRETCISC Mod. Guactds aha flip scat Be ae Moeteee one Pee na ea 28
Chapter2- -Hoatlaoeare-hesearch Wethods .. 2-5. aa. Se pees oe 54
Bernadette Howlett, PhD
IMirOCWCHOMNRs Se Ais 45-225. ole am ae cae, 6 Fe ee ere 31
Research ParaGioims: 5 Ao 408.4 Apa 83 SS, ole ee ea eee eee yee 32
Case Study Mire Martinez Iasi lins ©finial aes war-esnare n ener e nner ft ee eer 49
Chapter SUMUMALY Seay ih cic es Vee ee ey ene ce, poner 5
Chapter 3* Health Cormmunication Ss: 20%) eee eae eee ee eas Do
EllenJ.Rogo, PhD
IA hOGU Ct OMtemmemes emt ie corer eres eater ete steht tue eee ewe een eaten er a 55
HealtimCommuUnicanion Wunineunelerocess of Patient Care. enti aitner 56
Patient EducationoMaterials’.”. . eka pew tomee afer epee Melee iy enero A 68
Natronallealth EG UcaiOnn 4.55 Stag iad. Stes ners eee ne sane aa ue WS
alezildg (Cormnminieelioau ioe Cojamaniviqiny MOWICEOM -. 22a ncn coo ubnoconvce 74
HealthmGommnumicanton Using rite Comnaun(Caviontew «sss ae ener we 79
Interprofessional Communication During Patient and
COsaaiam
iat ACivauentetel JNOUN AINE) 5 3 5:o> acoce Fa loli obdicyotiions senda a olorokae out 81
iv | Contents

CASEVSUUGV AH eet curticen ojo otke win be Geecci eka? CG gin btoft ste oes te a ec aa 81
CASS StU Wiens a warttie MrmAcdatee «at wietetarta a.eins ona tet, aie eae een eer 82
GASCHSLUCVASUMUMNAME Sane giemi e eka emis serie or(rien batcltent = 2 creciietem Neeeee nanan 82
Chapter 4 Lotating RelevantEVidenice: 2. G5... ee a eke eae om So 87
EllenJ.Rogo, PhD
[SquAKOYeIDCiKehale ciate | hearin cn eee e eta er Soe mere tn tras clot OR 87
JP)evanaubaye! SiKefOS) Wo) IMofechite! INE EXWehaln ENaMOKNele! Se oe oe odo eo esa et sae 88
SSAC AVIAN lope HN POKEsaNCLE NADAS). een we bee et ew oe eo ae 95
ENGINES: IBBICIO! ION OAC AVE INSISOWIGCES. 2 non ke Gear on we ooo yada 100
IRENE! SMC MNSivehSGES — oon pwn oe dein oo HORA rg Hk Gop oa et oe 110
OyasenibZiae! REMAIN IEMIEEINCE occa n od teh pe OF aH ORNS Duc soe nec ec mse 110
COMClUGINGATINOUCIS tere ns houses a se een eenA get hastiki ai ese eee eee are ite
Case Study #1: PPAARE Question and Literature Search
OMS Moning GessatlomyPenOGUCtS mma) atte s | niet: aa ee ee 112
Case Study #2: PPAARE Question and Literature Search on Sleep Apnea .... . 114
Case Study SUMMARIES 4a ane. see keen ee ne OS er 114
Chapter 5 SDeSCripLIVenslaustiCS aa. osc bmadh tg irksyeke © © axis noah a ea 121
Bernadette Howlett, PhD
INCROGUCHON SMart recite od Te iG cd Stans ne Ak eee Cen 121
Basle StalisticsiBackSrouncannoOwledSener Oc anlar nen tnt tnt eninnentere ree 121
Daca IVAOSS WM IPO SINISE INOSSEEICI oc cee sue ana i) dao ee ota 126
DSS CRUE SCALIS TIC Cane Wae tote ia eon ne, Cea oe ee doa aes A ds Oe 151
WiSUEM IREESSMZWOMS OF IDEN ooo bow oc ne oe eo ant ee ca ey te egw Se)
GNAO TER SUC Vea amen or oee eet Ren at Cae cen hercnpets Aske en en ee 147
Answers to Basic Statistics Background Knowledge Probe................. 149
Chapter me eEteniUal GtantSliCs 20 Weta ieeieekn trate Met: 6 Coed oak ics es ay, eee 15]
Bernadette Howlett, PhD
ItrOGUCHION SEteatime catty ent. Gee actee, |< 5a a aeticats cic emo Ai. mae eee iil
NMS C MCE INSSSSINC ANIFROCESS con aa oa eaGoe uc aso ney coder ewebuanneca- key
RavaimetnCanciNonparanneinicrotausnicall leStsen siti tilts iii 154
BOON cr mee gta ns oe eGR RRs a a, Kael iis amy a 2s > yg ee 55)
Alp lan(Probal ol hy) arama. ercren ar ee sass PY.s ¢.cass. mac.2 ee eae eee 163
SSH STAUISUICS Meese emmes Mor tht ee cect oe aed cao eee See ee Ne eee kee
WSR SEA VeVID(out rs cin sear eerie ae EUR, RRR St nar RM LR eds rnnnFat INS
WOmbGence Inver VallSueme tas trees eee ar en eee ae 2, oi ae an ene 168
IierentialtStavistics amet ta! cea ee nee ee ee ae en rr 169
Rellability-and VAleitycs, <5, iseaneee Ger crea el hk. 0 eee Way
Chapter Suna yeece we a eete xc eee ee heais make ee Ap. 5. ee IS
EMOTOISOCSia co cyt nic oe xr mee taae et ett Ree hoard arcsMas co NS 180
ATISINETSIEOJE NET CISCS: tums, Mee eater ea nae ae a ee 184

