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
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:
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:
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:
Provide original research (are not critically appraised)
• Individual Journal Articles (not critically appraised)
• Randomized Controlled Trials (RCTs)
• Cohort Studies
• Case-controlled Studies
• Case Series/Reports
Include:
• PubMed
• Ovid MEDLINE
• Cochrane Central Register of Controlled Trials
• 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?
• 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.
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.
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.
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.
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.
“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.
Questions? Thank You!