community training in evidence based practice 3-28-13

Community Training in Evidence-

Based Practice

This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, under Contract No. HHSN-276-2001-000007-C with the Houston Academy of Medicine-Texas Medical Center Library

Agenda for today:

-Attendees will understand the basics of evidence-based practice and resources that can assist

searches for evidence-based literature. (25 min)

-Attendees will search PubMed and PubMed Clinical queries for evidence-based literature.

(45 min)

-Break (5 min)

-Attendees will apply search strategies across multiple other “free to search” resources for locating evidence-based literature. (45 min)

- Attendees will learn how to obtain information

from their local libraries or other free information sources. (5 min)

Evidence-Based

Practice Basics

Evidence-Based Practice

Clinical Expertise

Best Research Evidence

Patient Values &

Expectations

EBP

Why EBP?

Continually discovering improved treatments and methods

Healthcare providers must stay current

EBP keeps healthcare providers up-to-date

Evidence Based Practice:

A 5-step Practice

1) Assess: What is it you want to know?

2) Ask: Use PICO to create a question

3) Acquire: Search for good evidence

4) Appraise: Assess the evidence

5) Apply: Use what you’ve found

Assess & Ask: PICO

Patient: Who is your patient?

Intervention: What do you want to do with this patient?

Comparison (optional): Is there an alternative treatment/cause etc. to consider?

Outcome: What do you hope to accomplish?

PICO Example:

In an 86-year old man with coronary artery disease, is aspirin a

more effective agent than heparin in reducing risk of

stroke?

Acquire: Identify & Select Resources

3 Categories

Background Information

Filtered Information

Unfiltered Information


Provide original research (are not critically appraised)

• Individual Journal Articles (not critically appraised)

• Randomized Controlled Trials (RCTs)

• Clinical Trials

• Cohort Studies

• Case-controlled Studies

• Case Series/Reports

Include:

• PubMed

• Ovid MEDLINE

• Cochrane Central Register of Controlled Trials

• PsychINFO

• CINAHL

Databases:

Provide broad overviews of medical topics

• Clinical reference books

• Clinical reference websites

• Practice Guidelines Include:

• MedlinePLUS

• National Institute of Health Databases:





• Clinical Trials

• Cohort Studies



Include:

• PubMed

• Ovid MEDLINE


• PsychINFO

• CINAHL

Databases:

Filtered

Provide reviews of original research (are critically appraised)

• Systematic Reviews

• Meta-Analyses

• Critically Appraised Topics and Articles Include:

• Cochrane Database of Systematic Reviews

• Ovid MEDLINE

• PubMed

• National Guideline Clearinghouse (topics)

• The ACP Journal Club (articles)

Databases:




• Cohort Studies



Include:

• PubMed

• Ovid MEDLINE


• PsychINFO

• CINAHL

Databases:

• A) A newspaper article about breast cancer in the Houston Chronicle

• B) A “Letter from the Editor” about obesity in Parenting Magazine

• C) Information about Type 2 Diabetes from the “Health Topics” section of MedlinePLUS

• D) Information Dr. Oz writes on his Facebook page

Which of these is

an Evidence

Based Practice

Resource?

Thank you!

Any Questions?

(http://www.pubmed.gov)

• PubMed is a freely searchable literature database provided by the National Library of Medicine.

• It contains 22 million biomedical citations.

• A mobile version is available on tablets and smartphones.

Translating your PICO question into a PubMed database search (search strategy)

• Pick out the most important key terms from your PICO question.

• Usually, when more search terms are entered into a search query, it will result in fewer articles.

• Use “Article Types” to find your filtered or unfiltered results.

• Use “Publication Dates” to specify the most recent results or a defined time period.

• “Additional Filters” can help you narrow your results closer to the key terms from your PICO question.

PubMed vs. PubMed Clinical Queries

• Performing a basic PubMed search will look in all records of the database for your search terms.

• Clinical Queries adds specifications to your search to locate items in a subset of articles that relate to you search.

• You can find filtered literature through “Systematic Reviews.”

• You can find unfiltered literature through “Clinical Study Categories.”

Obtaining articles

• Some free full-text articles are available through PubMed Central.

• Having a membership with a library can increase the full-text access to items found in PubMed.

Searching Exercise

• Spend some time practicing searches in PubMed.

• Find 1 example of a filtered article.

• Find 1 example of an unfiltered article.

Questions?

“Free to search” resources

There are many freely

accessible web sites that contain reliable evidence-based health information. These are available from both private and public

organizations.

Medline Plus (http://www.medlineplus.gov)

• A consumer level resource containing information on a wide range of topics on health from the National Library of Medicine

• Users can browse/search by Health Topics to view information on specific conditions.

• Users can browse/search Drugs & Supplements to view information on pharmaceuticals.

• The entire site is available in Spanish, as well as, multiple Languages for some information.

http://www.medlineplus.gov/

National Institutes of Health (http://health.nih.gov)

• The National Institutes of Health oversee many governmental health organizations, including the National Library of Medicine. Their Health Information site provides consumer level information.

• Health Topics can be browsed alphabetically or searched.

• Health Categories give broad topics to browse.

http://health.nih.gov/

TRIP Database (http://www.tripdatabase.com)

• A commercially run site that includes content from PubMed, The Cochrane Library, and other evidence based sources.

• Basic search enables you to find information across multiple sources.

• PICO search function lets you translate you PICO question easily.

http://www.tripdatabase.com/

Clinical Trials (http://www.clinicaltrials.gov)

• This focuses on searching for information with regards to clinical studies (both publicly and privately funded) that have been completed or are currently active.

• What are clinical trials? “A research study using human subjects to evaluate the effect of interventions or exposures on biomedical or health-related outcomes.”

• Basic search can be used to search across all available clinical study information.

http://www.clinicaltrials.gov/

The Community Guide (www.thecommunityguide.org)

• This gives access to findings from all Community Preventive Services Task Force findings. It highlights systematic reviews and strives to present interventions that are effective.

• Browse Topics for a broad view of findings related to various health conditions.

• Searching enables access to items available from The Community Guide or the Center for Disease Control and Prevention.

//Gleason/allen.lopez/My Documents/www.thecommunityguide.org

“Free to search” exercise

• Find 2 items concerning a health topic of your choosing (articles, web sites, or other) from any of the sites discussed.

• Identify if these items are basic, filtered, or unfiltered levels of evidence.

Where else can I go?

• Public libraries are great resources for accessing databases, help with searching, and other guidance.

• The TMC Library is currently creating a subject guide based around this class. It will be available at http://libguides.library.tmc.edu/ on or before April 30, 2013.

http://libguides.library.tmc.edu/

Questions? Thank You!

community training in evidence based practice 3-28-13

Health & Medicine