PART II Applications of Evidence-Based Practices: seer eine eer nines. (mete oetn smn 185
Chapter7 Epidemiologwin Bvidence-Basedietacticeu mn. faa.) ee ane 193
Gloria A. Jones Taylor, DSN, RN; BarbaraJ. Blake, PhD, RN, ACRN;
and D. Dennis Flores, BSN, ACRN
IMVtrOGUCEIOLY, 5. aie ces ea «ce I ea ra OS:
History of EpIGemilologyy. , . eee merce aera neces ce ae ee ee 19S
Important Epidemiological Comee Oisyase aan tens ae OS
 Contents |v

Disease Occurrerite.....1.. Ree Made Leelee. wien eee 196

Appilsationsof Epidemiology . .... ticcanxenb igh et os ca es Wi
Sociocultural Considerations... us... ved ee OR oe po 198
Geography ANA DSMOgP*ra ony ons: cena cacao os Ne om ao ons oe 198
incidence snd Prevalencé. wi. i. w ca 0 RL ete ete o.oo cts keys)
ASK Factors and SCreeniny 0. scoravs wis SERIE ses oie fg os 200
Foidemiclogy Biostatistles... os. accy anus spe v4 SUA Seo ele yee oe 201
DUUIGICS Sf PFOPTIOSS oy ds ko, s ecsics, tc ge en RE yo ce oe Zi
Locating Epidemiological Informationwirj4 22 cae Ales. 3. - ee 216
Critiquing Epidemiological Researchinn, . « seereeeneremeen rene) etre ANGE
CPBDICT SUTRIMEIY ooo en a ck toad bmn 4 cee, SR ce ect ene ANS
FRRETCISCS oa sace cutis oct tyas ag TREN SERN, QDR See heer tone pe 218
AISWENS TO EREMCISES a 5.4 dug ous ah ah) Ae Re RS 2 ne tare eee 221

Chapter 8 Evidence-Based Practice in Assessment and Diagnosis ............ ES,

Bernadette Howlett, PhD
IEPOCMORT OR weve ses afew a Moet ane oy = 4) ee ee ee ee De)
Types ofr Diagnostic Procedutiesiequd pega sl. GR. Soap eo Ae Dow
Diagnose Tool Selection) actors ages: & arate ee ween arte es tere 232
Diagnostic Guidelines, Algorithms, and Standards of Care................. 255
Diagnostic BiostatisticsaAmaAct ar ck well et Cre Ieewainges 10 0 a nae vee Zo)
Chapten SuUmmmaryite eis Oris MASE aah 5 ree es re eee 246
EXGICISES I yee BAD Sian bs She al Se en ria a ee ee 246
ATSWELS TOVEXEKCISCS Ee Ais el Sete) Lia cee Se ae ae es eee 247

