Finding the Evidence: Search Basics

Ilo-Katryn Maimetsilo@yorku.ca

416-736-2100 x33927Steacie Library room 102K

Evidence-Based Health Care

“The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making”

(Sackett et al., 2000)

AGENDAA. Sources of Information – Library website

a. Databases & More

B. Study Design – Hierarchy of Evidence C. Conducting a Literature Search

a. Search tips and Boolean Logicb. Keyword searchingc. Subject heading searching

D. Steps in Evidence-based practiceE. Levels of Pre-Appraised Evidence

• Select Sources that will most likely answer the question: – If the information is most likely found in Medical or

Nursing research journals then start your search in a database that indexes that kind of research:

• Cinahl (Nursing and Allied Health)• Medline(OVID) and PubMed• SCOPUS (interdisciplinary - indexes part of Embase)• Web of Science (very interdisciplinary)

– Note that sometimes relevant research is indexed in: • PsychINFO (psychology)• Eric (education)

A. Identify Sources of Information

A. Sources of Nursing Information in the York Library Website:www.library.yorku.ca

Access the Research Guides

Research Guides• Use the Research Guides to locate:

– General/Getting Started: Dictionaries, Encyclopaedias and e-books

– Articles/Finding articles: • Links to Databases • Systematic Reviews and Evidence-based Practice

Resources

– Advanced/Advanced Research:• Association and organizations • Webguides and other resources

– Other Related Research Guides and Resources

Nursing Research Guide

http://researchguides.library.yorku.ca/nursing

B. Study Design: The hierarchy of Evidence

Study Designs: descriptive and analytic

Centre for Evidence Based Medicine, University of Oxford http://www.cebm.net/index.aspx?o=1039

Hierarchy of Evidence: Study Designhttp://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2289252

Connie Schardt, Medical Centre Library, Duke University

Cohort Studies

Systematic Reviews

Meta Analyses

Case Control Studies

Case reports / case series

Randomized Controlled Trials

Secondary studies which review original research

Experimental designs

Observational reports and studies

Case Reports• Reports of observations of diseases, adverse

reactions or unexpected events – E.g. observations in the 1980s of a rare cancer

combined with pneumonia led to the discovery of HIV-AIDS

• However, there are no controls and so there is no statistical validity, and you cannot draw conclusions or make statistical comparisons.

Case Control Studies

• These are used to examine Harm questions– Begin with an outcome or issue – Look backwards in time to identify a possible

exposure, or risk factor– E.g. observations of lung cancer incidence in the

1950s led to an examination of patient records that uncovered links to cigarette smoking

Peto R. Darby S. Deo H. Silcocks P. Whitley E. Doll R. (2000) Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 321(7257):323-9.

Case Control Studies

• Are quick, inexpensive, convenient and ethical because the patient already has the condition.

• However, evidence is based on recall which may be biased, or on past records which may not be complete because they were created before knowing what the questions were.

• There may be confounders that are common to both groups

• It is difficult to choose appropriate controls.

Cohort studies• Involve 2 or more populations:

– Exposed: having a specific condition or receiving a particular treatment over time

– Non-Exposed: group that has not been affected by the condition or treatment being studied

• Follow the populations forward in time – sometimes for many years to determine the effect of the exposure.

• E.g. long-term effectiveness of influenza vaccines in community dwelling elderly people

Nichol KL, Nordin JD, Nelson DB, Mullooly JP, & Hak E. (2007). Effectiveness of influenza vaccine in the community-dwelling elderly. New England Journal of Medicine, 357(14):1373-1381.

Cohort studies• Observations are of people in their natural

settings• Evidence is strengthened by natural time

sequence – exposure occurs before the outcome

• Ethical in that patients self-select (this may also be a source of bias)

• Possible confounders• Long follow-up – often many years even

decades.

Randomized Controlled Trials

• True experimental design that introduces a therapeutic randomized/control-placebo intervention

• Follows subjects forward in time to determine the effects of interventions

• Randomization is key and involves randomly assigning individuals to groups

• Less prone to bias, best for establishing efficacy• May present ethical dilemmas • Is very expensive and time-consumingMüller O, Traoré C, Kouyaté B, Yé Y, Frey C, Coulibaly B, et al. (2006). Effects of insecticide-treated bednets during early infancy in an African area of intense malaria transmission: A randomized controlled trial. Bulletin of the World Health Organization, 84(2):120-126.

