evidence based practice for nmahp fellowship programme
TRANSCRIPT
Trainer: Isatou N’jie
Knowledge and Library Services
Barts Health NHS Trust
Introduction to Evidence Based
Practice for NMAHP EBP Fellows
12th January 2015
Objectives
• Identify the type(s) of information you might need for Evidence
Based practice
• What is the purpose of evidence-based practice, the hierarchy of
evidence and the key steps of evidence based practice?
• Be aware of the coverage and content of the health databases
• Understand how to search the key databases electronically
• Plan a search strategy using the PICO formula
• Run a search query on one of the EBP resources
The Purpose of Evidence-Based Practice • Aim: To deliver high-quality care to an individual patient.
• Means integrating clinical expertise with up-to-date information
from clinically relevant research in making decisions about the
care of individual patients.
• To achieve this, health care professionals must therefore keep up
to date with new perspectives on care and they must learn to adopt
a process of evidence-based practice that is open to scrutiny by
their peers and the public
• They need to be able to critically evaluate ideas and experiences
and apply what they have learnt to their practice
Hierarchy of Evidence
Filtered
Information
Unfiltered
Information Qu
ali
ty o
f th
e E
vid
en
ce
• Systematic reviews and meta-analyses constitute a comparative analysis
of research and are at the apex of the pyramid.
• The systematic review of several randomized trials has become the “gold
standard” for judging whether a treatment does more good than harm.
1. Ask a searchable clinical question;
2. Find the best evidence to answer the question;
3. Critically Appraise the evidence;
4. Apply the evidence with clinical expertise, taking the patient's
wants/needs into consideration;
5. Evaluate the effectiveness and efficiency of the
process.
The 5 steps of EBP
PICO
Population
(Patient/Problem)
What are the most important characteristics of the patient? This may include
the primary problem, disease, or co-existing conditions. Identify the main
concepts and alternative terms
- Deep vein thrombosis, DVT, Venous thrombosis, prophylaxis
Intervention
(drug, procedure,
diagnostic test,
exposure)
Which main intervention are you considering?
- Compression stockings, pressure stockings
What factor/s may influence the prognosis of the patient? - Sex, Age, Co-
existing problems? What was the patient exposed to?
Comparison
What are the main alternatives to compare with the intervention?
Are you trying to decide between two diagnostic tests or no medication?
Outcome
What can you hope to accomplish, improve or affect?
What are you trying to do for the patient? Relieve, eliminate the symptoms,
Prevent or reduce the risk?
Scenario: Are compression stockings effective in preventing deep vein thrombosis?
Developing a Search Strategy
Take your PICO and find keywords:
• Synonyms/ Spelling variations
e.g. Deep vein thrombosis, DVT, Venous thrombosis
Compression stockings, pressure stockings
• Boolean logic i.e. AND , OR , NOT
e.g. Venous thrombosis AND Compression stockings (will find
documents containing both of your terms) OR will find documents with
either one term or the other term
• Phrase searching use "inverted commas" to search for phrases
e.g. “Deep vein thrombosis”
• Truncation * (asterisk) use to search for word stems, e.g. compres*
- compression, compress, compressing
Resources to find ‘Best Evidence’
Knowledge and Library Services
http://bartshealth.nhslibraries.com
You will need an NHS Athens
Username and Password to use
the databases. You can self-register
for an Athens account online
Click on the “Athens Registration”
and follow the link to register online.
If you already have an Athens account
start your search by clicking on
NHS Evidence.
NHS Evidence - Advanced Search NHS Evidence - http://www.evidence.nhs.uk/ Click on the link to
“Journals and Databases”
Healthcare Database Advanced Search (HDAS) provides access to an
extensive set of journals and bibliographic databases via Athens.
Login via Athens and search one database at a time for the best results – tick
to select a database then click on ‘Search’.
Cochrane Database of Systematic Reviews
Cochrane Library - http://www.thecochranelibrary.com
The Cochrane Database of Systematic Reviews (CDSR) is the
leading resource for systematic reviews in health care. The
Clinical Answers tool offers practical evidence for healthcare
decision-making.
Each clinical answer is
linked to a clinical question
and you can ‘drill down’ to
the evidence from relevant
Cochrane reviews.
TRIP Database
TRIP Database - http://www.tripdatabase.com/search
Trip is a clinical search engine which allows users to conduct a PICO
search. It simultaneously searches evidence-based sources of
systematic reviews, practice guidelines, and also searches
MEDLINE’s Clinical Queries,
medical image databases, videos
and patient information leaflets.
Search Results:
Systematic reviews
Guidelines
Evidence Based Synopsis
Controlled Trials
Countries
Critical Appraisal Is the process of carefully examining research to judge its trustworthiness, value and
relevance in a particular context (Burls, 2009)
Clinical Define the Search Appraise Decide Evaluate
Problem Question
PICO Tool Finding the Evidence Critical Appraisal
• Who is the Author?
Often we come across news articles that make unjustified scientific/ medical claims.
• Is the study valid? The first step is to decide whether the study was unbiased by evaluating its methodological
quality.
• What are the results? Are the study’s results clinically important. e.g. did the experimental group show a significantly
better outcome compared with the control group?
• Are the results useful? How does the evidence apply to your question? e.g. Is it likely that your patient or population
may have different characteristics to those in the study?
Check lists are commonly used for the critical appraisal of different study designs:
http://www.sign.ac.uk/methodology/checklists.html#
http://cebmh.warne.ox.ac.uk/cebmh/education_critical_appraisal.htm
Practical Exercise
Thank you for your attention!