Evidence-based Practice Resources for HINARI Users (Module 7.2)

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Evidence-based Practice Resources for HINARI
Users(Module 7.2)
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Evidence-based Practice Resources for HINARI
Users

• Instructions - This part of the
• course is a PowerPoint demonstration intended to
  introduce you to Evidence-based Practice and
  related HINARI resources.
• module is off-line and is intended as an
  information resource for reference use.

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Table of Contents Part A

• Evidence-based Medicine (EBM)
• Definition
• What, why and how of EBM
• 5 step EBM process ask, access, appraise, apply
  
• and access
• Limitations of EBM

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Table of Contents Part B

• HINARI Resources
• Clinical Evidence
• Cochrane Library
• EBM Guidelines
• BMJ Practice
• HINARI EBM Journals

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Table of Contents Part C

• Other (Internet) Resources
• PubMeds Clinical Queries and Type of Article
  Limits
• Clinical Practice Guidelines definition
  examples
• Cochrane Library Abstracts
• PubMed Health clinical effective research
• Trip Database
• Evidence Updates - BMJ and McMaster University
• Knowledge Translation Learning Modules Canadian
  Institutes of Health Research
• Essential Health Links gateway annotated links
• Johns Hopkins POC-IT Guides
• Other useful websites

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Evidence-based Practice (EBP) Definition

• "Evidence-Based Practice requires that
  decisions about health care are based on the best
  available, current, valid and relevant evidence.
  These decisions should be made by those receiving
  care, informed by the tacit and explicit
  knowledge of those providing care, within the
  context of available resources."
• Sicily statement on evidence-based practice.
  BMC Medical Education, 2005 Jan 55(1)1

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What is EBP?

• The integration of best evidence from current
  research, patient preferences and values, and
  clinical expertise to clinical questions
  (Sackett, 2000) in a timely fashion.

EBP
Best available evidence is consistent research
evidence with high quality and quantity
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Why EBP?

• To improve care
• To bridge the gap between research practice
• Kill as few patients as possible (O. London)
• A new treatment might have fewer side effects.
• A new treatment could be cheaper or less invasive
• A new treatment may be necessary in case people
  develop resistance to existing therapies, etc.
• To keep knowledge and skills current (continuing
  education)
• To save time to find the best information

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How does EBP help?

• A patient comes to a clinic with a fresh
  dog bite. It looks clean and the nurse and
  patient wonder if prophylactic antibiotics are
  necessary. The nurse searches PubMed and found a
  meta analysis indicating that the average
  infection rate for dog bites was 14 and that
  antibiotics halved this risk to 7.
• For every 100 people with dog bites, treatment
  with antibiotics will save 7 from infection
• Treating 14 (NNT) people with dog bites will
  prevent 1 infection
• You explain these numbers to the patient along
  with possible
• consequences and patient decides not to take
  antibiotics.
• On a follow up visit you find out that he did
  not get infected.
• Glasziou P, Del Mar C, Salisbury J. EBP Workbook,
  2nd. ed. BMJ Books, 2007.

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What are some Barriers for EBP?

• Overuse, underuse, misuse of evidence
• Time, effort, skill needed
• Access to evidence
• Intimidation by senior clinicians
• Environment not supportive of EBP
• Poor decision making

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The 5 Step EBP Process

• 1. ASK Formulate an
  answerable clinical question
• 2. ACCESS Track down the best
• Evidence
• 3. APPRAISE Appraise the evidence for its
  validity and usefulness
• 4. APPLY Integrate the results with your
  clinical expertise and your patient values/local
  conditions
• 5. ASSESS Evaluate the effectiveness of
  the process

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Step 1 ASK a focused (answerable) clinical
question

• Background questions (What do I know about this?)
• Foreground (Clinical) QuestionsP Patient,
  population or problem (Who are the patients or
  populations? What is the disease?)
• I Intervention (What do you want to do with
  this patient (e.g. treat, diagnose,
  observe)? C Comparison intervention (What is
  the alternative to the intervention (e.g.
  placebo, different drug, nothing?)
• O Outcome (What are the relevant outcomes
  (e.g. morbidity, mortality, death,
  complications)?

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Why should I use PICO?