Systematic Reviews

• Secondary research that:– Focusses on a clinical topic– Involves a thorough review of the literature,

published and unpublished– Studies are subject to detailed scrutiny of their

quality for inclusion– Summarizes data for drawing conclusions that

inform practice.Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005312.

Meta Analysis

• Mathematically/statistically pools the data from individual studies – Sources of data can be the articles included in a

systematic review or from otherwise selected primary studies, both peer-reviewed and grey literature

• Present results as if it were from a large studyBahekar AA, Singh S, Saha S, Molnar J, Arora R. (2007). The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis. American Heart Journal, 154(5): 830-7.

Systematic Review/Meta Analysis

• Exhaustively reviews the current literature• Articles are critically evaluated for inclusion• Pooled data allows validation of findings in small

studies• Publication bias may be a problem as negative results

are less often published than positive results• Conducting them is very time consuming and so also

expensive• Data parameters and collection methods are not

always the same from study to study, and so studies cannot be easily combined.

Study Design: Hierarchy of Evidencehttp://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2289252

Connie Schardt, Medical Centre Library, Duke University

Cohort Studies

Systematic Reviews

Meta Analyses

Case Control Studies

Case reports / case series

Randomized Controlled Trials

Secondary studies which review original research

Experimental designs

Observational reports and studies

Qualitative vs. Quantitative

• EBP started as part of medicine to determine best practices in quantitatively measurable procedures, effects, etc. However, in nursing, many questions are asked that cannot be answered by quantitative data. – For example: what is the lived experience of

women identified as carriers of the BRCA gene? • In most EBP rating scales, qualitative evidence

is deemed to be low on the scale for quality and validity

Quantitative Study Designs based on question type DiCenzo, Guyatt, Ciliska, 2005, pg 28

1. Healthcare interventions: treatment, prevention, therapy

2. Harm: causation or etiology3. Prognosis: future course of the condition4. Diagnosis/assessment5. Economics: economic efficiency of healthcare

programs or interventions

Qualitative Study Designs: DiCenzo, Guyatt, Ciliska, 2005, pg 32

• Case studies: involves studying a number of related cases in depth to inquire into an observed phenomenon. The belief is that understanding them will lead to a deeper understanding of a larger collection of cases.

• Ethnography: involves studying people within a culture in an intensive, ongoing, participatory way. The researcher is immersed in the culture for the duration of the study.

Qualitative Study Designs: DiCenzo, Guyatt, Ciliska, 2005, pg 32

• Grounded Theory: involves discovering meanings that people assign to people and objects or situations that they interact with. The purpose is to develop a theory to account for individual differences. Interviews and observation are used to collect data

• Phenomenology: examines the daily lived experience of people. Data are collected through in-depth interviews.

Qualitative Systematic Reviews:

• Do not use statistical methods to combine findings and data

• Adhere to a systematic process for retrieving sources, selecting sources, and critiquing sources

• Their purpose is to synthesize the findings from multiple studies, and this process is called Meta-synthesis.

Levine and Feldman, 2006, pg 178

Qualitative Meta-Syntheses:

• Uses data from different qualitative studies that are linked because they are about the same or a related by topic. The methodologies used can be different.

• Is neither an integrated review nor a secondary analysis of primary data.

• Rather it is an analysis of the findings of these studies

Integrative Reviews:

• Are similar to qualitative systematic reviews, however, they use broader, often less rigorous methods to systematically combine the results of a body of studies. Stevens, 2002, pg 530

• “The integrative review method is an approach that allows for the inclusion of diverse methodologies (i.e. experimental and non-experimental research) and has the potential to play a greater role in evidence-based practice for nursing”

Whittemore, 2005, pg 547http://users.phhp.ufl.edu/rbauer/ebpp/whittemore_knafl_05.pdf

Realist Syntheses:• Focus is on understanding and analyzing the

mechanisms by which an intervention works or fails to work

• Provides an explanation rather than a judgement about implementation and success of an intervention

• Accounts for not just outcomes but also context of the intervention

• By nature, RSs are well suited to complex implementation interventions

Realist Syntheses:• Implementation interventions are by nature

complex and multi-faceted. • When developing and implementing an

intervention, there is an underlying theory about how it should work.

