COMMDIS416 1nd Edition Lecture 4 Outline of Last Lecture I. ASHA Benefits II. Texas A&M Non-Compliance III. AuD Assistants a. AuD Assistant-Educational Requirement b. AuD Assistants c. AuD Assistant Guidelines d. Roles and Responsibilities of the Audiology Assistant e. AuD Assistants are NOT Permitted to…f. Audiology Assistant Continued IV. Supervising Audiologist (AuD)a. Supervising Audiologist-Roles and Responsibilities V. Audiology Assistant VI. Code of Ethics VII.Which ASHA Code of Ethics is Violated?a. Ethical Principle 1 b. Ethical Principle 2 c. Ethical Principle 3 d. Ethical Principle 4 VIII. What is a Dilemma?a. Dealing with Ethical Dilemmas IX. ASHA Trends X. Examples of Typical Ethics Inquiries-ASHA XI. Dilemmas-Employer Demands a. Dilemmas-CFYb. Dilemmas-CulturalXII. Ethical Scenario Outline of Current Lecture I. Evidence-Based Practice II. What is Evidence-Based Practice?III. Key Steps in the EBP Process These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.IV. Levels of Evidence a. Example b. Example V. Non-Evidence Based Treatments VI. Scientific Fraud VII. Systematic Reviews and Practice Guidelines VIII. Barriers to Evidence-Based Practice IX. Systematic Reviews a. Evaluating the Quality of a Systematic Review X. Practice Guidelines XI. ASHA’s N-CEPXII. Improving Quality of Services a. Learning Questions Current LectureI. Evidence-Based Practice - Evidence-based practice (EBP) – utilizes the best clinical evidence in making patient caredecisions typically from research. EBP translates knowledge into practice- Research (R) - applies a methodology whether quantitative or qualitative to develop, uncover, create, find, add to our knowledge base- Quality Improvement (QI)- utilizes a system to monitor and evaluate the quality and appropriateness of care (outcomes) based on EBP - Evidence-Based Practice (EBP): What is the best approach for diagnosing and treating communication impairments? What research has been done that could provide clinical practice guidelines?- Research (R): Does intervention “A” work better than intervention “B”? What’s been studied? Where are the gaps?- Quality Improvement (QI): Is our treatment working? How are we measuring clinical outcomes?II. What is Evidence-Based Practice?- Conscientious use of current best evidence to make decisions about patient care. A commitment to constant reexamination of practices through research and outcome analyses.- A problem-solving approach to clinical practice based upon:1. Systematic search for and appraisal of most relevant evidence to answer questions2. One’s clinical experience and expertise3. Patient preference and values - Use a representative sample (they should represent the people you are trying to help)- Blinding: of individuals running the study (experimenter) and those measuring the data (prevent measuring bias) - Important to have a LARGE sample (increases statistical power) III. Key Steps in the EBP Process- Step 1: Frame the Clinical Questiono Not too broad in scope - Step 2: Find the Evidence o Google scholar, medline, UMASS libraries - Step 3: Asses the Evidence- Step 4: Making the Clinical Decision-Integrate evidence with clinical expertise, patient preferences - Step 5: Assess Outcome IV. Levels of Evidence 1. Level 1: Systematic Reviews: Authors have systematically searched for/appraised/evaluated and summarized the research for a specific topic 2. Level 2: Randomized Control: patients have randomly been assigned to a treatment group/experimental and a control group 3. Level 3: Cohort Studies: Patients have been assigned to 2 or more treatment groups, butthere in NO control (i.e., comparing treatment A with treatment B) a. Example - Ramig, L., Sapir, S., Countryman, S., Pawlay, A., O’Brien, C., Hoehn, M., and Thompson, L.(2001). Intensive voice treatment (LSVT®) for patients with Parkinson's disease: a 2 year follow up. Journal of Neurology, Neurosurgery, and Psychiatry, 71(4), 493-498. - (Partial) Abstract: OBJECTIVES: To assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT®), a method designed to improve vocal function in patients with Parkinson's disease. METHODS—Thirty-three patients with idiopathic Parkinson's disease were stratified and randomly assigned to two treatment groups. One group received the LSVT®, which emphasizes high phonatory-respiratory effort. The other group received respiratory therapy (RET), which emphasizes high respiratory effort alone. Patients inboth treatment groups sustained vowel phonation, read a passage, and produced a monologue under identical conditions before, immediately after, and 24 months after speech treatment.o LEVEL 3-Cohort Study (lacks a control group) b. Example - Roy, N. et al. (2013). Evidence-Based Clinical Voice Assessment: A systematic review. American Journal of Speech-Language Pathology, 22, 212-226.- (Partial) Abstract: Purpose: To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. Method: The American Speech Language Hearing Association (ASHA) National ‐ ‐Center for Evidence Based Practice in Communication Disorders staff searched 29 ‐databases for peer reviewed English language articles between January 1930 and ‐ ‐April 2009 that included key words pertaining to objective and subjective voice measures, voice disorders, and diagnostic accuracy. The identified articles were systematically assessed by an ASHA appointed committee employing a ‐modification of the critical appraisal of diagnostic evidence rating system.o LEVEL 1-Systematic Review (long time-span) V. Non-Evidence Based Treatments  Miracle Mineral Solution (MMS): In bleach therapy, an individual with ASD is given adiluted form of bleach orally or through an enema in an attempt to cure their symptoms. Bleach doses are given repeatedly; supporters of this treatment have recommended that children drink the bleach mixture up to eight times per day or receive an enema up to three times per week. The rationale for the treatment is thatbleach can eliminate bacteria, parasites, yeast, and heavy metals and consequently eliminate ASD symptoms. This treatment has been widely denounced for the harm it can cause as well as its complete lack of scientific basis. Ingesting