libr 534 expert searching for health librarians
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“Expert searching for health librarians: in the evidence-based era…”
Dean Giustini, UBC librarian / October 2015
Expert searching to support user groups in medicine
What is evidence-based medicine?
“…evidence-based medicine (EBM) is the conscientious, explicit & judicious use of current best evidence in making decisions
about the care of individual patients”
Sackett, et al. BMJ 1996;312:71-72
Dr. David Sackett
Landmark article in 1992 JAMAGuyatt G, Cairns J, et al (McMaster University)
JAMA 1993 – 2000 series of articles◦ Then: “Users' Guides to the Medical Literature” (2008 ed.)
Last 15 - 20 years, three (3) major trends◦ Explosion of systematic reviews◦ Rise of search engines e.g., Google Scholar◦ Knowledge tools (“point of care”) & mobiles/social
EBM – a glance back 20 years
EBM integrates evidence with care
…evidence should always integrate with clinical expertise & preferences, values & circumstances of patients & families
Patient Values/Local Conditions
Best Evidence
Clinical Expertise
• Background questions require use of background information
• Foreground questions are asked by experts
• Answers are found by searching the biomedical databases
Is it background …or foreground?
Five Steps of EBM
The five steps:
• Step 1 — Frame your clinical question• Step 2 — Find the “best evidence”• Step 3 — Critically appraise that evidence• Step 4 — Integrate best evidence into practice• Step 5 — Evaluate steps 1-4
Ask
Access
Appraise
Assess
Apply
Use PICO to frame foreground Qs
P = Patient Can you describe the patient or problem? Can you describe the population?
I = Intervention What main intervention (or treatment) will be considered?
C = Comparison Do you want a placebo comparison /or drug comparison?
O = Outcome What is the desired outcome or effect for patient?
Is equal to:
Relevance of information X validity Effort/work required
Health librarians have two (2) options: Find relevant information for physician (they determine its value) Find authoritative sources that do the finding /validating for clinician
Usefulness of medical information
MOST clinically relevant (at the top) Least clinically relevant (at the bottom)
Hierarchy of Evidence Tr
acki
ng D
own
Filtered & Critically Appraised
Expert Opinion / Not Filtered
Background info
Validity/Strength of Inference
Time Spent in Critical Appraisal
Hierarchy of Evidence find evidence at level for clinician
Where is ALL the evidence?SYSTEMATIC REVIEWS
• Cochrane Library via OvidSP • PubMed Clinical Queries / Haynes filters
CLINICAL PRACTICE GUIDELINES
• National Guideline Clearinghouse (US)• Canadian Medical Association Infobase
RESEARCH CRITIQUES
• ACP Journal Club 1996- • Bandolier 1994- & BestBETs
EVIDENCE SUMMARIES
• BMJ Clinical Evidence & FirstConsult• UpToDate
META-SEARCH ENGINES• TRIP+ & SUMSearch
P = Patient, population or problem (Who is the patient or population of patients? 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 intervention e.g. placebo, different drug, nothing?)
O = Outcome (What are the relevant outcomes (e.g. morbidity, mortality, death, complications)?
PICO frames the information need
• Defines a clinical scenario• Prepare you to search• Places focus on patient-centered questions• Developing a clinical question using PICO requires:
• some background about the condition• some understanding the patient • outcomes & beliefs important to the patient• Prognosis
– Disability? Quality of life? Cost? Improvement of symptoms?
Why use PICO?
• Search via OvidSP• Includes all Cochrane topic reviews “Cochrane Library”• Includes clinical trials register• Articles reviewed in ACP Journal Club or BMJ Evidence-Based Medicine• Papers in Database of Abstracts of Reviews of Effectiveness (DARE)• Studies in DARE meet strict EBM scoring criteria
Uses “Keywords” to search OvidSP’s EBMRUBC library access: http://resources.library.ubc.ca/644
EBM Reviews (meta-search)
Cochrane Database of Systematic Reviews
• Search via OvidSP• Independent non-for-profit international collaboration• Reviews are among studies of highest scientific evidence• Minimal bias: evidence included/excluded on basis of explicit criteria• Reviews involve exhaustive searching for studies & clinical trials, both published
and unpublished• Abstracts are available for free; consumer summaries are free also
UBC library access: http://resources.library.ubc.ca/231/
Uses “Keywords” to search Cochrane …
Database of Abstracts of Reviews of Effects (DARE)
• Search via OvidSP• Produced by the National Health Services' Centre for Reviews and
Dissemination (NHS CRD) at the University of York, England• DARE is a full text database containing critical assessments of systematic
reviews from a variety of medical journals • DARE contains structured abstracts of systematic reviews• Its records cover topics such as diagnosis, prevention, rehabilitation,
screening, and treatment
UBC library access: http://resources.library.ubc.ca/489
ACP Journal Club• Search via OvidSP• Consists of two journals, ACP Journal Club (American College of Physicians) and
Evidence-Based Medicine, by ACP & British Medical Journal• Editors select studies (includes reviews) that are methodologically sound and
clinically relevant (high-quality) • Some topics may not be found• Review top clinical journals; top therapy, diagnosis, harm &prognosis Qs• Commentaries on each study's value• Helps physicians understand and apply evidence• Reveals changes in medical knowledge
UBC library access: http://resources.library.ubc.ca/230
Follow up files on HLWIKI
Scoping reviews | Grey literature | Hand-searching |Snowballing
Expert searching | Grey data ("hard to find" data) | Grey literature searching in medicine | Grey literature - part II
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