Chapter 9 Evidence-Based Practice in Treatment, Harm, and Prevention....... 249

Bernadette Howlett, PhD
IMEROGUCTION. Sfx ate cmee¢ ee Gee acs 6 Sipe up a ee ee ae 249
ireatmentiReseanchy cocoate erate See a ae ne 250
MMEAMIMENE SELECUOM A ena. ee gece ae nee ae 251
TheatmenvAlgonithinasranc: Expert GUI C)INCS sare. re eee er nenenre 262
SCUCLES OMELARTI tice Sos oe 5c en ee ees er ee 266
SLUGIESHOL PREVIOMA tates: c.6%. seca aricsomaces) leyRata a ES ear Teen 268
BIOStAlISHCSuiMN IneAlmenl ci alinbyeliCelaG esVet©.)arin n iran eee nee 270
Chapters UNIIN aT meee ae <u eo eee ee a Oe
JERGSIN GIN Ie OUR 5 Gere ee, eo ae ee ete COU RM sentence args GSEs Ge Ai Ae bine <De 276
AMS WEES COME KENCISES oe a epost 5 Seether Eau aie ce eae 280

Chapter 10 Evidence-Based Practice and Pharmaceutical Information.......... PASS)

Teresa Shelton, MPAS, PA-C and Bernadette Howlett, PhD
IFqUBiaOXG
[0(G/ SOG 8 Anata ine on Ss I care RE te lA ct iat once OE nat Sie Sloface: tio fla. aioe 283
MAE IPI Lineal Sates: INGORESAMGWIWS oc ocoratacapacscaesuvuseoue 287
Mne COS? Or PaeininekeswinilcaiseCehal WES eI! che ce soe nannna se 291
Lips-orkowste-UsecYourRSR Wisely nc sais. «ns er ae + aioe Sone eee 293
SOMETIMES GO. IVEGC. BOR... taaaeen deren tng Girara yin suciees Kae ane ee 294
PeriOmmini@alimiely IROSSALCIY § <5 Apegeee penreeets Rie e 5 ec ere Ra GED aa 2048
DRACO
LEO MAUI eSWehd SWIM Smead on mon wg ao Sooo oy a load doe 295
SEVGLETRIS (ee eR ee eae cee a a een ae eH ae SN 296
CTA De ieSCIGA Yi he sitie GR ok ech eeiaas Gin ayalene ude ONT Rccna ans PRG Padre cos 299
EEXCUCIS CMR Rt NEn EEIeee ecco ts ue baa me em CETERA med, em eh, ce yt 300
vi | Contents

Appendix, SuperStatin Package INsert. 2... . Wve; ira! 2 enemas 7 vain aneieee 303
MESS MONE! NMC WAMENBONG woh cay Ghtho none G neta hae on fa ao bee 303
SN NEN iad chagile tele)(61s) A Ree ALLSUn La ciclo kka soem hr cer 303
CHAM CAS MULES ey aca aeatncwinas a Me EUROS. PROD AIROO UE x Gee he meres 304
MNaKelisehavaygts clavel WISZNCle’. Armenian cotkb hhh ein Molson tear Oba oan eZ 5305
GCOMGPAIMCICARIOR Se aceaye uf tic gh eames Matte Aovteee atten PIMP Rao cretour enc earsoca 305
PLECAUUIOMS ieee pentwe Artest aac aeoad eee, Sate SUM tan, 5.stan ag ume eae Rte 306
Ue MCE raCuOM Garver. mecca te cued acta Mien amen bee em EE. oe eure gr na caiemea ae 306
WSSU SOE CIIEHPODUIAGIONSHA ct en ramers alate ore, GTRENOR a ot citer ee eee 307
POVELSEREACUOUG amen fees ciao, PO ROR IRIEL | cd moat teem wey 307
OVERCOSACE eo are enter Atl aecrty Sart ds5,5 Se ee NL cP OE hoc, Ghee ere eg 307
DOSES Nel ANevTava ZINGIGI Ae Hee oo ceoeeiede eugene Gn laniwunl ewe n © ea aoe: 308
PON VIODIGG mere femme Bis Sin a hd ty eth aR SAIS. > tess eee eee ae 308
Chapter 11 Implementation and Evaluation in Evidence-Based Practice ........ 309
EllenJ.Rogo, PhD
MUO CUCUIC Ie rte mer tte ih ierMchame lai ove & eave @ OIRO, oe ohare pacha 309
Appraise the Irustworthiness of Quantitative Evidente #74... .... -; 255. sae 310
Cininicall Ajojoaisell Oi @ Olueniisinwe Swe, ooo. onaocmanspoeseaceayacoes- 313
SUMUICMUIE Oni Ai OQiveermvimaine INCSOaitel a INGOT . oo oc acl ee ene ree cee ee Sif
SWSUSMMEINC INEWIEWS GING! WISIBE/NIEINSES. co oc uancwpacwpeeser coe c esas 324
Comparison of Quantitative and Qualitative Research.................... 326
Ap ORalserine sMusnVonininess Of OUalitalivie EVidemCems mae = lenis ern SPATE
CribcalAnalysis Of a Qualitanive Studyo mre verte, ee Gateneet . eas Seen oa oee 328
lhanyakerameimiannion eral WRNWEIIOM, 2.50.4 ec 0c ec oe ee pe eee es 557,
CHAD ESRPSUMO TEVANY strrea: hah tN Aen ome eat hl Be Slag as SE,
EMEUCISCH Mees reas en at aer eRe en Beitr re nace. Cy Est ace aye Ree 340
FAISWICTSRUOas NCHC|S Callumurars rar ye ioe: aah Batas ter hives ic tes aa ee moe Dan
KCN CISC 2 toh. ern ee peer matter Sindy get here is ee bce, 3s ee ee 352
AUIS W CL SUUO NEKO LCISChZearwee. cr Rep taster isecte Tecate! cece: rate Atom Re Ie Sey

