Laura Banfield, Health Sciences Library

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Developing Research Questions Searching for the
Evidence

• Laura Banfield, Health Sciences Library

January 2009
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Learning Objectives

• Review the definition of Evidence (Informed)
  Based Practice and the steps in the process
• Formulate questions using PICO and PS models
• Introduce the concept of preprocessed evidence
  and the hierarchy of evidence
• Identify databases and sources for locating
  pre-processed evidence

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Evidence-Based Practice (EBP)

• The integration of best research evidence with
  clinical expertise and patient values to
  facilitate clinical decision making
• (Sackett et al., 2000)

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Clinical Decisions
Clinical state, setting, and circumstances
Patient preferences and actions
Clinical Expertise
Clinical Expertise
Health care resources 
Research evidence
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Steps of EBP

• Construct a relevant, answerable question from a
  clinical case.
• Search the literature to retrieve the best
  evidence.
• 3. Critically appraise the literature (evidence)
  for validity and applicability.
• 4. Apply the evidence to your clinical practice.
• 5. Evaluate the outcome or performance.

From Flemming, K. (1998). Asking answerable
questions. Evidence-Based Nursing, 1(2),
36-7.
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Steps of EBP

• Construct a relevant, answerable question from a
  clinical case.
• Search the literature to retrieve the best
  evidence.
• 3. Critically appraise the literature (evidence)
  for validity and applicability.
• 4. Apply the evidence to your clinical practice.
• 5. Evaluate the outcome or performance.

From Flemming, K. (1998). Asking answerable
questions. Evidence-Based Nursing, 1(2),
36-7.
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What Type of Question is it?
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Formulating the Question

• (Quantitative)
• P -- Population/Situation
• I -- Intervention/Exposure
• C -- Comparison/Counter Exposure
• O -- Outcome

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Question

• Intervention
• Is exercise more effective than rest for
  relieving chronic back pain?

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Question

• Population
• Intervention
• Comparison
• Outcome

• People with back pain
• Exercise
• Bed rest
• Reduced pain

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Question

• Causation
• Does the presence of hand sanitizer stations in
  nursing homes reduce the number of infections
  transferred to residents?

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Question

• Population
• Exposure
• Comparison
• Outcome

• Nursing home residents
• Hand sanitizer stations
• No hand sanitizer
• Reduced infection

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Formulating the Question
(Qualitative) P -- Population S -- Situation
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Question

• How do people with HIV/AIDS living in a rural
  community feel about disclosing their status to
  their health care provider?

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Question

• Population
• Situation

• People with HIV/AIDS
• Disclosing their status to their health care
  providers

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Hierarchy of Pre-processed Evidence

(Haynes, 2007)
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Systems

• Support clinical decision making through linking
  all relevant best research evidence about a
  clinical situation directly to a patients
  record.
• (Haynes 2008)
• Sources of Systems
• Integrative Electronic Patient Records

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Summaries

• Summaries integrate best available evidence from
  lower layers to provide a full range of
  evidence concerning management options for a
  given health problem.
• (Haynes, 2007)
• Sources of Summaries
• Clinical Practice Guidelines
• Evidence Based Texts

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Nursing Best Practice Guidelines
http//www.rnao.org/bestpractices/

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National Guideline Clearinghouse
http//www.guideline.gov/
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BMJ Clinical Evidence
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ACP PIER (Physicians Information and Education
Resource)
Available through STAT!Ref
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ACP PIER
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ACP PIER
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FirstCONSULT
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FirstCONSULT
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Syntheses Systematic Reviews

• Consolidate the literature on a specific topic
• comprehensive identification of studies
• review of study relevance
• evaluate methodologic quality
• extraction and analysis of data
• draw of conclusions
• Sources of Synthesis
• The Cochrane Library
• Health Care journals

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Cochrane Libraryhttp//www.thecochranelibrary.com
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Synopses
Synopses of individual studies or systematic
reviews encapsulate the key methodologic details
and results required to apply the evidence to
individual patient care.
(Haynes, 2001)

• Sources of Synopses
• Database of Abstracts of Reviews of Effects
  (DARE)
• health-evidence.ca
• Evidence-based abstraction journals

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DARE Database of Abstracts of Reviews of Effects
http//www.crd.york.ac.uk/crdweb/
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DARE Synopses of Syntheses
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Evidence Based Nursing
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Single Studies

• To keep up with the literature
• To update summaries and systematic reviews
• To contribute to clinical decisions if no higher
  preprocessed level is available

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PubMed
Clinical Queries
Special Queries
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PubMed Clinical Queries
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PubMed Special Queries
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CINAHL Clinical Queries
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CINAHL - Clinical Queries
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TRIP (Turning Research into Practice)
http//www.tripdatabase.com
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TRIP Searching across the Hierarchy
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EBN Resources Page
http//hsl.mcmaster.ca/education/nursing/ebn
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Library Sessions

• Monday January 19 1100 am - 1200 pm
• 100 pm - 200 pm
• 200 pm - 300 pm
• 300 pm - 400 pm
•  Tuesday January 20 100 pm - 200 pm  
• 200 pm - 300 pm  
• 300 pm - 400 pm
•  Wednesday January 21 1000 am - 1100 am  
• 130 pm - 230 pm 
• 230 pm - 330 pm

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Questions??

• Laura Banfield
• Nursing Librarian
• banfie_at_mcmaster.ca
• Ext. 20239