• To help define problem in clarify it in your own
  mind
• To prepare for searching
• To ask patient centered questions. Treatment of
  Pneumococcal Pneumonia SHOULD be different for
• Terminal Cancer Patient
• Elderly, Severely Demented Patient
• Young, mother of 2 children
• Developing the question requires
• Some background knowledge of the condition
• Understanding of the patient and what are the
  outcomes and beliefs that matter to this patient
• Death? Disability? Quality of life? Cost?
  Improvement of symptoms?

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Example Intervention Questions

• Identify background questions, create a PICO and
  a focused clinical question for this case
• 54 year old male patient was diagnosed with
  intermediate grade prostate cancer and wants to
  know whether to get a radical prostatectomy or
  radiation treatment. He is concerned about death
  from prostate cancer and also risks of impotence
  and incontinence.

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Formulate the Clinical Question

• PICOP - 54 year old male with intermediate grade
  prostate cancer
• I - radical prostatectomy
• C- radiation treatment
• O- reduce risk of mortality, impotence, and
  incontinence
• Focused clinical questionIn 54 year old male
  patients with intermediate grade prostate cancer
  is radical prostatectomy more effective compared
  to radiation treatment in reducing the risk of
  mortality, impotence, and incontinence?

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EBP Step 1a Classify the type of the question

• What is the treatment? Question of
  INTERVENTION/PREVENTION
• What causes the problem? Question of ETIOLOGY,
  RISK
• Does this person have the problem? Question of
  DIAGNOSIS
• Who (and how likely) will get the problem?
  Question of PROGNOSIS

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Etiology and Risk QuestionsWhat causes a disease
or health condition?

• The reverse of intervention questions-they deal
  with harmful outcomes of an activity or exposure
  (public health issues)
• Develop a clinical question for the case
• S. is a smoker and just found out that she is 3
  months pregnant. She quit smoking immediately.
  But she is worried if her developing baby was
  harmed and if the baby is at risk for having
  developmental problems. She is asking you if
  smoking during the first trimester can harm her
  baby?

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Etiology or Risk Questions

• P-babies of mothers who smoke
• I-smoking in first trimester
• C-nothing
• O-increase risk of developmental problems
• Question Are babies of mothers who smoke during
  their first trimester at an increased risk of
  developmental disabilities?

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Diagnosis Questions

• These questions are concerned with how accurate a
  diagnostic test is in various groups and in
  comparison to other tests or usually to a gold
  standard test.
• As part of your clinic assessment of elderly
  patients, there is a hearing check. You think
  that a simple whispered voice test is very
  accurate compared to other methods. You want to
  do a literature search. What is your question?
  (1)

Glasziou P, Del Mar C, Salisbury J. EBP Workbook,
2nd. ed. BMJ Books, 2007.
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Example

• P-elderly people
• I-whispered voice test
• C-no test (or other tests)
• O-accurate diagnosis of hearing problems
• Question In elderly people, does the whispered
  voice compared to other tests give an accurate
  diagnosis of hearing problems?

Glasziou P, Del Mar C, Salisbury J. EBP Workbook,
2nd. ed. BMJ Books, 2007.
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Templates for EBP Questions

• For a therapy In _______(P), what is the effect
  of _______(I) on ______(O) compared with
  _______(C)?
• For etiology Are ____ (P) who have _______ (I)
  at ___ (Increased/decreased) risk for/of_______
  (O) compared with ______ (P) with/without ______
  (C)?
• Diagnosis or diagnostic test Are (is) _________
  (I) more accurate in diagnosing ________ (P)
  compared with ______ (C) for _______ (O)?
• Prevention For ________ (P) does the use of
  ______ (I) reduce the future risk of ________ (O)
  compared with _________ (C)?
• Prognosis Does __________ (I) influence ________
  (O) in patients who have _______ (P)?
• Melnyk B. Fineout-Overholt E. (2005).
  Evidence-based practice in nursing healthcare.
  New York Lippincott Williams Wilkins.

