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Human Subject Research

Working in an evidence-based practice relies upon a combination of strong research evidence, well-developed clinical expertise, and patient values. With regard to that strong research evidence, it occurs within a regulatory context designed to protect the human participants who volunteer for clinical trials and other forms of scientific and clinical research. Something needs to...
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Publication Bias

I’ve just read a fascinating piece of hard-hitting investigative journalism, the book “Bad Pharma” by the medical provocateur Ben Goldacre (Goldacre B. Bad pharma: how drug companies mislead doctors and harm patients. New York, NY; Faber and Faber, 2013). You might know of him from some of his TED talks, wherein he demonstrates how...
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A Different Take on Orthopedic Testing: Using Sensitivity and Specificity

So, let me ask you a question. If someone told you that they had a disc prolapse at L5 that was, according to the MRI report, “large enough to completely occlude the left IVF at L5,” what kind of picture would your mind’s eye consider? What would you expect to see during a physical...
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The Evidence-Based Approach, in Brief

Evidence-based practice is predicated upon an approach to information assessment known as the 5 As. This stands for: Ask, Acquire, Appraise, Apply and Assess. Let’s look at this in the context of an actual patient encounter. Let’s begin with you seeing a patient whose problem lies outside your area of expertise and knowledge. Perhaps...
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Clinical Reasoning in Spine Pain, Volume 1: Review

From our blogger Dr. Robert Cooperstein comes this review of the new text from Dr. Donald Murphy. Donald Murphy has written a book entitled Clinical Reasoning in Spine Pain, Volume I. He authored most of it himself but there is contributed material from Gary Jacob, David R, Seaman, and Steven Heffner. About half an...
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Confidence Intervals

I would guess that by now you have come across the term “confidence interval” while reading a clinical trial or another kind of paper. This is a critically important concept for clinicians and academics in healthcare to grasp. CIs are typically used when, instead of wanting the mean value of a sample, we instead...
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Evidence-Based Chiropractic, Briefly Described

Over the past few weeks, I’ve had several discussions where evidence-based chiropractic (EBCP) has been discussed. The administration at Palmer College, where I work, committed some time ago to the inclusion of EBCP in our DC curriculum, and I teach a course devoted to a thorough presentation of its concepts. Yet confusion remains, and...
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Resources for the Evidence-Based Practitioner: Textbooks

Like any other area of healthcare, evidence-based practice is simply a set of skills applied to benefit a patient. And like any other set of healthcare skills, it can be learned. However, the EBP movement is relatively new, beginning in the 1980s but really only taking wing in the last 10 years. For those...
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Motivational Interviewing

One of the most difficult issues related to teaching evidence-based practice is that one of the three main planks of the discipline is relatively poorly understand often little discussed. This is patient values (the other two are, as most of us are now well aware, evidence from the literature, and clinical expertise and experience). ...
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Greetings and Salutations!

No doubt by now you have heard your friends, colleagues and various others talk about the evidence-based practice movement. You have heard them tell you it is not all about scientific research, that it incorporates clinical expertise as well as patient values, but it may not be immediately clear to you what that really means....
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