• Deterministic theories cannot always explain or predict implementation outcomes in every context.

http://www.ccsr.ac.uk/methods/publications/RMPmethods2.pdf

Narrative Synthesis:• Method to synthesize research in the context of

systematic reviews that uses a narrative approach to summarize findings.

• Does not exclude numerical analyses and can occur alongside Meta-analyses

• Combines heterogeneous studies, and has not (yet) been developed according to consensual structurally and thematically coherent framework to describe a complex body of evidence

What kind of study is this?

Good place to start – not exhaustive

Health Sciences Library, McMaster University.

Tips for Searching for the Evidence [Internet] [cited 2012 1/8/2012]. Available from: http://hsl.mcmaster.ca/education/nursing/ebn/search.htm

C. Conducting a Literature Searcha. Search tips and Boolean Logic

The logic of searching - Tips

• Booleans, Brackets, Truncation, Quotation marks– These features apply to most but not all Health

and Science Databases– If you are not sure, always check the Help Menu to

see the syntax for the database you are searching

The logic of searching

Use Boolean Logic to put together your search terms:

AND OR NOT

Boolean Logic: AND

AND: Finds those citations that contain both search terms joined by AND

AND is used to find the intersection of different concepts

isolation AND depression

Boolean Logic: AND

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isolation AND depression

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Boolean Logic: OR and brackets: ()

OR: Finds citations with ANY search terms joined by OR

OR is used to join synonyms and related terms of the same concept:

isolation OR quarantineread: either isolation OR quarantine OR bothN.B. use brackets if you have more than one

term for a concept: (isolation OR quarantine)

Boolean Logic: OR

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(isolation OR quarantine)

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Boolean Logic: NOT

NOT: Finds citations that DO NOT contain these search terms (check the database syntax to see what is used for the exclusion term e.g. some use BUTNOT)

NOT is used to exclude a set of results when you find that you are too many false hits on an unrelated topic

(Isolation OR quarantine) NOT seclusion

Boolean Logic: NOT

QuarantineIsolation

Seclusion

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Truncation and Wildcard• Truncation symbol: * To use truncation, enter the root of a

search term and replace the endings with an *. – Example: typing nurs* will find the words nursing, nurse, or

nurses as well as nursery, nurseries etc.

• Wildcard symbol: ? To use the wildcard, replace each unknown character with a ?. – For example, type wom?n to find all citations containing woman

or women. – NB: the wildcard replaces a single character, so behavio?r will

only retrieve behaviour and not behavior because the number of characters do not match

• Note that different databases may have different symbols and techniques for Wildcard and Truncation

Phrase searching• MEDLINE and CINAHL- the search: well being will find

well and being anywhere in the text fieldsIn Medline, to find the phrase well being search: well being Searching well adjN being will find articles where well and being are within N words from each other in any orderIn CINAHL, to find the exact phrase well being search: ”well being”

Different databases may have additional operators such as Adjacency Operators – check the Help Files for these

Boolean Logic: Test Example

Which phrases would you find with the search:Isolat* AND depress*

1. Isolation is associated with falls2. Quarantine is required for SARS3. Isolation can trigger depression4. Isolation is associated with adverse effects5. Is depression an outcome of isolation?

Test Example

Which article(s) would you find with the searchIsolat* OR quarantin*

1. Patients with MRSA are isolated2. In vitro protein isolation 3. Quarantine prevents the spread of rabies4. DNA purification is a complex process5. Both isolation and quarantine can have

detrimental effects on emotional well-being

Use Brackets to Group Together Search Terms

Which phrases would you find with the search:

(isolat* OR quarantin*) AND (depress*) NOT seclu*

• Isolation can lead to depression• Quarantining patients with MRIs can trigger depressive

symptoms • Rabies was isolated from quarantined raccoons • Does severe depression warrant seclusion?

Conducting a Literature Search1. Identify a problem for investigation 2. Develop a structured research question 3. Identify key concepts in the question4. Develop a Keyword search strategy by identifying

searchable terms: a) Find keywords: synonyms & related terms for each conceptb) Combine with Boolean Logic

5. Subject Heading Search – using MeSH or equivalent6. Select sources of evidence e.g. databases7. Test search with vocabulary suitable to the database8. Modify your search strategy if necessary9. Run the search10. Retrieve articles and appraise them for suitability

Define the Problem

• Determine a Problem that you want to investigate:

• Example Problem:Current practice requires that patients with multidrug-resistant infections be place in isolation. However, isolation has recently been associated with adverse effects on patients’ mental well-being.

