nursing research resources
DESCRIPTION
Introduce IUON students to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.TRANSCRIPT
Guide to Nursing ResourcesEBN : Accessing the Research
Learning Objectives
Introduce student to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.
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What is EBM?“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.
Evidence Based Medicine
EBM Decision Model:"Evidence-based medicine (EBM) is
the integration of best research evidence with clinical expertise and patient values."
EBM Cycle:Ask, Acquire, Appraise, Apply and
Act
Primary Evidence
Primary evidence includes the original reports of research studies and are included in journal citation databases: MEDLINE: randomized controlled
trials CINAHL: research EMBASE SCIRUS
Secondary Evidence
Secondary evidence is the analysis of research studies and is found in:
MEDLINE: meta-analysis, practice guidelines, consensus development conferences
CINAHL: meta-analysis, practice guidelines, research based nursing practice
Cochrane Database of Systematic Reviews Database of Reviews of Effectiveness
(DARE) National Guidelines Clearinghouse
Information ‘Pyramid’
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EBM journals Cochrane DB systemic reviews
Clinical Practice Guidelines
primary research articles
CINAHL, MedlineAssoc. websites,
textbooksGoogle
Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514
Evolution of LiteratureEvidence PyramidThe base of the pyramid is where
information usually starts with an idea or laboratory research. As these ideas turn into drugs and diagnostic tools they are tested in laboratories models, then in animals, and finally in humans. The human testing may begin with volunteers and go through several phases of clinical trials before the drug or diagnostic tool can be authorized for use within the general population. Randomized controlled trials are then done to further test the effectiveness and efficacy of a drug or therapy.
As you move up the pyramid the amount of available literature decreases, but increases in its relevance to the clinical setting.
Type of Study Meta-
Analysis Systematic
Review Randomized
Controlled Trial Cohort studies Case Control studies Case Series/Case Reports Animal
research/Laboratory studies
Evolution of EB Information
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Systems [computerized decision support]& Summaries [EB textbooks]
Synopses [EB journal abstracts]
Syntheses [systematic reviews]
Studies [original journal articles]
Based on: Haynes, Brian. “Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information
services for evidence-based healthcare decisions”/ Evidence based medicine. 2006 Dec. 11(6):162-4.
Medical Databases CINAHL
EBSCOhosthttp://support.epnet.com/training/tutorials.php CINAHL.com
Online traininghttp://www.cinahl.com/library/library.htm
Medline EBSCOhost PubMed
Online traininghttp://www.nlm.nih.gov/bsd/disted/pubmed.html
Evidence in MEDLINE
Searching for evidence in MEDLINE includes several steps:
formulate a clinical question run a subject search
Ex. heart disease and aspirin select a strategy to retrieve
literature related to therapy, diagnosis, prognosis, harm/etiology.
Evidence in CINAHL formulate a clinical
question run a subject
search use the Research
limit on the Main Search Page.
This is a very effective way to limit retrieval to research studies in CINAHL.
Tutorial: http://www.hscl.ufl.edu/help/CINAHL/index.htm
Cochrane Database of Systemic Reviews
includes the full text of the regularly updated systematic reviews of the effects of healthcare
prepared by The Cochrane Collaboration
can be searched by combing keywords or phrases.
The Browse Topics icon retrieves a list of Cochrane Groups who prepare and maintain the reviews in respective clinical areas, such as nursing.
http://www.cochrane.org/index.htm
Database of Reviews of Effectiveness (DARE) Database of Reviews of Effectiveness (DARE) a full text
database with critical structured abstracts of studies reported in various medical journals.
What is Systemic Review?
Systematic reviews are known as the highest level of evidence in clinical research.
Developed countries are developing their medical guidelines based on the information provided by systematic reviews of effectiveness.
Therefore, it is mandatory for all professionals involved in the delivery of healthcare, to reach to a good understanding about systematic reviews.
This web site offers information about what systematic reviews are, and how to conduct them.http://ssrc.tums.ac.ir/SystematicReview/
The National Guidelines Clearinghouse includes evidence-based practice guidelines from various health centers and organizations. It can be searched by disease, treatment or organization. The Clearinghouse includes a feature comparing attributes of two or more guidelines.
HealthWeb
The Evidence-Based Health Care section of HealthWeb includes a wealth of information about EB organizations, databases and publications.
The Tools and Tutorials has many helpful links including the EBM Tool Kit and EBM Toolbox.