NER ee ance tanta ats eH Ey Oya tectreeao Sicily Ocavaly CeO Ieee foo ke See ee 357
 Preface

The concept for this book was born of the need for a One of the most frequent encounters health-
text to accompany a course in evidence-based medi- care providers experience with healthcare-related
cine and biostatistics. These topics are taught early in evidence is through the pharmaceutical sales
many health professional training programs across pitch. This textbook gives readers the knowledge
the country and around the world. Although useful and tools to make self-informed, evidence-based
and informative resources are available on these top- decisions and to communicate effectively with
ics, many of them are geared toward experienced professionals in the pharmaceutical and other
clinicians or designed to prepare students to perform healthcare-related industries.The book also reviews
biomedical research. The content and organization common biomedical research and statistics termi-
of this book emerged and solidified over years of nology. A glossary of terms is also included.
teaching physician assistant, public health, nursing,
and dental hygiene students.
OBJECTIVES AND THE NEED
This entry-level textbook for health professional
FOR THIS TEXT
students explores the basic concepts of evidence-
based practice with a clinical emphasis. The text Evidence-based practice (EBP) is a powerful tool
utilizes cases and examples derived from primary for healthcare providers. This book is designed
care. A pragmatic strategy is employed in this to help readers achieve two objectives related to
book, teaching the skills needed to access, inter- EBP: (1) to locate, interpret, evaluate, and apply
pret, evaluate, and apply evidence to interpro- research to the care of individual patients and
fessional, patient-centered healthcare decisions. (2) to communicate effectively about research
Practice exercises are included to provide applied to patients, colleagues, and other professionals.
learning experiences. These activities engage stu- Many books and resources are available to help
dents in communication about evidence-based practitioners understand the array of sophisticated
practice with other health professionals, patients, concepts involved with EBP. Too often, however,
families, and professionals in related fields, includ- these resources focus on statistics and research,
ing pharmaceutical representatives. emphasizing how to design and conduct clinical

