ebm_search for literature

8/22/2019 EBM_Search for Literature

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Searching forEvidence Based Medicine

Literature

Welcome

Aug 2012


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What is Evidence-Based Medicine?

The goal of (EBM) is to be aware of the evidence on

which ones practice is based, the soundness of the

evidence, and the strength of inference the evidence

permits. The strategy employed requires a cleardelineation of the relevant questions(s); a thorough

search of the literature relating to the questions;

a critical appraisal of the evidence, and its application

to the clinical situation; and a balanced application of

the conclusions to the clinical problem.a

aPreface (2002). In Guyatt GH, Rennie D. (Eds.),

Users Guides to the Medical Literature (pp. xiv). Chicago: AMA Press.


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The Exponential Growth of the Literature

PubMed "indexed journals represent an increasingly smaller

portion of the broader universe of medical information.

NLM (National Library of Medicine) estimates that currently

about 14,000 biomedical journals are published and it selects

only about one-quarter of new submissions for indexing based

on quality and relevance to biomedical topics. These biomedical

journals, in turn, represent only a small fraction of the growing

array of information sources on the Web."

Druss, BG, et al. Growth and decentralization of the medical literature:

implications of evidence-based medicine.JMLA. 2005;93(4):499-501


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Steps in the Evidence-Based Process are:

(Citrome, & Ketter, 2009)


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Step 1

Formulate the Question


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Clinical questions should be directly relevant to theproblem. The question can be phrased to facilitatesearching for a precise answer by using PICO:

the Patient, population or problem being addressed

the Intervention being considered

the Comparison intervention or exposure, whenrelevant

the clinical Outcomes of interest

(Washington Health Sciences Libraries, 2007)

Using PICO to focus the question:


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Definitions from McKibbon, 2009

Diagnosisthe process of identifying a disease or condition. Making the correctdiagnosis is the foundation for making decisions on clinical intervention.

What disease or condition does my patient have?

Clinical questions often arise from central issues:(Straus, 2005)

Therapyan action or intervention that can potentially improve care or prevent

diseases or conditions.

What is the best treatment for this disease or condition?

Etiologythe cause of a disease, condition or situation. It may also be referred to as

harm or causation.

What is the cause of my patients disease or condition?

Prognosisthe progression of a treated disease.

What outcome can be expected from the treatment/intervention used?


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Step 2

Search for the Answers


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Professor Archibald Cochrane,CBE FRCP FFCM,(1909 - 1988)

stressesthe importance of using evidence from randomizedcontrolled trials because these were likely to provide much more

reliable information than other sources of evidence


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A

awww.cochrane.org

prepared reviews

based on the

best available evidence


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www.thecochranelibrary.com


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Filtered Information

Unfiltered Information

Cochrane Database of Systematic Reviews

Topic Reviews in the Cochrane Database of Systematic Reviewsaa

Database of Abstracts of Reviews of Effectiveness (DARE)

NHS Economic Evaluation Database

Cochrane Methodology Register

ACP Journal Club

Cochrane Central Register of Controlled Trials

PubMed

PubMed

National Guideline Clearinghouse

Health Technology Assessment

PubMed

Hierarchy of Evidence and Corresponding Databases

(TTUHSC Preston Smith Library, 11/21/2008)


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Mouse over Databases


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and click Ovid


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Click All EBM Reviews


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Enter

as the first keyword search.

obesity


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Enter as the

second keyword search.

surgery


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For better results, enter keywords separately

and then combine with Boolean operators.


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AND

X

X

Click on the boxes

next to set 1 and set 2.


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Boolean Logic - AND

surgeryobesity and


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Results of AND combination.

(Note that AND narrows results.)


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3 AND obes*.ti.Enter to narrow to

articles with any suffix of obesity in the title.


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By entering obes*, the computersearches for any suffix of the word:

obese

obesity

This is called truncation.


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4 AND surgery.ti.Enter to narrow to

articles with surgery as a word in the title.


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Results are narrowed

to 87 articles.


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Other search techniques:

Look for additional terms such as bypass or banded

Use Boolean OR

banded

or

bypass


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Search

Results


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Click Display

to view articles


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Systematic Reviews assess randomized trials and provide a comprehensive

summary of the available evidence.