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EBP Step1b Decide on the best type of study for
questionFor each type of question there is a
hierarchy of evidence
Therapy/PreventionWhat should I do about this problem? RCTgtcohort gt case control gt case series
DiagnosisDoes this person have the problem? cross-sectional study with blind comparison to a gold standard
Etiology/HarmWhat causes the problem? RCT gt cohort gt case control gt case series
Prognosis/PredictionWho will get the problem? RCT gtcohort study gt case control gt case series
Frequency and Rate How common is the problem? cohort study gt cross-sectional study
NOTE A well designed systematic review of RCTS
(randomized controlled trials) is best as it is
least biased therefore more valid.
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Hierarchy of Study Designs for Intervention
Experimental
Observational
Observational
Observational

• To recognize the type of study ask the questions
• Is intervention randomly assigned? Yes-RCT
  No-Observational study
• When were the outcomes determined?
• After the exposure-cohort study (prospective
  study)
• During the exposure-cross-sectional study
• Before the exposure-case-control study
  (retrospective study based on recall)

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EBP Step 2 ACCESSTrack Down the Best Evidence

• Start hunting from the best resource Match
  your question to the best medical information
  resource for this question.
• Well designed Systematic Reviews¹ can be a great
  place to start they contain commentary about
  validity ¹A systematic review involves the
  application of scientific strategies, in ways
  that limit bias, to the assembly, critical
  appraisal, and synthesis of all relevant studies
  that address a specific clinical question.
• Cook DJ, Mulrow CD, Haynes RB. Annals of Internal
  Medicine March 1, 1997 126 (5) 376.

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Hierarchy of Evidence- Access evidence at the
level that will give you the best evidence
Track Down
Filtered Critically Appraised
Expert Opinion and Not Filtered
Background info.

• Most clinically relevant (at the top) Least
  clinically relevant (at the bottom)

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Factors included in different types of
evidence-based research
Evidence, hierarchies, and typologies horses for
courses, Petticrew M, Roberts H, Journal of
Epidemiology and Community Health, 663 (March
2012)
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Why not get info only from textbooks and review
articles?

• Texts and review articles?
• Dated perhaps by several years
• Often biased
• Author chooses article that he/she agrees with
  (or has written)
• Author chooses articles of his/her friends
• Author does not identify all the relevant
  literature
• Reviews methods are not explained
• These resources help with background knowledge
  (learn about disease) not foreground (answer the
  specific clinical question for this patient)

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Why not get info only from guidelines?

• They can assure standards of care but
• Can be biased
• May not always be developed by experienced
  experts
• Are not always evidence-based
• Can work for most patients but not for all
• Can work in some circumstances but not in all
• Can be dated
• There may not be guidelines for everything

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Filtered and Critically Appraised Evidence-Based
Resources

• The Cochrane Library by The Cochrane
  Collaboration via Wiley
• Independent non-for-profit international
  collaboration
• Reviews are among the studies of highest
  scientific evidence
• Minimum Bias Evidence is included/excluded on
  the basis of explicit quality criteria
• Reviews involve exhaustive searches for all RCT,
  both published and unpublished, on a particular
  topic
• Abstracts searchable for free on the Internet
  complete database is available via HINARI for
  most countries
• 1995-

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Benefits for using not-evaluated databases for
EBM research (PubMed, Cinahl)

• Create comprehensive search strategies
• Conduct systematic reviews of the literature
• Conduct synonym searching utilizing thesauri
• Set up and distribute alerts relating to
  evidence-based medicine
• Limit to specific populations publication types
• Utilize EBM built-in filters (search strategies)

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EBP Step 3 AppraiseDetermine if the results
are valid and useful

• Appraisal principles (primary and secondary
  research)
• What is the PICO of the study? Does it match my
  question?
• How well was the study done? Is it biased?
• What do the results mean? Are they real and
  relevant?
• More University of Oxfords Center of EBM
  http//www.cebm.net/index.aspx?o1157
• Tools for evaluating studies can be found in the
  Evaluating the Evidence section in the EBM
  tutorial at
• http//www.hsl.unc.edu/Services/Tutorials/ebm/welc
  ome.htm

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EBP Step 4 APPLY Integrate the results with
your clinicalexpertise and your patient values

• Question to ask
• Is the intervention feasible in my settings?
• What alternatives are available?
• Is my patient so different then those in the
  study that the results cannot apply ?
• Will the potential benefits outweigh the
  potential harms of treatment ?
• What does my patient think? What are his cultural
  beliefs?
• Individual decision making/group decision
  making/choice
• Explaining risks and benefits to patients
  https//docs.google.com/View?idd7k3gkg_679hnvn54c
  8
• Visual Rx http//www.nntonline.net/visualrx/

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EBP Step 5 ASSESSEvaluate the effectiveness of
the process.How am I doing?