Vii
viii | Preface

studies. Although these skills are important for re- osteopathic medicine, physician assistant studies,
searchers, they are less relevant for healthcare stu- dental hygiene, and nursing require the teaching
dents and educational programs whose interests of EBP. Here are a few examples of accreditation
focus on quality clinical practice. standards related to EBP and evidence-based
Other EBP resources with a more clinical nursing.
emphasis have been written outside of the United The Liaison Committee on Medical Education
States. The concepts, language, and examples in (LCME) is the national accrediting authority
these texts do not fit with the healthcare system for medical education programs leading to the
in the United States. Lastly, other books on EBP MD degree in the United States and Canada. Its
remain highly abstract, offering no applied learn- education standard number 6 states:
ing experiences. This textbook provides mean-
The curriculum ofamedical education program must
ingful learning activities through communications
incorporate the fundamental principles of medicine
such as writing a letter to an insurance company,
and its underlying scientific concepts; allow medical
explaining the evidence regarding treatment to a
students to acquire skills of critical judgment based
patient, selecting a diagnostic tool, and designing on evidence and experience; and develop medical
community-based educational materials. These students’ ability to use principles and skills wisely in
brief applied-learning experiences, along with solving problems of health and disease. (www.lcme
clinical case studies, help students bridge the gap .org/functions20 1Ojun.pdf)
from the abstract concepts of research, statis-
tics, and technical jargon to the concrete skills of Predoctoral osteopathic schools of medicine
healthcare decision making and communications. are accredited by The American Osteopathic
Association’s Commission on Osteopathic College
Accreditation, (COCA)... The,core..competencies
INTENDED AUDIENCE of the COCA state:
This book was developed for teaching EBP to college At minimum, a graduate must be able to: (1)
students who have a basic science and Statistics Demonstrate basic knowledge of osteopathic phi-
background. We have written with medical, dental, losophy and practice and osteopathic manipulative
physician assistant, nursing, dental hygiene, phar- treatment; and, (2) Demonstrate medical knowl-
macy, rehabilitative professions, and public health edge through one or more of the following: passing
programs in mind. This textbook is intended to be of course tests, standardized tests of the NBOME,
incorporated into the larger curriculum of entry- post-core rotation tests, research activities, pre-
level training programs. It is designed to accom- sentations, and participation in directed read-
pany a semester-long course in EBP. We presume ing programs and/or journal clubs; and/or other
evidence-based medical activities. (www.do-online
the readers of this book also have a set of primary
.org/pdf/SB03-Standards_of_Accreditation
textbooks and other references appropriate for their
_July%201,%202010.pdf)
training programs.
The Commission on Collegiate Nursing Education
ACCREDITATION AND (CCNE) accredits nursing programs. The CCNE’s

PROFESSIONAL STANDARDS standards call for nursing programs to incorporate

guidelines from the AACN (American Association
Satisfaction of accreditation standards is just one of Critical-Care Nurses). The AACN includes a host
reason for programs to teach EBP. It was also one of of expectations related to evidence-based nurs-
the reasons this book was written. For example, ac- ing, which are too lengthy for purposes of this
crediting bodies for schools of allopathic medicine, discussion. However, we include one of the AACN
 Preface | ix

statements here regarding baccalaureate nursing Physician assistant (PA) programs are accred-
education: ited by the Accreditation Review Commission on
Professional nursing practice is grounded in the Education for the Pyeician Assistant (ARC-PA)
translation of current evidence into practice. Regarding the PA curriculum, the most recent
Scholarship
for the baccalaureate graduate involves ARC-PA standards state:
identification of practice issues; appraisal and in- The curriculum establishes a strong foundation
tegration of evidence; and evaluation of outcomes. in health information technology and evidence-
As practitioners at the point of care, baccalaureate based medicine and emphasizes the importance of
nurses are uniquely positioned to monitor patient remaining current with the changing nature of clini-
outcomes and identify practice issues. Evidence- cal practice.
based practice models provide a systematic
process for the evaluation and application of sci- The ARC-PA holds PA programs to the following
entific evidence surrounding practice issues... . standard:
Dissemination is a critical element of scholarly prac-
The program curriculum must include instruction to
tice; baccalaureate graduates are prepared to share
prepare students to search, interpret and evaluate
evidence of best practices with the interprofessional
the medical literature, including its application to
team. (www.aacn.nche.edu)
individualized patient care. (www.arc-pa.org)
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 Acknowledgements

