novel tools and resources for an evidence based practice barbara walker, ph.d. [email protected]
TRANSCRIPT
The Framework
Best available research evidence
Patient’s situation and circumstances
Clinical Expertise
Clinical Expertise
CD
EBP begins and ends with the patient
Formulate Questions
Find the best
evidence
Appraise the
evidence
Apply the Evidence
Assess the impact
Types of Clinical Questions
• Diagnosis• Therapy• Harm• Etiology• Prognosis• Cost-effectiveness
• Background
• Foreground
By Content By Format
THIS SLIDE COURTESY OF SUE LONDON RUTH LILLY LIBRARY
background
foreground
Background questions
Foreground questions
Amount of experience
Background Questions
• What are the criteria for diagnosing …?• What are the known risks associated
with…• What is the cost-effectiveness of …• What is the prognosis for…• What treatments have been found to be
most effective for…?
P = Patient Population or Problem
I = Intervention
C = Comparison
O = Outcome
Foreground Questions
Formulating a Foreground Question (PICO)
• Patient or Population
• Intervention
• Compared to…
• Outcome you would like to measure or achieve
In middle aged women with migraine headache
Is there any evidence that acupuncture
Compared to sham treatment, Relaxation training, Biofeedback training, and/or Cognitive Behavioral Therapy
Decrease frequency, intensity, and/or severity of migraines
Why formulate questions so carefully?
…QUESTIONS DRIVE THE SEARCH
WHAT to look for ?
WHERE to look?
HOW to search?
High Sensitivity
THIS SERIES COURTESY OF SUE LONDON IUPUI LIBRARY
High Specificity
WHAT:
WHERE:
HOW:
Synthesized literature
Specialized databases
Specialized search strategies/filters
SECONDARY LITERATURE: papers that synthesize original studies
PRIMARY LITERATURE
SYSTEMATIC REVIEWS EB Meta-analyses
EB Guidelines
Traditional reviews
Systematic vs. Traditional Reviews
• Focus on a clear clinically relevant question.
• End with a clinical bottom-line.• Specific, pre-determined method and
format.• Research on research.• Search for all relevant studies.• Avoid bias• Goal is replication
PRIMARY LITERATURE
SECONDARY LITERATURE
Systematic reviews
EVIDENCE-BASED
Traditional reviews
Guidelines
What are we looking for?
Evidence that has already been scientifically synthesized for us
A new type of literature• Systematic reviews• Evidence-based guidelines• Others
Where and how ?
Start at the top
You can search specifically for one thing or…
SYNTHESES Systematic Reviews (Cochrane)
Individual articles (Medline and PsycINFO)
SYNTHESES Systematic Reviews (Cochrane)
Individual articles (Medline and PsycINFO)
USE ADVANCED
SEARCH and
read the search tips
SYNTHESES Systematic Reviews (Cochrane)
Individual articles (Medline and PsycINFO)
TRIPAdvantages:
– It’s free public access– It contains ONLY evidence-based material
Disadvantages– Searches are broad– May not contain exactly what you need– Everything in TRIP is evidence-based but
there is evidence-based literature NOT in TRIP.
SYNTHESES COCHRANE SYSTEMATIC REVIEWS
Individual articles Medline and PsycINFO
http://clinicalevidence.bmj.com/ceweb/index.jsp
UPTODATE
DYNAMED
http://www.psychology.sunysb.edu/eklonsky-/division12/
ESTs from Div 12
SYNTHESES COCHRANE SYSTEMATIC REVIEWS
Individual articles Medline and PsycINFO
With a subscription you can
obtain detailed reviews or you can access
summaries free on www.cochrane.org.
SYNTHESES COCHRANE SYSTEMATIC REVIEWS
Individual articles Medline and PsycINFO
Medline and PsycINFOEBP techniques
MEDLINE
PSYCINFO
Adapted from Shahram Yazdani, 2002
Cochrane / others
IT IS IMPORTANT TO SEARCH BOTH
You may miss some of the best EB resources by searching only PsycINFO
MEDLINE PSYCINFO
DATABASES contain the articles
MEDLINEPSYCINFO
DATABASES
VENDORS
Create interfaces to bring the articles to you
VENDORS
PUBMED
free
CSA ILLUMINA
PsycINFO
OVID
$$$$$$$$
MEDLINE
EBSCO
PubMed
• Clinical Queries• Keywords vs. Controlled vocabulary
CLINICAL QUERIES
http://www.ncbi.nlm.nih.gov/pubmed/
Interested in finding articles about acupuncture as a
treatment?
Why not just type keywords?
Keywords look for that exact word in the article.
Acupuncture Acupressure Behavior Behaviour
Tension headache Muscle contraction headache
Depression Major depressive disorder
Controlled Vocabulary
Librarians “tag” each article with labels based on the concepts in the article. These labels are standardized.
This allows the user to retrieve information that uses different terminology for the same concept.
Medline: MeSH terms
Why : We need to find the relevant scientific evidence quickly and efficiently to inform our practice
What: – A newer literature (pre-appraised)
Where and How: (work your way down the pyramid)
SYNTHESES Systematic Reviews (Cochrane)
Individual articles (Medline and PsycINFO)
Uptodate / Dynamed / emedicineClinical EvidenceEvidence-based guidelinesEB journals (EBMH)ESTs
The evidence can come to you: Alerts?
AlertsIndividual journals and databases
Medline and PsycINFO:
save your searchautomatic email
Ask within your own field…
Librarians are your friends…
EBP begins and ends with the patient
Formulate Questions
Find the best
evidence
Appraise the
evidence
Apply the Evidence
Assess the impact
Questions and Discussion….