Ask a Structured Question

• Develop a Question that will focus the information you will be gathering

• Example Structured Question:Does patient isolation increase the

incidence of depression?

Identify Key Concepts

• What are the main concepts in your question?Does patient isolation increase the incidence of depression?

Concept 1: patientConcept 2: isolationConcept 3: depression

C. Conducting a Literature Searchb. Keyword searching

b. Developing a Search Strategya. Identify keywords from the concepts

Q: Does patient isolation increase the incidence of depression?

Concept 1:Patient

Concept 2:Isolation

Concept 3: Depression

Quarantine Mental healthMental wellbeingMental well beingMental well-beingPsychological impact

4. Develop a KW Search Strategy

• Combine synonyms within each concept with OR:

Concept 1:patientConcept 2:isolation OR quarantineConcept 3:depression Concept 3a: mental OR psychologicalConcept 3b: health OR wellbeing OR well-

being OR well being OR impact

Develop a Search Strategy

• Identify alternate endings for each word:

Concept 1:patient[s]Concept 2:isolat[ion, ed] OR quarantin[e, ed] Concept 3:depress[ion, ed] Concept 3a: mental[ly] OR psycholog[y, ical,

ically] Concept 3b: health[y] OR health[y] OR wellbeing OR well-being OR well being OR impact

4. Develop a KW Search Strategy • Replace different endings with truncation symbol *

and insert quotation marks to search for phrases:

Concept 1:patient*Concept 2:isolat* OR quarantin*Concept 3: depressi* Concept 3a: mental* OR psychologic*Concept 3b: health* OR wellbeing OR well-

being OR “well being” OR impact*

4. Develop a KW Search Strategy

Patient* AND (Isolat* OR quarantin*) AND (depressi* OR ((mental* OR psychologic*) AND (wellbeing OR “well being” OR well-being OR health* OR impact*)))

N.B. Make sure all of your brackets “add up” Run this search in all the databases you have selectedN.B. Some databases don’t support nested Booleans

Run your search!

Set Limits• If you find you get

very many results, chances are that a systematic review has already been conducted to synthesize the evidence.

• Limit your search to the available limits OR select Additional Limits to focus your search

C. Conducting a Literature Searchc. Subject heading searching

Medical Subject Headings (MeSH)

• Make searching in MEDLINE so powerful.• MeSH are specific terms that are used to index

articles in MEDLINE. – They are hierarchically organized and linked to express

the specificity of topics so that narrower terms are more granular, and broader terms are more general.

– They provide a consistent way to find articles that are about the same topic but use different terminology.

• CINAHL also features MeSH headings as well as CINAHL subject headings

Subject Heading searching:Medline and CINAHL

Keyword search:

Citations Cancer Neoplasms Tumor Tumour Tumours

cancer

GERD Abstract mentions esophageal cancer

Subject Heading searching:Medline and CINAHL

Keyword search:

Citations Cancer Neoplasms Tumor Tumour Tumours

cancer

Map to SH

GERD Abstract mentions esophageal cancer

Subject Heading searching:Medline and CINAHL

Keyword search:

MeSH

neoplasms

Citations Cancer Neoplasms Tumor Tumour Tumours

cancer

Map to SH

GERD Abstract mentions esophageal cancer

Strategy for Subject Searching in Medline and CINAHL:

– Identify each concept in the topic and its synonyms – Search one term (KW) at a time to find Subject

Headings that match the concepts• combine subject headings for one concept with OR• combine Different concepts with AND

– Initially try to keep your search broad to ensure that you find enough relevant articles.

– Once you have determined how many results you have and assessed their quality, you can refine your search with

• subheadings AND/OR limits

Medline(Ovid) Clinical Queries

• Reviews • Therapy • Diagnosis • Prognosis • Causation-Etiology • Economics • Clinical Prediction

Guides • Qualitative • Costs

• Maximizes sensitivity• Maximizes specificity• Best balance of

sensitivity and Specificity

Databases: PubMed• Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical

– Results of searches are limited to specific clinical research areas:

• Clinical Study Categories:– Therapy – Diagnosis– Etiology– Prognosis– Clinical Prediction guides

• Two types of retrieval emphasis:– specific – sensitivity

Databases: CINAHL (EbscoHost)