• Am I asking questions?
• Am I writing down my information needs?
• What is my success rate in the EBM steps?
• How is my searching going? Am I becoming more
  efficient?
• Am I periodically syncing (checking) my skills
  and knowledge with new developments?
• Teach others EBP skills
• Keep a record of your questions

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Limitations of EBP

• Limited scope of evidence-it will never be
  complete
• The quality of research available
• Keeping it patient centered, cost effective
• Evidence from Randomized Controlled Trials for
  real life patients
• Communicating uncertainties
• Decision making

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Table of Contents Part B

• HINARI Resources
• Clinical Evidence
• Cochrane Library
• EBM Guidelines
• BMJ Practice
• HINARI EBM Journals

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If you are interested in learning more about EBM,
go to the online tutorial Introduction to
Evidence-Based Medicine from the Health Sciences
Library, University of North Carolina
(USA) http//www.hsl.unc.edu/Services/Tutorials/e
bm/welcome.htm
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To access the HINARI Evidence-based Medicine
resources, we must Login to the HINARI website
using the URL http//www.who.int/hinari/
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Logging into HINARI 2
We will need to enter our HINARI User Name and
Password in the appropriate boxes, then click on
the Login button. Note If you do not properly
sign on, you will not have access to
Evidence-based Medicine resources that are
located in the Reference Sources drop down menu.
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From the HINARI Reference Sources A-Z list, we
also can find tutorials for learning more about
EBM. In this example, we will link to BMJ
Learning.
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From the BMJ Learnings Browse our modules
listing, we have clicked on Clinical Epidemiology
and located four EBM-related tutorials.
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From the Reference Sources A-Z list, there are
four valuable EBM- related sites. First, we will
click on the Clinical Evidence link, a resource
for informing treatment decisions and improving
patient care. It is published by the BMJ
Publishing group.
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In the Clinical Evidence site, you can search by
Sections, Full review list or (keyword) Search
this site. Also note that there is a Clinical
Evidence Userguide in multiple languages and
links to the Latest updated reviews.
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Using the Search this site option, we have
completed a keyword search for tuberculosis and
identified 73 documents. The links include
clinical evidence Guidelines, Keypoints,
Interventions and Updates about this topic.
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We have further limited this search by combining
tuberculosis and HIV. This has resulted in 56
documents. We will click on the link to
Tuberculosis in people with HIV.
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The initial page of HIV treating tuberculosis
initially displays Interventions based on
clinical questions. Note that also you have
access to Key points, About this condition,
Updates, Guidelines and References. We will
click on the Guidelines hyperlink.
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The Guidelines page contains the title, name of
organization and hyperlink to 10 documents from
key health agencies. The guidelines have been
sourced from the National Guidelines
Clearinghouse (USA).
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We have clicked on the Full review list option
and displayed the topics under the A alphabetical
list. This A-Z subject access contains an
extensive list of topics and clinical evidence
material.
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From the Reference Sources A-Z list, we now will
click on the Cochrane Library link. The Cochrane
Library contains high-quality, independent
evidence including reliable evidence from
Cochrane and other systematic reviews and
clinical trials. It is published by John
Wiley. Note the full-text reviews are available
to Band 1 only while Abstracts can be accessed by
all users.
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The Cochrane Library

• COCHRANE LIBRARY The Cochrane Collaboration.
  Oxford Update Software
• 1996-. Updated quarterly.
• Cochrane Database of Systematic Reviews (CDSR)
• High-quality pre-evaluated systematic reviews
  from all over the world
• International, not-for-profit organization
• Complete reviews and protocols (reviews that are
  still in progress)
• CDSR abstracts are in Medline but there is no
  link to full-text of the review
• Specific topics, explicit evaluation criteria to
  minimize bias