OtherSearch Engines Medstory SearchMedica Google Scholar MammaHealth MedlinePlus OminiMedicalSearch
Databases Nursing Reference
Center DynaMed Up-to-Date MosbyNursingIndex NurseConsult InfoPOEMS
Steps to answering Clinical Questions using the Medical
LiteratureThe Anatomy of the Clinical
Question:1. Formulate a clinical question
("PICOT" approach):Patient characteristicsIntervention being consideredComparison intervention (if any)Outcome of clinical interestTimeframe
2. Run your subject search.
3. Select the MEDLINE strategy to answer the question:
Therapy, Diagnosis, Prognosis, Harm/Etiology.
(including study design/article type)
For Quick Searches
A question of... Therapy
Limit search to Publication Type - Randomized Controlled Trial pt
In-depth EBM Searches: Therapy
exp research design/ or exp clinical trials/ or comparative study/ or placebos/ or multicenter study.pt. or clinical trial$1.pt. Or random$.ti,ab. or (single blind$ or double blind$ or triple blind$3).ti,ab. or placebo$1.ti,ab. or (clinical adjtrial$1).ti,ab. or exp epidemiologic research design/ or (controlled clinical trial or randomized controlled trial).pt. or practice guideline.pt. Or feasibility studies/ or clinical protocols/ or exp treatment outcome/ or double blind method/
For Quick Searches
A question of...Diagnosis
Combine subject search with search for exp "sensitivity and specificity"
In-depth EBM Searches: Diagnosis
exp "sensitivity and specificity"/ or false negative reactions/ or false positive reactions/ or (sensitivity or specificity).ti,ab. or (predictive adj value$1).ti,ab. or (likelihood adj ratio$1).ti,ab. or (false adj (negative$1 or positive$1)).ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or double blind method/ or single blind method/ or practice guideline.pt. Or consensus development conference$.pt. or random$.ti,ab. or random allocation/ or (single blind$3 or double blind$3 or triple blind$3).ti,ab.
For Quick Searches
A question of...Prognosis
Combine subject search with search for exp cohort studies or exp risk
In-depth EBM Searches: Prognosis
exp cohort studies/ or prognosis/ or exp mortality/ or exp morbidity/ or (natural adj history).ti,ab. or prognos$.ti,ab. or course.ti,AB or predict$.ti,ab. or exp "outcome assessment (health care)"/ or outcome$1.ti,ab. or (inception adj cohort$1).ti,ab. or disease progression/ or exp survival analysis/
For Quick Searches
A question of...Harm/Etiology
Combine subject search with search for exp cohort studies OR exp risk
In-depth EBM Searches: Harm/Etiology
random$.ti,ab. or exp epidemiological studies/ or odds ratio/ or cohort$.ti,ab. or (case$1 adj control$).ti,ab. or risk$.ti,ab. or (odds adj ratio$1).ti,ab. or causa$.ti,ab. or (relative$1 adj risk$).ti,ab. or predispos$.ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or exp risk/ or practice guideline.pt. or exp case-control studies/ or exp cohort studies/
For Quick Searches
4. Locate other sources of evidence as necessary.
5. Examine the evidence, critically appraise/evaluate the literature.
6. Apply the evidence + clinical experience + the patient's preferences.
7. Evaluate patient outcomes.
In-depth EBM Searches
4. Once copied, paste it into the search box in MEDLINE.
5. Click "Perform Search."6. Combine this set with your
original search using AND (i.e. 1 AND 2).
(EBM filters developed by the Miner Library at the University of Rochester Medical Center)
http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf
NoteYou can save each of these EBM filters as a separate
search in MEDLINE so that they can be run as needed when searching MEDLINE
To do this: Authenticate to a new MEDLINE session with a
blank search history. Copy and paste one EBM filter. Click "Perform Search." After retrieving search results, click "Save Search
History." Select "Permanent," and name the search (ex.
EBM Therapy or Therapy Filter).
To use save searches: Run your subject search. Click "Run Saved Search." Select the EBM filter to run based
on the type of question being asked (Therapy, Diagnosis, Prognosis, or Harm/Etiology).
Combine the two searches using AND.
Evidence Based Medicine Toolkits & Tutorials
For further clarification and practice check out more online training ‘EBM Toolkit’ based on the series in JAMA:
http://www.med.ualberta.ca/ebm/ebm.htmOR
From Duke University Medical Center:http://www.hsl.unc.edu/services/tutorials/EBM/welcome.htm
Thank you Ann Celestine, BA MLS AHIP
Library Director