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Nursingmedical evidencebased searching : finding the gems

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Title: Nursingmedical evidencebased searching : finding the gems


1
Nursing/medical evidence-based searching
finding the gems
  • August, 2006
  • Presented by
  • Beth Lewis, MLS Sherri Place, MLS
  • Talbot Research Library

2
What you will learn today…..
  • What is meant by evidence-based literature?
  • Why is it important and helpful?
  • What are sources of EBL?
  • How can I easily locate evidence-based medicine
    literature on specific topics?

3
What is Evidence-Based Medicine?
  • Evidence based medicine is the conscientious,
    explicit, and judicious use of current best
    evidence in making decisions about the care of
    individual patients. The practice of evidence
    based medicine means integrating individual
    clinical expertise with the best available
    external clinical evidence from systematic
    research.
  • Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB,
    Richardson WS. Evidence based medicine what it
    is and what it isn't. BMJ. 1996 Jan 13 312
    (7023) 71-2.

4
Whats Evidence-based medicine?
  • EBM is not just searching the literature for good
    information, it is a much more rigorous
    methodology in gleaning substantive information
    about patient conditions and analyzing the
    strength of those results.
  • Bartkowiak, BA Searching for evidence-based
    medicine in the literature part 1 The Start
    Clin Med Res 2004 2(4)254-255

5
In other words, what it is and what it is not
  • Not cookbook medicine requires integration of
    clinical expertise and external evidence
  • Identifies and applies interventions to maximize
    the quality and quantity of life for individual
    patients
  • Not restricted to randomized trials and
    meta-analyses involves tracking down the best
    external evidence with which to answer clinical
    questions

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Why is evidence-based medicine needed?
  • Time constraints too many journal articles to
    keep up with and synthesize (19 articles per day
    in general medicine alone and one hour a week to
    read!)

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Searching for the Evidence Drilling through the
medical literature
Grandage, Karen K, et al. , 2002
8
Evidence-Based Practice Tools Summary
9
Where can you search for evidence-based
literature ?
  • Databases
  • Cochrane databases
  • PubMed (Medline)
  • CINAHL PsycINFO
  • Textbooks
  • UpToDate
  • Harrisons Online
  • ACP Medicine
  • ACS Surgery
  • Journals - such as Evidence-Based Nursing ACP
    Journal Club
  • Organizations and websites
  • National Guideline Clearinghouse
    (www.guideline.gov)
  • Nursing Best Practice Guidelines
  • Oncology Nursing Society Evidence Based Practice
    Resource Center

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But before you search
  • There are some steps to take first!

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Very important in searching for evidence based
information
  • FRAMING THE QUESTION

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Framing the question
  • Literature searches most likely to be successful
    if theyre based on well-formulated questions
  • Dissecting a question into its component parts to
    facilitate finding the best evidence a
    fundamental skill of evidence-based practitioners
  • Need a focused searchable question

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PICOT format components of an answerable,
searchable question
  • Standardized format for constructing clinical
    questions
  • Patient population of interest
  • Intervention of interest
  • Comparison of interest
  • Outcome of interest
  • Time frame

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Patient population
  • Age
  • Gender
  • Ethnicity
  • With certain disorder

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Intervention or issue of interest
  • Exposure to disease
  • Risk behavior
  • Prognostic factor

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Comparison
  • Issue to be compared
  • Easily identified if question is about therapy
    but if question is about meaning or prognosis
    there may be no comparison

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Outcome
  • Desired outcome upon which the issue/intervention
    and comparison will be evaluated
  • Risk of disease
  • Accuracy of diagnosis
  • Rate of occurrence of adverse outcome

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Time Frame
  • May not always be used

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Framing the question - focus the clinical query
  • Do steroids help septic patients?
  • In patients with sepsis (population)
  • Does treatment with steroids (intervention)
  • Compared with no steroids (comparison)
  • Alter mortality (outcome)?

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Essential steps to a search strategy
  • Formulate a well-built clinical question without
    jargon or ambiguity
  • Determine the type of db appropriate for the
    question
  • Determine the type of study design to best answer
    the question
  • Enter a search term, and begin combining searches
    to find relevant evidence
  • Further restrict for study design, methods,
    English, human, etc.

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Turning unstructured clinical questions into
structured questions
  • Example smoking cessation
  • Initial question is the nicotine patch
    effective?
  • Type of study? Quantitative
  • Improved searchable question Among young women
    who are moderate smokers, does nicotine
    replacement therapy increase the probability of
    smoking cessation?

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Quantitative study or Qualitative study
  • Nature of the question determines quantitative or
    qualitative study
  • To answer questions of how many or how much
    quantitative studies
  • To answer questions about how people feel about
    or experience certain situations qualitative
    studies

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Quantitative questions
  • The population who are the patients/clients?
    Individuals, families, groups, etc? Age or sex
    group? Specific health care problem?
  • Intervention or exposure which preventive,
    therapeutic or health services interventions?
  • Outcome what are patient-relevant consequences
    of the intervention

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Qualitative questions
  • The population who are the patients/clients?
    Individuals, families, groups, etc? Age or sex
    groups? Specific health care problem?
  • The situation What circumstances, conditions or
    experiences do you need to know more about?