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The initial page of this site has a title,
abstract or keyword option Search engine. You
also can Browse Cochrane Database by broad
subject heading . The initial page also
highlights New and Updated Cochrane Reviews. We
will go to the Advanced Search. Also from the
initial page, there is a link to the Cochrane
Journal Club.
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We have opened the Advanced Search option where
you can specify search fields and have the
ability to combine terms using AND/OR/NOT
operators. In this text Advanced Search, we have
combined diarrhea child using the Search All
Text option with the wildcard () used to locate
the terms child and children. Note that you also
can complete a MeSH Search, look at your Search
History or Saved Searches.
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The Advanced Search results for diarrhea child
has retrieved 451 records from the Cochrane
Database of Systematic Reviews. You have the
option to Export All Results (save). Note if the
results of your search are too many, you can
narrow it by limiting the keyword search to Title
instead of Search All Text.
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The screen displays the Abstract of the first
systematic review listed in the search - Oral
zinc for treating diarrhoea in children. To
access the full-text review, click on the Full
PDF hypertext link in the left column. Other
options are Summary and Standard. Also note the
hypertext links to specific sections of the
systematic review.
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We have displayed the Abstract of the systematic
review that includes the Background, Objectives,
Search strategy, Selection criteria, Data
collection and analysis and Main Results.
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The final section of the Abstract is titled Plain
language summary. This section is useful for
disseminating the results to groups of health
workers and patients. Also note the Main results
and authors conclusions (the bottom line) as
these sections discuss the reviews results and
how they should be used.
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We have displayed the PDF Full version of the
Oral zinc for treating diarrhoea in children
systematic review. Other options include Summary
and Standard files. Note The url that contains
http//hinari-gw.who.int/whalecom... shows that
we have logged in to HINARI properly and will
have access to the full-text version of this
review.
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From the Advanced Search page of the Cochrane
Library, we have clicked on the Cochrane Reviews
By Topic hyperlink. This has displayed the
Topics for Cochrane Reviews. From this extensive
list, you have another option for locating
subject- specific material. Note that there are
other search lists including an A-Z list, Updated
Reviews and New Reviews.
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For more training material, you can click on The
Cochrane Library Help hyperlink. We have opened
the Search Manual. Another option is a listing
of Web Updates.
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Cochrane LibraryAccess to the Abstracts is free
from a link at
www.cochrane.org/cochrane-reviews
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After accessing the Cochrane Collaboration
(http//www.cochrane.org/), click on the Cochrane
Library link. This will give you access to the
Librarys search options and the abstracts but
not the full-text articles.
Click here
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We now access the third Reference Sources option
for evidence-based health information - EBM
Guidelines.
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This is the initial page of EBM Guidelines
Evidence-Based Medicine. Also published by John
Wiley, this resource is a collection of clinical
guidelines for primary care combined with
evidence-based research. You can Search by
keyword or Browse database contents by EBM
Guidelines, Evidence summaries, Pictures, Audio
samples, Videos and Programs.
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We have completed a keyword search for Influenza.
The results page includes summaries of the key
issues including Related resources and References
and links to important websites. Also included
are links to the Evidence summaries.
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We have displayed the first Evidence summary.
Each link contains a brief review of the study
and notes the reference(s).
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We now access the fourth Reference Sources option
for evidence-based health information BMJs
BestPractice a combination of research
evidence, guidelines and expert opinion.
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We have completed a keyword search for diabetes.
Note the drop down menu with the broad category
results of the search.
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The results for the diabetes search are displayed
in broad subject categories. Note that each
category contains full-text documents on the
Highlights, Basics, Prevention, Diagnosis,
Treatment, Followup and Resources.
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HINARI Evidence-Based Journals(other journals
may have EBM articles)
We have browsed the E in the HINARI Find
journals by title list and it notes several
journals for evidence-based practice.
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Table of Contents Part C

• Other (Internet) Resources
• HINARI/PubMeds Clinical Queries (Clinical Study
  Categories Systematic Reviews citations) and
  Type of Article Limits (Meta-Analysis,
  Randomized Control Trial Clinical Practice)
• PubMed Health clinical effective research
• Trip Database
• Evidence Updates - BMJ and McMaster University
• Knowledge Translation Learning Modules Canadian
  Institutes of Health Research
• Essential Health Links gateway annotated links
• Other useful websites
• Summary