The three lead authors would like to thank all of the grateful to the students who have taken my EBP
people who contributed to this text, both directly courses—they are the reason I wanted to write this
and indirectly. We want to thank our contributing book. I wish to acknowledge Teri Peterson, the stat-
authors Gloria A. Jones Taylor, DSN, RN; Barbara istician for the Division of Health Sciences at Idaho
J. Blake, PhD, RN, ACRN; and D. Dennis Flores, State University. Through my work with Teri on
BSN, ACRN. countless research projects over the years | gained
It took 3 years to fully realize this book, and 14 a deep understanding of research and appreciation
years of education for this project. As such, my for the importance of a team approach to research.
husband, Richard, and my sons, Jacob and Calvin, | want to thank Kate Erickson, Rebecca Hall, Jessica
have committed as much of their lives to this book Fullmer, and Kathy Evans. They are exceptional stu-
as did |. The writing of this book was, in some dents, researchers, and scholars from Idaho State
ways, similar to competing in a professional car University who worked closely with me throughout
race. If a racecar driver alone tried to compete, he the process of developing this book. I wish to thank
or she could not get past the starting line. The car the teachers and staff at Holy Spirit Catholic School,
and the race require a team. My team included my in Pocatello, ID, whose demonstration of outstand-
co-authors, my immediate and extended family, ing education and steadfast support of my family
my friends, many of my colleagues, my students, has been a constant inspiration to me. | am sorry
and the teachers whose classes | took during my I cannot identify by name everyone who has been
education. Ellen Rogo has been a colleague, men- by my side throughout this process. | hope you all
tor, and friend for many years. I wish to thank her know how very grateful I am.
for everything she has taught me. Teresa Shelton Bernadette Howlett, PhD
was once a student who took an EBP course from
me and has since become both a friend and valued Life for me has been a journey surrounded by in-
colleague. My family members were unwavering in dividuals who have loved and supported me in my
their confidence in me throughout this project, as professional pursuits. During my younger years, my
were my colleagues and students. I will be forever parents, Audrey and James Spangler, my brother,

xi
xii | Acknowledgements

Jim, and my grandparents provided unconditional on the relevance of types of scientific evidence and
love and ongoing support as a valuable gift to me further expanding my knowledge and use of medi-
throughout my journey. My grandmother Mary, as cal statistics. Thank you for creating this book, and
a spiritual icon, helped me realize the many bless- inviting me to be a part of the project. The health
ings in my life, and to live life by values that are professional students that receive this EBP text
important. My own family has been a significant in place of four separate books deserve this all-
inspiration for my professional endeavors. To my in-one tool for learning. Most of all, 1 am grateful
husband, Paul Rogo, I appreciate your ability to for your guidance and friendship during my PA
keep me grounded in reality and for the adven- training and beyond. I look forward to more spir-
tures that provided relaxation during my scholarly ited conversations with you in the future. To Ellen
pursuits. My son Paul Marco, | thank you for your Rogo, your expertise, time, and extensive com-
support and being proud of my accomplishments, mitment to creating this textbook are incredibly
as Iam proud of yours. To Jason, my youngest son, appreciated. Other thanks go to past and present
I am eternally grateful for your ongoing computer colleagues in the pharmaceutical and physician as-
and technical support to complete this project; your sistant professions, including Gregg Luke, RPh, for
talents continue to impress me. My mother-in-law, performing chapter reviews and for generously ad-
Ruth Rogo, has always been proud of my accom- vising me on drug therapy in my clinical practice;
plishments as a working mother and | thank her to the pharmaceutical industry, for training me on
for her support. To my grandsons, Braxton and the basics of therapeutics, as well as for creating
Gunner, | wish you a lifetime of love, happiness, medications that improve patients’ quality of life;
and success. It has been an honor and a privilege and to my preceptors and mentors of clinical med-
to work with Bernadette Howlett. Her wealth of ical practice who have shown me how they prac-
knowledge of evidence-based practice and her tice EBP and further teach me to think critically
dedication and commitment to the writing of this when making important treatment decisions with
textbook are noteworthy. | cherish the hours we patients. Finally, | express infinite gratitude to my
spent together and the laughs we had. To Teresa friends and family who have supported me in my
Shelton, thank you for your valuable insights into medical career; especially my husband Brett, for
the pharmaceutical industry. being my source of courage and encouragement.
EllenJ.Rogo, RDH, PhD You are a true partner. To Zane and Kepa, thank
you for the joy of being our greatest creations and
First, | wish to acknowledge my co-authors. To inspiration.
Bernadette Howlett, thank you for educating me Teresa Gabiola Shelton, MPAS, PA-C
 About the Authors

