Download - EBP: Library Tools for Clinical Content Christina L. Wissinger MS, MLIS Clinical Informationist
EBP: Library Tools for Clinical Content
Christina L. Wissinger MS, MLISClinical Informationist
Library Resources http://www.welch.jhu.edu/index.cfm
Research Assistance and Instruction provided by department Informationist/Librarian Performing Searching, Creating Search Strategies,
Database Education, Citation Management Software Training, Systematic Reviews consultation etc.
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Evidence Based Practice Study Designs Levels of Evidence The EBP Process EBP Literature Resources
Levels of Evidence: Study design
Medical Center Library, Duke University
Stronger
Weaker
Levels of Evidence for Treatment
1a: Systematic reviews of randomized controlled trials1b: Individual randomized controlled trials
(with narrow confidence interval) 1c: All or none randomized controlled trials
2a: Systematic reviews … of cohort studies2b: Cohort studies or low quality randomized controlled trials
(<80% follow-up) 2c: 'Outcomes' Research
3a: Systematic review … of case-control studies 3b: Individual case-control study
4: Case-series (and poor quality cohort and case-control studies)
5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or 'first principles'
Edited from UK Centre for Evidence Based Medicine http://minerva.minervation.com/cebm/
Stronger
Weaker
EBP: Steps
4 Incorporate into Patient Care
1 Refine Question
2 Select Sources
2 Formulate Query
2 Perform Search
5Evaluate Process
No
Y es2Evaluate results:
Satisfactory?
3 Critically Appraise: Strong?
Y es
No
1. Refine the clinical question
2. Find the best evidence 3. Critically appraise
the evidence4. Integrate the critically
appraised informationwith your clinical expertise
5. Evaluate steps 1-4 for effectiveness and efficiency
Sackett, et al, Evidence-Based Medicine, 2000
p. 3-4
First Steps for searching the EBP literature EBM Subject guides http://www.welch.jhu.edu/internet/ebr.html
EBP databases National Guidelines Clearinghouse - EBM practice guidelines
Cochrane - Systematic reviews of literature on specific subjects
PubMed Clinical Queries - Evidence Based filters for Medline (must use MeSH)
Subject Specific Databases with EBP Literature Orthopedics and Rehabilitation Subject Guide
http://www.welch.jhu.edu/eresources/eresources_subject_action_alpha.cfm?wmesh_id=59
PEDro : The Physiotherapy Evidence Database -(Physical Therapy Systematic Reviews)
CINAHL : Cumulative Index to Nursing and Allied Health Literature – (use the evidence based medicine limit)
First Steps for Searching the Medical Literature PubMed EMBASE The Cochrane Library
PubMed Searching Techniques Boolean
AND, OR, NOT MeSH – Medical Subject Heading used to
refine a search [MeSH] – Searching indexing terms [MAJR]- Searching as a Major indexing term
Keywords [All Fields] – Searching for the keywords in every
field Limits
Age, Publication type, Language, Gender etc.
PubMed Searching Techniques Use PubMed Clinical Queries to limit to EBP
literature Find your MeSH terms first then cut and past them
into Clinical Queries search box MyNCBI
Set up search alerts Save Searches Save Collections Limited Customization of PubMed layout
The Cochrane Library Search using Keywords and MeSH MeSH searches must be created one term at a time Cochrane Contains:
Cochrane Database of Systematic Reviews Summaries of the best evidence available
Cochrane Central Register of Controlled Trials Track down the original studies
Health Technology Assessment Database Completed and ongoing health technology assessments from
around the world, looking at the medical, social, ethical and economic implications of health technologies (e.g. pharmaceuticals, vaccines, medical and surgical procedures) with a view to informing policy decisions..
NHS Economic Evaluation Database Provides information on cost alongside information on
effectiveness
EMBASE Europe's PubMed Excellent source for drug information Contains Medline (PubMed) and EMBASE
literature Uses EMTREE instead of MeSH
Exp/ - EMTREE term mj/ - Major Focus
Limits Age, Publication type, Language, Gender etc. Use the Evidence Based Medicine Limits to find
EBP Literature
RefWorks Store citations from various databases Create bibliographies in over 800 citations
styles Write N Cite – Creates in text citations in over
800 styles Create Group Accounts for collaborations
Case Studies: Use PubMed, EMBASE & Cochrane
Research Question 1 Rehabilitation
therapy treatment strategies for ataxia
Research Question 2 Evidence for exercises
to assist with improvement in fine motor control. Is there any evidence
that exercises such as manipulating pins, other small objects, or doing screwing tasks or lacing tasks really create improvement in them over time given initial impairment.
Research Question 1 PubMed
EBP Search Strategy: use the MeSH term "Ataxia"[Mesh] in Clinical Queries
using the Therapy Filter Literature Search Strategies:
Option 1: Use the MeSH term with the subheading "Ataxia/therapy"[MAJR]
Option 2: Use the MeSH term "Ataxia"[MAJR] and the subheading for Therapy or the MeSH term "Rehabilitation"[MAJR]
Use the EBP limits (Meta-Analysis[ptyp] OR Practice Guideline[ptyp] OR Randomized Controlled Trial[ptyp] OR Controlled Clinical Trial[ptyp])
Limit your searches to Human and English
Research Question 1 EMBASE EBP Search Strategy
Use the Emtree terms for 'ataxia'/exp/mj AND ('therapy'/exp/mj OR 'rehabilitation'/exp/mj)
Use Evidence Based Medicine Limits ([cochrane review]/lim OR [controlled clinical trial]/lim
OR [meta analysis]/lim OR [randomized controlled trial]/lim OR [systematic review]/lim)
Limit your search to Humans and English
Research Question 1 Cochrane Searches are EBP if you use the
review tab Go to the MeSH search and run the search for
ataxia Next run the search for rehabilitation Go to Search History and combine the searches
with an AND
Research Question 2 PubMed
EBP Search Strategy: use the MeSH terms ("Exercise"[MeSH] AND "Motor
Skills"[MeSH]) in Clinical Queries using the Therapy Filter
Literature Search Strategies: use the MeSH terms ("Exercise"[MAJR] AND "Motor
Skills"[MAJR]) use the EBP limits (Meta-Analysis[ptyp] OR Practice
Guideline[ptyp] OR Randomized Controlled Trial[ptyp] OR Controlled Clinical Trial[ptyp])
Limit your searches to Human and English
Research Question 2 EMBASE EBP Search Strategy
Use the EMTREE terms for 'motor performance'/exp/mj AND 'exercise'/exp/mj
Use Evidence Based Medicine Limits ([cochrane review]/lim OR [controlled clinical trial]/lim
OR [meta analysis]/lim OR [randomized controlled trial]/lim OR [systematic review]/lim)
Limit your search to Humans and English
Research Question 2 Cochrane Searches are EBP if you use the
review tab Go to the MeSH search and run the search for
motor skills Next run the search for exercise Go to Search History and combine the searches
with an AND
Your Informationist/Librarian Please do not hesitate to contact me for
assistance. I’m here to help and to support your work!
Christina L. Wissinger, MS, MLISClinical InformationistWelch Medical Library1900 E. Monument Street, Room [email protected]
http://www.welch.jhu.edu/liaison/CLW.html PMR Portal -
https://infosuite.welch.jhmi.edu/PMR/