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Table of Contents Part C

• Other (Internet) Resources
• PubMeds Clinical Queries and Type of Article
  Limits
• Systematic Reviews (BioMed Central)
• Clinical Practice Guidelines definition
  examples
• Cochrane Library Abstracts
• PubMed Health clinical effective research
• Trip Database
• Evidence Updates - BMJ and McMaster University
• Knowledge Translation Learning Modules Canadian
  Institutes of Health Research
• Essential Health Links gateway annotated links
• Johns Hopkins POC-IT Guides
• Other useful websites

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We now search for evidence-based articles using
PubMed. From the main HINARI webpage, go to
PubMed by clicking on Search inside HINARI
full-text using PubMed. Remember you must login
to HINARI to have access to the full-text
articles.
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Open the Clinical Queries box. This search tool
assigns filters to keyword searches - to locate
articles on Clinical Studies, Systematic Reviews
and Medical Genetics. Note for these PubMed
applications, all individuals will have access to
the free full text articles. The examples are
from HINARI/PubMed searches and, for those
properly logged in, will also include access to
articles from HINARI participating publishers.
74
On the PubMed Clinical Queries page, we have
entered the type 2 diabetes AND developing
countries search.
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The default search results for the Clinical Study
Categories are Category Therapy and Scope
Broad. Other options in the Category drop down
menu are Etiology, Diagnosis, Prognosis and
Clinical Prediction Guides. There are 142
articles for Therapy Broad and 20 articles for
Systematic Reviews. Note you can go directly to
PubMed Clinical Queries.
The direct link to PubMed Clinical Queries is
http//www.ncbi.nlm.nih.gov/pubmed/clinical
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For the Scope option, we will enter Narrow and
for the same type 2 diabetes AND developing
countries search.
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The Therapy (Category) and Narrow (Scope) type 2
diabetes AND developing countries search has
resulted in 11 citations. We now will click on
the See all option (bottom of the page). Note
that the results for Systematic Reviews and
Medical Genetics also are displayed.
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We have displayed all 11 articles for this search
including 7 HINARI and 8 Free Full Text
articles. Remember - you can access the
full-text articles by clicking on these Filters
or changing the display from Summary to Abstract.
Note that the specific search is listed in the
Search box including the AND (Therapy/Narrowfilte
r) for clinical studies categories and
systematic reviews.
79
We have clicked on the See all option for the
systematic reviews results. The type 2 diabetes
AND developing countries AND systematic sb
search resulted in 20 articles.
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If you have a MY NCBI account, you can add
Meta-analysis, Randomized Control Trials and
Systematic Reviews to your Filters. Go to Manage
Filters, click on Properties option and put each
term in the Search with terms box. When you save
a PubMed search, you will be sent an email
listing new articles on the specific topic with
these filters. Remember that you will need to go
to HINARI to get the full-text articles. In this
example, Free Full Text, HINARI, Meta-analysis
and Systematic Reviews are listed in Filters.
81
Another tools from PubMed is using the Filters
option see left-column. We have checked the
Meta-Analysis box in the Article Types section
and entered hypertension in the PubMed Search
box. The search Results number is 1239. Note the
Filters activated Meta-Analysis line below the
Results number. Filters can be activated from
any search results page. Remember to clear them
before beginning other searches.
82
Now displayed are the results of a hypertension
search with the Systematic Reviews Article Type
filter activated. The citations for this search
include 1158 Free Full text and 2368 HINARI
articles.
83
Now displayed are the results of a hypertension
search with the Randomized Controlled Trial
Article Type filter activated. The citations for
this search include 2862 Free Full text and 6667
HINARI articles.
84
The final displayed search are the results of a
hypertension and developing countries search
with the Meta-Analysis, Systematic Reviews and
Randomized Controlled Trial Article Type filters
activated. The citations for this search total 64.
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Definition Clinical Practice Guidelines

• "Clinical practice guidelines are systematically
  developed statements to assist practitioner and
  patient decisions about appropriate health care
  for specific clinical circumstances" (Institute
  of Medicine, 1990)