• Clinical Queries include:– Therapy – Prognosis – Review – Qualitative – Causation (Etiology)

• Emphasis – strategies– High sensitivity– High specificity– Best Balance

Databases: EBM Reviews(Ovid)

• Includes six databases: – Cochrane Database of Systematic Reviews; – Cochrane Central Register of Controlled Trials; – Cochrane Methodology Register; – Database of Abstracts of Reviews of Effects; – Health Technology Assessment Database; – NHS Economic Evaluation Database

• Search with keywords

Manage your references with RefWorks (Medline)

Step 1: Select a reference by clicking in the checkbox

Step 2: click Export in the toolbar

Step 3: This opens a window for exporting directly to RefWorks

Step 4: Click Save The RefWorks Login window will open

Step 5: Log into RefWorks to complete the export

See RefWorks handout for more details

Manage your references with RefWorks (CINAHL)Step 1: Select a reference by

clicking Add to FolderStep 2: Go to Folder ViewStep 3: Export opens a window

for exporting directly to RefWorks

Step 4: Click Save The RefWorks Login window will open

Step 5: Log into RefWorks to complete the export

See RefWorks handout for more details

RefWorks Information

D. Steps in Evidence-Based Practice

D. Steps in Evidence-Based Practice 1. Observe and analyse the situation2. Ask a focused question from a clinical observation that can

be answered through research and other evidence sources. based on PICO: OR– Patient or Problem– Intervention or treatment– Comparator or Control – Outcome

based on PS:– Patient– Situation

based on PCD:Levine and Feldman, 2006, pg 232 – Patient– Cues – Differential diagnosis

D. Steps in Evidence-Based Practice 3. Search for the best evidence available from the Hierarchy

of Pre-processed Evidence4. Appraise it for validity and suitability to answer the

questions by asking:– What is the validity of the evidence I have uncovered?– Are the results of the studies clinically, (educationally OR

administratively depending on your question) significant or important?

– Is the evidence usable with my population of patients, (students OR nurses) in the setting in which I practice?

Levine and Feldman, 2006

D. Steps in Evidence-Based Practice

5. Integrate the evidence with clinical expertise and patient’s perspectives in the care of the patient

– Clinical expertise refers to our assessment of the patient’s condition through subjective history-taking combined with the objective findings of lab results and physical examination results.

– Patients’ perspectives include their belief and value systems combined with their life choices and treatment choices.

6. Evaluate effectiveness of the care/treatment and whole process

– This includes self-evaluation as an integral part of reviewing the process we have just gone through to answer the question.

Levine and Feldman, 2006

E. Levels of Pre-Appraised Evidence

Levels of Pre-Appraised Evidence including Quantitative and Qualitative Studies

modified from Levine and Feldman, 2006, pg 179

1. Evidence from a quantitative systematic review or meta-analysis of all relevant Randomized Controlled Trials or Evidence-Based Clinical Practice Guidelines based on systematic reviews of RCTs

2. Evidence from at least one well-designed Randomized Controlled Trial3. Evidence from well-designed controlled trials without randomization 4. Evidence from well-designed case-control and cohort studies5. Evidence from Meta-synthesis i.e. systematic reviews of descriptive and

qualitative studies 6. Evidence from integrative reviews7. Evidence from a single descriptive or qualitative study8. Evidence from opinion of authorities or expert committees

Types of Studies for Types of Questions

Therapy Randomized controlled trial (RCT), cohort, case control, case series

Diagnosis Cohort studies with comparison to gold standard test

Prognosis Cohort studies, case control, case series

Etiology/Harm RCT, cohort studies, case control, case series

Prevention RCT, cohort studies, case control, case series

Cost Economic analysis

http://www.ebbp.org/course_outlines/searching_for_evidence/#AA

Levels of Pre-Appraised EvidenceQuantitative Studies http://libguides.ucalgary.ca/nurs385http://www.library.ualberta.ca/uploads/HealthSciences/200717155.pdf

Synthesis

Summaries

Systems

Synopses of Single Studies

Studies

Synopses of Syntheses

1. Computerized Decision Support Systems Links best evidence with electronic patient records

2. Recommended Practice Guidelines

3. Summarizes findings in a high-quality systematic review to answer a focused clinical question

4. Systematic Review consolidates literature on a specific topic

5. Synopsis of single high-quality study that can inform practice

6. Single Peer-reviewed articles

6. Studies

• Primary studies are the least critically appraised of all the levels of evidence, and so are the last resource to use if there are no higher levels of evidence available.

