Reducing Diagnostic Uncertainty What the Evidence-Based Researcher Can Do for Clinical Practitioners

My talk is really about reducing diagnostic uncertainty. I could've sub-captioned it machinations of a recreational researcher, but I didn't. Instead I would like to sort of be more inclusive. Take some real scientists and combined with those of us that are more casual researchers or clinical researchers and talk about what our research can mean to practitioners. To take the findings that we generate and get them in the hands of people who can then implement them with patients to improve patient care.

And so my talk, if I can get my fingers to work right here, find the right buttons, it's going to have two parts. The first part is really going to be kind of a general background, quick background on evidence-based practice and what researchers, as all of us in this room can do, to facilitate clinicians using the information that we come up with, the scientific findings. The second part, I'm going to take you on a journey. And this is really looking at what are the methods of taking data that we generate that's usually come from the study of groups and how we're trying to make that applicable to individual patients. So how do you move from group data down to the single individual? And I have to say is that this has been a journey for me that's been going on for-- actually a little over a decade. So it's going to have twists and turns and there'll be some rabbit holes. And at the end, I'm actually going to ask you for some help with some of the problems and questions that I currently am trying to face because I want to wrap this project up before I die or become too demented to be able to do so. So I'm going to look through you for some input and assistance along the way.



Evidence Based-Practice



So evidence-based practice, I'm going to tell you a little bit of what I think it is and then how it's performed. So what is evidence-based practice? This is a very long definition. It's something that has evolved, for me, since some publications that I had in 2009, 2010. But evidence-based practice is a value driven pattern of practice that integrates best, meaning the best quality research you can find, that's often derived on the study of populations to inform decisions about individuals. And then it goes on to say in the context of the provider's expertise, individual patient values with the goal of maximizing clinical outcomes and quality of life for the patient in a cost-effective manner while addressing the concerns of the providers and referral sources. Believe me, I think that's the longest, I think, grammatically correct sentence. It's very compound-complex. My eighth grade grammar teacher would be proud of me. But really when you break it down, there's seven components to this. And the three that really have to do with the evidence-based practice of the first three, it's value driven. It integrates research, clinical research, derived from the study of groups to inform decisions about individuals. And most of this is relatively objective. Value is a little bit iffy by what you mean by value. And again, this is something that old folks do. You look back at things that you learned when you were young and you realize how important they were in framing your current thoughts. 



Evidence Pyramid



In evidence-based practice, they talk about the evidence pyramid. Levels of evidence. And some are more stringent and have more power than others. At the bottom we have things like book chapters, or this talk, expert opinion. But really, looking at systematic reviews, meta analysis, certainly making use in neuropsychology of a journal, Neuropsychology Review, which is primarily meta analyses and reviews, a great source. But in most cases, our work is going to fall into one of these three categories. The type of research we do, case controlled studies, cohort studies, or randomized cohort studies. We should know what those are because, again, we can use that to describe our research in the title so that, again, people can begin to get an idea of whether it fits their bill of what they're looking for.