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Sources of evidence
  • Optimal nursing information resources depends
    to a large extent on
  • the type of question youre asking
  • how much time you have
  • the resources available to you
  • Use pre-processed resources (A lot of the work
    is already done for you)

26
Pre-filtered or pre-processed info.
  • Sources to consider
  • Clinical practice guidelines
  • Evidence-Based Nursing and other journals
  • Cochrane Library
  • PubMed Clinical queries
  • CINAHL and PsycInfo (Clinical Queries filters)
  • UpToDate

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Unprocessed databases
  • CINAHL
  • PubMed
  • PsycINFO

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Some evidence-based terms to know
  • Qualitative study
  • Quantitative study
  • Systematic review
  • Meta-analysis

29
Systematic review
  • A rigorous method of summarizing the findings of
    studies that address a focused clinical question
  • Most commonly have been used with quantitative
    studies
  • When looking for the best evidence high-quality
    systematic reviews are preferred to single
    studies (these reviews address targeted clinical
    questions using strategies that decrease the
    likelihood of bias)

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Meta-Analyses
  • Meta-analyses are systematic reviews that combine
    the results of several studies using quantitative
    statistics

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What is best to look for?
  • Systematic Reviews!

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Evidence-Based Practice Tools Summary
33
Lets search for evidence based Literature
  • Start from the Talbot Research Library home page
  • http//pubutils.fccc.edu8180/slide/files/www/rese
    arch/library/index.html

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You should know…
  • Link to Pubmed from our home page.. Because then
    you will get our online journal links
  • You dont need a password to search Cochrane,
    Cinahl or PsycINFO, or to access the evidence
    based online journals (that are owned by the TRL)

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Cochrane database
  • The first database to search when seeking to find
    an answer to a clinical question
  • Small database (compared to Medline and CINAHL)
    only one publication type systematic reviews
    (best) including meta-analyses (a type of
    systematic review)

37
The Cochrane Library
  • Electronic resource for locating high quality
    information quickly
  • Focus is primarily systematic reviews of
    controlled trials of therapeutic interventions
  • Cochrane reviews are also indexed in PubMed but
    not as up to date as Cochrane Library
  • Numerous databases
  • Valuable source of synthesized evidence
    (preappraised) for clinicians
  • Highly esteemed database

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Databases in Cochrane Library
  • Cochrane Database of Systematic Reviews
    completed proposed systematic reviews, which
    have been peer-reviewed to insure they meet
    rigorous standards of methodology updated
    quarterly. More than 3000 full Reviews and 2000
    Protocols (Reviews in Progress)
  • Database of Abstracts of Reviews of Effects
    (DARE) includes systematic reviews that have
    been published outside the Cochrane Collaboration
  • The Cochrane Central Register of Controlled
    Trials thousands of references to clinical
    trials what Cochrane investigators have found
    from a wide range of sources. Considered to be
    worlds largest database (375,000) of randomly
    controlled trials.

39
The Cochrane Collaboration
  • Named in honor of Archie Cochrane, a British
    medical researcher who contributed to the
    development of epidemiology as a science and
    stressed the importance of using evidence from
    randomized controlled trials (RCTs)

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Systematic Reviews and Protocols
Register Title
Write Protocol ( 3 months)
Editorial Board
Prepare Review (12 months)
Cochrane Library
Updated Review (24 months)
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Cochrane Review
  • This Cochrane systematic review includes
    information on the methodology, the inclusion and
    exclusion criteria, the results, and a discussion

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More on Cochrane Library
Browse Feature
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Cochrane Library on Wiley
  • Advanced Search allows you to specify search
    field
  • MeSh Searching allowed Select MeSH Search
  • Search by title of Review
  • Search by Cochrane Group
  • Can save searches and set up Alerts
  • Updated quarterly

56
PubMed Clinical Queries
  • A user-friendly approach to evidence-based
    searching
  • Dont need to know Mesh (subject headings)
  • Uses preset research methodology filters which
    enable searchers to locate relevant
    methodologically sound studies that meet
    evidence-based standards for therapy (or
    interventions) diagnosis, etiology, and
    prognosis
  • New systematic review filter retrieves relevant
    systematic reviews indexed in PubMed, including
    those in the Cochrane database

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For Advanced PubMed users
  • TIP! To pull Systematic Reviews from a Search
    Strategy that youve already been working on,
    just add AND systematicsb to your existing
    strategy

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More Tips on PubMed
  • Try using evidence in the title field combined
    with another concept
  • Try using the MeSh subject heading,
    Evidence-Based Medicine in combination with
    your concept
  • Try Using OR to combine results from the above
    2 searches
  • CAUTION this can lead to false drops so be
    sure to review your results!