Bernadette Howlett, PhD, is the director of to the Field of Adult Learning from the American
research for a rural Critical Access Hospital Society of Training and Development.
(Bingham Memorial Hospital, Blackfoot, Idaho) and Ellen J. Rogo, RDH, PhD, is currently an as-
was formerly an associate professor and research sociate professor in the Department of Dental
coordinator for a physician assistant (PA) studies Hygiene at Idaho State University in Pocatello,
program. She is currently an affiliate faculty mem- Idaho, and was previously an associate profes-
ber with the Institute of Rural Health at Idaho State sor at Fairleigh Dickinson University College of
University contracted to design and teach courses in Dental Medicine, Division of Dental Hygiene.
evidence-based practice as well as interprofessional She has been a dental hygiene educator for
practice. She has taught evidence-based medicine more than 30 years, with administrative lead-
for 9 years and was the coordinator for a cumula- ership positions as the coordinator of a degree
tive evaluation and a capstone assessment course completion program and department chairper-
in a physician assistant graduate program. She is son. Her experience includes teaching courses
an accomplished researcher and has a doctorate in research methodology and evidence-based
in adult and organizational learning. She is also an practice to undergraduate students as well as
expert in online education. supervising dental hygiene research, literature
In addition to teaching in a graduate PA program, analysis and synthesis, and thesis research for
Dr. Howlett has also taught graduate-level classes graduate students. Dr. Rogo also mentors gradu-
for nurse practitioner, dental hygiene, and public ate students and faculty in their research, grant
health programs. She also taught a freshman semi- writing, and manuscript-preparation endeavors.
nar course for more than 10 years. Dr. Howlett Her accomplishments include numerous national
has coordinated and designed clinical trials, and and international presentations and publications
has written numerous publications, national paper in a variety of professional journals. In addition,
presentations, and international conference pre- she has authored several book chapters and has
sentations. She is a recipient of the John L.V. Bobell received a number of research grants. Dr. Rogo
Award for Outstanding Dedication and Devotion has designed and conducted quantitative and

xiii
xiv | About the Authors

qualitative research investigations on clinical and For the past 10 years, her career focus has been
educational topics. in the pharmaceutical and medical fields. She has
Teresa Gabiola Shelton, MPAS, PA-C, is a physi- combined her knowledge of medical Spanish
cian assistant residing in Cache Valley, Utah. She and Hispanic culture as well as pharmacology
holds a master’s degree in physician assistant stud- and medical practice training for the provision of
ies, a national license to practice family medicine services in a family practice setting. In her cur-
with the National Commission on Certification of rent position at a rural community health center,
Physician Assistants (NCCPA), and is currently Teresa provides health care to a population of
licensed to practice in Utah. Her undergraduate medically underserved people in northern Utah
degrees are in foreign languages and business. and southeastern Idaho.
 Contributors

BarbaraJ. Blake, PhD, RN, ACRN Gloria A. Jones Taylor, DSN, RN

Associate Professor of Nursing Professor of Nursing
WellStar School of Nursing WellStar School of Nursing
Kennesaw State University Kennesaw State University
Kennesaw, Georgia Kennesaw, Georgia

D. Dennis Flores, BSN, ACRN

Grady Health System
Atlanta, Georgia

XV
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 Reviewers

R. David Doan III, MS, PA-C Adam J. Thompson, PhD, LAT, ATC
Evidence Based Medicine Instructor Professor
Physician Assistant Program Director of Athletic Training Education
Western Michigan University Indiana Wesleyan University
Kalamazoo, Michigan Marion, Indiana

Claudia Leiras-Laubach, PhD Eric Vangsnes, PhD, PA-C

Director of Research, College of Health Chair and Program Director Physician Assistant
Professions Department
Assistant Professor, Physician Assistant Studies/ Western Michigan University
Allied Health Studies Kalamazoo, Michigan
Grand Valley State University
Grand Rapids, Michigan Linda J. Vorvick, MD
Medical Director
Eric C. Nemec, PharmD, BCPS MEDEX Northwest Division of Physician Assistant
Clinical Assistant Professor Studies
College of Pharmacy Department of Family Medicine
Western New England University University of Washington School of Medicine
Springfield, Massachusetts Seattle, Washington