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Overview of Guidelines

• Describe a range of generally accepted approaches
  for the diagnosis, management, or prevention of
  specific diseases or conditions
• Define practices that meet the needs of most
  patients in most circumstances
• Are recommendations that are based on evidence
  from a rigorous systematic review and synthesis
  of the published medical literature
• Primarily for use by clinicians--physicians,
  nurses, and other health professionals in
  clinical practice

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Using the Filters option, we now will activate
the Practice Guideline Article types filter and
enter malaria treatment in the PubMed Search
box. You can click on more than 1 box in the
Article types section. The results of this search
are 31 citations. Note the Limits Activated
Practice Guidelines text below the results line.
Remember that you must remove this before
beginning another PubMed search.
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apps.who.int/medicinedocs/documents/s16427e/s16427
e.pdf
Examples of Clinical Practice Guidelines
documents from the Kenya, South Africa and
Uganda.
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www.health.go.ug/docs/ucg_2010.pdf
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www.kznhealth.gov.za/research/guideline2.pdf
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Additional CPG resources

• National Guideline Clearinghouse (USA)
• http//www.guideline.gov/
• Open Clinical Clinical Practice Guidelines
• http//www.openclinical.org/guidelines.html
• About Clinical Practice Guidelines
• http//www.nhlbi.nih.gov/guidelines/about.htmwhat
  
• John Hopkins POC-IT Guides ABX, Diabetes and HIV
• http//www.hopkinsguides.com/hopkins/ub

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We have opened the initial issue April 2012 -
of Systematic Reviews, an open access journal
published by BioMed Central. This and subsequent
issues can be access from the above url.
93
We have opened the initial page to the Johns
Hopkins POC-IT Guides ABX, Diabetes and HIV
Guides. These are evidence-based clinical
decision resources that are commercial products
but the material is available online for free.
94
We have opened the Johns Hopkins ABX Guide for
infectious diseases. Note that there is an A-Z
Topics list and also a keyword search engine.
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PubMed Health specializes in reviews of clinical
effective research which finds answers to
What Works in medicine and health care. It is
based on systematic reviews of clinical
trials. PubMed Health is a service provided by
the National Center for Biotechnology Information
(NCBI) at the U.S. National Library of Medicine
(NLM).
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From the Contents drop down menu, you can access
PubMed Healths information in the following
categories For consumers, Executive summaries,
Clinical guides and Full text reviews. We will
open the Executive summaries option. Note also
that PubMed Health contains a Medical
encyclopedia.
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The Executive Summaries Results is organized via
an A-Z alphabetical listing. This format also is
used for the other options in the Contents drop
down menu. We have entered HIV AND pregnancy in
the keyword search box.
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For the HIV AND pregnancy search, there are 368
Results displayed in PubMed Health. The initial
display is in the Summary format. By clicking on
the title, the Abstract will be displayed. The
Refine your search option organizes the results
by the categories in Contents drop down menu.
Also note the Medical Encyclopedia links to key
concepts in the search results.
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When available, PubMed Health contains links to
full-text documents. Displayed in this slide are
the titles from the H listing for the Full Text
Reviews. We will open the HIV in Pregnant Women
document.
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The Full Text Review contains a Structured
Abstract and then links to the various sections
of the Review (next slide).
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We have displayed the AIDS (Acquired immune
deficiency syndrome) definition from the A.D.A.M.
Medical Encyclopedia.
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Trip Database is a clinical search tool for
health professionals to identify quality clinical
evidence for clinical practice. It allows
simultaneous searching of multiple sites which
speeds up the question answering process.
Registration is required but free and gives the
users additional resources.
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We have completed a search for malaria AND
bednets. The results are displayed with, in some
cases, links to Full Text.
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Preview goes to source in this case PubMed We
have completed a search for malaria AND bednets.
The results are displayed with, in some cases,
links to Full Text.
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Fulltext goes to journal The Lancet Infectious
Diseases and will be asked to pay for the
article. Need to copy citation and go to HINARI
A-Z journals list We have completed a search for
malaria AND bednets. The results are displayed
with, in some cases, links to Full Text.
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For this search, we checked 4 boxes and now will
Export selected links as a CVS file.
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The report is displayed as an Excel spreadsheet
with the title, url, publication and date of each
checked citation. Access to full-text journal
articles will depend on whether they are free
full text articles or if your institution is
eligible for HINARI or has a subscription.
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We have displayed the Advanced Search for the
trip database.
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EvidenceUPDATES contain a searchable database, an
email alerting system and links to selected
evidence-based resources. Registration is
required but free.
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We have entered chloroquine resistance in the
tools search box.
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For this search there are 14 matches that note
the citation information plus type of article
(e.g. Review, Original). Access to the full-text
article again will be if it is a free full text
one or your institution has access via HINARI or
a subscription.
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EvidenceUPDATES contain options to Download
Citations including to several commercial
reference manager softwares. We will download to
the Text File option.
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In the Text File option, the abstracts for the
checked results are listed in a Notepad file.
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EvidenceUPDATES also contains an Advanced Search
option that initially is based on disciplines,
categories and populations. From the drop down
menu, subcategories for each broad discipline
will be displayed.
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The Canadian Institutes of Health Research web
site contains four Knowledge Translation Learning
Modules. Several of these online courses are
relevant for evidence based practice and use of
knowledge to make informed health decisions.
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The Essential Health Links gateway contains
annotated links to numerous Evidence-Based
Medicine resources available on the Internet.
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We have opened the initial page to the Johns
Hopkins POC-IT Guides ABX, Diabetes and HIV
Guides. These are evidence-based clinical
decision resources that are commercial products
but the material is available online for free.
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We have opened the Johns Hopkins ABX Guide for
infectious diseases. Note that there is an A-Z
Topics list and also a keyword search engine.
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Additional Evidence-based Health Resources