• They include Quantitative and Qualitative Research articles with Randomized Control Trials (RCT) considered to be the highest level

• Can be accessed through databases such as:– CINAHL– MEDLINE(Ovid and PubMed)– Proquest Nursing and Allied Health– Embase (accessed from SCOPUS)

5. Synopses of Studies

• Synposes of Single Studies provide a brief, sufficiently detailed summary of a high-quality study that can inform clinical practice.– Evidence-based nursing (open access journal)– Evidence-based midwifery– Bandolier (UK)– Health Services/Technology Assessment Texts

(HSTAT) (NLM-US) – ACP Journal Club

4. Sytheses/Systematic Reviews /Meta-analyses/Integrative Reviews

• Systematic Reviews summarize and analyze the primary literature on a specific topic.

• Identify all relevant studies• Review study relevance and Evaluate methodologies• Extract and analyze data• Draw conclusions based on common findings, themes

• Examples:• Nursing+ (McMaster University) • Evidence Based Medicine Reviews : Cochrane DSR, ACP Journal Cl

ub, DARE and CCTR• Joanna Briggs Institute – Systematic Reviews• The Cochrane Library (public) access from YorkU: EBM Reviews• CINAHL and MELDINE

4. Systematic Reviews• “Systematic reviews provide a summary of the

literature on a particular topic. • They summarize …, appraise and communicate the

results and implications of otherwise unmanageable quantities of research.

• Systematic reviews bring together separately conducted studies (sometimes with conflicting findings) and synthesize the results.

• In this way they contribute to the evaluation of both existing and new technologies and practices.”

Canadian Best Practices Portal

3. Synopses of SynthesisShort summaries of high-quality systematic

reviews including commentary on the methodology and clinical applications of the review

• They are short but often offer enough information to support clinical decisions– Canadian Best Practices Portal– Worldviews on Evidence-Based Nursing (journal)– Centre for Reviews and Dissemination– Database of Abstracts of Reviews of Effects (DARE)– www.health-evidence.ca

(DiCenso A, Bayley L, & Haynes RB. 2009)

2. Summaries

“Summaries integrate best available evidence from the lower layers (drawing on syntheses as much as possible) to provide a full range of evidence concerning management options for a given health problem.”

(Haynes, 2006 p 162)

2. Summaries

• Recommended Practice Guidelines integrate evidence-based information about specific nursing issues and provide regular updates:– CNO Compendium of Standards of Practice for Nur

ses in Ontario

– RNAO Nursing Best Practice Guidelines – The Canadian Best Practices Portal– National Guideline Clearinghouse– Joanna Briggs Best Practice Information Sheets

1. Systems

• Computerized Decision Support Systems– Evidence-based clinical information systems

integrate and summarize all relevant and important research evidence about a clinical problem.

– Are updated as new evidence becomes available– Link best evidence with electronic patient records – E.g. UpToDate and MedWeaver

Levels of Pre-Appraised Evidencehttp://libguides.ucalgary.ca/nurs385

www.oahpp.ca

Synthesis

Summaries

Systems

Synopses of Single Studies

Studies

Synopses of Syntheses

Computerized Decision Support Systems Links best evidence with electronic patient records

Recommended Practice Guidelines

Summarizes findings in a high-quality systematic review to answer a focused clinical question

Systematic Review consolidates literature on a specific topic

Synopsis of a single high-quality study that can inform practice

Single peer-reviewed articles

References

• Evidence based nursing : A guide to clinical practice (c2005). In DiCenso A., (Ed.), . St. Louis, MO ;: Mosby.

• Evidence-based medicine: Mini manual. (2007). Retrieved 5/31/2013, 2013, from http://www.library.ualberta.ca/uploads/HealthSciences/200717155.pdf

• Teaching evidence-based practice in nursing : A guide for academic and clinical settings (c2006). In Levin R. F., Feldman H. R.(Eds.), . New York: Springer Pub. Co.

• Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546-553. doi: 10.1111/j.1365-2648.2005.03621.x

Thank you! Questions or Comments?

Ilo-Katryn Maimetsilo@yorku.ca

416-736-2100 x33927