Howard Straket, EdD, MPH, PA-C Evelyn Wilson, MHS, NREMT-P

Assistant Professor Assistant Professor
Director, Community Medicine Western Carolina University
Department of Physician Assistant Studies Gaffney, South Carolina
The George Washington University
Washington, District of Columbia

xvii
xviii | Reviewers

Becky Wolff, MSN, RN, MA Stephen W. Wyatt, DMD, MPH

Assistant Professor Dean and Professor
University of South Dakota University of Kentucky
Vermillion, South Dakota Lexington, Kentucky

Supakit Wongwiwatthananukit, PharmD, PhD Y. Tony Yang, ScD, MPH

Associate Professor of Pharmacy Practice Assistant Professor
College of Pharmacy George Mason University
University of Hawaii at Hilo Fairfax, Virginia
Hilo, Hawaii
Catherine L.E. Young, PhD
Marla Wonser, MSOT, OTR/L Visiting Assistant Professor of Biology and Public
Program Director Health
Casper College Ohio Northern University
Casper, Wyoming Ada, Ohio

Christine E. Wright, PhD, LOTR

Assistant Professor, Program in Occupational
Therapy
Louisiana State University Health Sciences
Center — Shreveport
Shreveport, Louisiana
Exploring the Variety of Random
Documents with Different Content
 Journalism - Teaching Resources
Fall 2023 - University

Prepared by: Instructor Davis

Date: August 12, 2025

Review 1: Problem-solving strategies and techniques

Learning Objective 1: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Learning Objective 2: Statistical analysis and interpretation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 3: Experimental procedures and results
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 4: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 5: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Case studies and real-world applications
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Appendix 2: Experimental procedures and results
Note: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 11: Comparative analysis and synthesis
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Comparative analysis and synthesis
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Historical development and evolution
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Research findings and conclusions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Statistical analysis and interpretation
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Fundamental concepts and principles
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Comparative analysis and synthesis
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Lesson 3: Current trends and future directions
Example 20: Experimental procedures and results
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 21: Diagram/Chart/Graph]
Key Concept: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 22: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Problem-solving strategies and techniques
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Practical applications and examples
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 26: Practical applications and examples
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Case studies and real-world applications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 28: Problem-solving strategies and techniques
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 29: Diagram/Chart/Graph]
Important: Problem-solving strategies and techniques
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Lesson 4: Literature review and discussion
Example 30: Historical development and evolution
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 33: Diagram/Chart/Graph]
Example 33: Assessment criteria and rubrics
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 34: Diagram/Chart/Graph]
Definition: Literature review and discussion
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Theoretical framework and methodology
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 37: Diagram/Chart/Graph]
Remember: Historical development and evolution
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Problem-solving strategies and techniques
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 39: Diagram/Chart/Graph]
Important: Comparative analysis and synthesis
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 40: Diagram/Chart/Graph]
Abstract 5: Fundamental concepts and principles
Important: Current trends and future directions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Interdisciplinary approaches
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 42: Diagram/Chart/Graph]
Practice Problem 42: Literature review and discussion
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 44: Best practices and recommendations
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 45: Key terms and definitions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Interdisciplinary approaches
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 47: Current trends and future directions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Key terms and definitions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 49: Diagram/Chart/Graph]
Note: Best practices and recommendations
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Exercise 6: Literature review and discussion
Important: Assessment criteria and rubrics
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Study tips and learning strategies
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Problem-solving strategies and techniques
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Historical development and evolution
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 54: Diagram/Chart/Graph]
Key Concept: Historical development and evolution
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Best practices and recommendations
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Best practices and recommendations
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 59: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Review 7: Practical applications and examples
Important: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 61: Fundamental concepts and principles
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 62: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 64: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Study tips and learning strategies
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 68: Key terms and definitions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Theoretical framework and methodology
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Lesson 8: Learning outcomes and objectives
Definition: Research findings and conclusions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Fundamental concepts and principles
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Research findings and conclusions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 74: Diagram/Chart/Graph]
Important: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 76: Theoretical framework and methodology
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 78: Diagram/Chart/Graph]
Practice Problem 78: Fundamental concepts and principles
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Historical development and evolution
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Module 9: Fundamental concepts and principles
Important: Problem-solving strategies and techniques
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Comparative analysis and synthesis
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 83: Diagram/Chart/Graph]
Definition: Practical applications and examples
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Statistical analysis and interpretation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Assessment criteria and rubrics
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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