• Bandolier Knowledge Oxford University
• http//www.medicine.ox.ac.uk/bandolier/knowled
  ge.html
• The Campbell Library http//www.campbellcollaborat
  ion.org/library.php
• DARE Database of Abstracts of Reviews of Effects
  http//www.crd.york.ac.uk/crdweb/
• Duke University Medical Center Library EBM
  http//www.mclibrary.duke.edu/subject/ebm?tabcont
  ents

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• EBM Librarian
• https//sites.google.com/site/ebmlibrarian/
• McMaster PLUS collection http//hiru.mcmaster.ca/h
  iru/HIRU_McMaster_PLUS_projects.aspx
• National Guidelines Clearinghouse
• http//www.guideline.gov/
• Nesbit Guide Evidence-Based Resources
• http//www.urmc.rochester.edu/hslt/miner/digital_l
  ibrary/evidence_based_resources.cfm

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Review/Summary

• Evidence-based practice depends on knowing the
  most recent, valid scientific knowledge.
• This involves finding the best studies.
• Sometimes others have evaluated the quality of
  the studies, including methodology many new
  evidence-based tools mentioned in this tutorial
  provide evaluation.

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• When there is no evaluation available, it is
  essential to evaluate the validity of the study.
• Tools for evaluating studies can be found in the
  Evaluating the Evidence section in the EBM
  tutorial mentioned earlier and found at
• http//www.hsl.unc.edu/Services/Tutorials/ebm/welc
  ome.htm

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• It is always important to consider studies in
  terms of applicability to and values of the local
  patient/situation.
• Evidence-based practice is a developing field and
  new, useful resources are continuously being
  developed.

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Appendix 1

• Appendix 1 Contains four case studies for
  developing Evidence-Based Practice curriculum
  experimental cancer research, EBP curriculum
  for pharmacy students, health literacy for
  pharmacy students and outreach activity for
  early intervention providers
• Developed byIrena Bond, Library Manager
  Associate Professor of Library and Learning
  ResourcesMassachusetts College of Pharmacy and
  Health Sciences

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Research Evidence

Practitioners Experience Local Conditions
Patient/Community Preferences Values

• This is the end of the Evidence-based Medicine
  for HINARI Users module.
• The material initially was developed by Gale G.
  Hannigan, PhD, MLS, MPH Professor Medical
  Informatics Education Librarian, Texas AM
  University.
• Material revised and enhanced by Irena Bond,
  Library Manager, Associate Professor of Library
  and Learning Resources, Massachusetts College of
  Pharmacy and Health Sciences.
• There is a workbook that accompanies this module.
  The workbook will take you through a live session
  covering the topics included in this
  demonstration with working examples.
• Updated 2012 07