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CINAHL
  • Bibliographic database for nursing and allied
    health
  • Has clinical practice guidelines, journal
    articles, research instruments, books reviews,
    and patient ed. materials.
  • Uses CINAHL subject headings
  • Useful limits publication type systematic
    review, and subject heading evidence based
    practice
  • NEW clinical queries filter and Evidence Based
    Practice under Special Interest Category

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CINAHL to get the evidence-based literature
  • Using the more limits feature, select under
    special interest category evidence-based
    practice (seems to get a lot more results)
  • Or, use subject term nursing practice,
    evidence-based
  • Or, use the new Clinical Queries limit

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PsycINFO
  • Scholarly literature in behavioral sciences and
    mental health
  • Can find relevant evidence to answer specific
    clinical questions
  • Has useful subject headings, like evidence based
    practice
  • Brand new clinical queries limit

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When searching for evidence based nursing also
consider
  • Clinical Practice Guidelines
  • Professional organizations

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Clinical practice guidelines
  • National Guideline Clearinghouse
    (www.guideline.gov) - (NGC), a public resource
    for evidence-based clinical practice guidelines
  • Registered Nurses Association of Ontario Best
    Practice Guidelines Project http//www.rnao.org/be
    stpractices/index.asp

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In PubMed CINAHL
  • Practice Guidelines can be pulled from the
    literature as a publication type in these
    databases

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National Guideline Clearinghouse
  • Supported by the Agency for Healthcare Research
    and Quality (AHRQ)
  • Guidelines systematically developed statements
    about a plan of care for a specific set of
    clinical circumstances involving a particular
    population
  • Best guidelines are based on rigorous scientific
    evidence (systematic reviews or randomized
    control trials)
  • NGC has structured abstracts about the guideline
    a summary for viewing, and links to full text
    guidelines

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Dont forget evidence based journals
  • Go to our library home page first

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Evidence-Based Nursing (EBN Online)
  • Online access from 1998-
  • Quarterly
  • Secondary publication studies published in any
    of more than 100 health care journals are
    identified, critically appraised, and summarized
    in brief abstracts
  • They include a substantially smaller set of
    articles than regular databases because it
    includes only articles which reviewers have
    decided meet basic standards of methodological
    quality

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Worldviews on evidence based nursing
  • Online access
  • a primary source of information for using
    evidence-based nursing practice to improve
    patient care
  • Includes best evidence available, including
    specific recommendations that support nursing
    practice around the world.
  • Teaching EBP feature each month will help you in
    doing EBP literature searching

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Textbooks
  • UpToDate
  • Harrisons Online
  • ACP Medicine
  • ACP Surgery

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UpToDate
  • UpToDate follows a hierarchy of evidence
    consistent with most evidence-based resources
  • At the top of the hierarchy are randomized trials
    of high methodological quality, followed by
    randomized trials with methodological
    limitations, observational studies, and
    unsystematic clinical observations
  • Inferences are stronger when the evidence is
    summarized in systematic reviews of the
    literature that present all relevant data.

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UpToDate
  • Each topic has an author who is an expert in the
    area discussed, and at least two separate
    physician reviewers. This group works together to
    perform a comprehensive review of the literature
    and carefully select studies for presentation
    based upon the quality of the study, the
    hierarchy of evidence discussed above, and
    clinical relevance

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UpToDate
  • Evidence is derived from a number of resources,
    including but not limited to
  • Hand-searching of over 330 peer reviewed journals
  • Electronic searching of databases including
    MEDLINE, The Cochrane Database, Clinical
    Evidence, and ACP Journal Club
  • Consensus guidelines
  • Published information regarding clinical trials
    such as reports from the Food and Drug
    Administration, as well as other sources of
    information produced by federal agencies such as
    the Centers for Disease Control and Prevention
    and the National Institutes of Health
  • Proceedings of major national meetings
  • The expertise of their authors, editors, and peer
    reviewers

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UpToDate
  • A fundamental principle of evidence-based
    medicine, as described by Dr. Gordon Guyatt from
    McMaster University, is that, "Evidence alone is
    never sufficient to make a clinical decision.
    Decision makers must always trade the benefits
    and risks, inconvenience, and costs associated
    with alternative management strategies, and in
    doing so consider the patient's values" 1. This
    principle has led some evidence-based resources
    to avoid making specific recommendations for
    patient care, since the recommendation needs to
    account for all of the factors cited. UpToDate
    has taken a different approach. It is the policy
    of UpToDate to make specific recommendations for
    patient care whenever possible.

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Librarians are here to help you
  • Training in CINAHL, PUBMED, PsycINFO
  • We do searches!
  • Call us x2710 or send an e mail
  • lib_reference_at_fccc.edu
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