Over 800 international journals are searched to locate articles.a

Systematic Reviews contain all known reference to trials on a particular intervention.

Evidence is assessed with explicit quality criteria to minimize bias ensure reliability.

Trials that meet assessment criteria can be combined to produce a morestatistically reliable result.

Data from studies are often combined statistically to increase the power of the findings

of numerous studies, which on their own may be too small to produce reliable results.

Authors appraise, and synthesize evidence from as many relevant

scientific studies as possible.


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Click EBM Topic Review


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Systematic reviews are prepared by Cochrane Collaborative Groups.

EBM Topic Review


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PDF link.


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Click Search


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Click Ovid Resources


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Click Cochrane Database of Systematic Reviews


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Click Cochrane Database of Systematic Reviews


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Click Table of Contents


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Additional Articles to Review


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Cochrane Group s

Inflammatory Bowel Disease

Injuries Group

Lung Cancer

Menstrual Disorders & Sub-Fertility GroupMetabolic & Endocrine Disorders

Methodology Review Group

Movement Disorders

Multiple Sclerosis

Musculoskeletal Group

Musculoskeletal Injuries Group

Neonatal Group

Neuromuscular Disease

Oral Health

Pain, Palliative Care & Supportive Care

Peripheral Vascular Diseases

Pregnancy & Childbirth

Prostatic Diseases & Urologic Cancers

Renal Group

Schizophrenia Group

Sexually Transmitted Diseases Group

Skin Group

Stroke Group

Tobacco Addiction

Upper Gastrointestinal & Pancreatic Diseases

Wounds Group

Acute Respiratory Infections

Airways Group

Anesthesia Group

Back GroupBreast Cancer

Colorectal Cancer

Consumers & Communication

Cystic Fibrosis & Genetic Disorders

Dementia & Cognitive Improvement

Depression, Anxiety, & Neurosis

Developmental, Psychosocial & Learning Problems

Drugs & Alcohol

Ear, Nose and Throat Disorders

Effective Practice & Organization of Care

Epilepsy

Eyes & Vision

Fertility Regulation

Gynecological Cancer

Hematological Malignancies

Heart Group

Hepato-Biliary Group

HIV/AIDS

Hypertension

Incontinence

Infectious Diseases


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Click Search


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Click All EBM Reviews


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Click Display

to view articles


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Click EBM Article Review

Scroll to article #3

ACP Journal Club is a joint online journal:


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Information summarizedin structured abstracts

include:aA

Methods Design

Intervention

Study categories include:aa

Prevention or treatment

Diagnosis

Prognosis

Etiology

EconomicsClinical prediction guides

Differential diagnosis

ACP Journal Club is a joint online journal:

ACP Journal Club by the American College of Physicians

Evidence-Based Medicine by the British Medical Journal Group

Over 100 clinical journals are screened for original studies that are methodologically sound & clinically relevant.


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ACP Journal Club includesbrief commentaries on:a

aa

Context

Methods

Clinical applications of findings


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ClickSearch Results


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For next article, type 8 and click Go

8 GO>


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Click EBM Article Review

O 3000 b t t f t ti i th t h b lit d


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Over 3000 abstracts of systematic reviews that have been quality assessed

Reviews answer questions about specific interventions


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Results of review and

critical commentary

About overall quality


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ClickSearch


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For next article, type in 22 and click Go

22 GO>


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Click Complete Reference


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CCRT does not contain

full-text. Access through

Gold Rush.

3/5ths of the records are

from PubMed

Relevant recordsfrom Embase

Other published and

unpublished sources

Reports from

conference proceedings


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Mouse over eJournals

and click Gold Rush


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journal of the american college of surgeonsType in


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Go back to Ovid Search.


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For the next article 59 GO>


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A

aReports on methods used in the conduct of controlled trials

Includes journal articles, books, and conference proceedings

Does not contain full text; access through Gold Rushaa

a

Click Next


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Completed and ongoing health technology assessments studies of:

medical, social, ethical, and economic implications of health care interventions

Aim is to improve the quality and cost-effectiveness of health care

Go to article #83

83


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Over 5000 abstracts

Systematically identifies

economic evaluations

from around the world


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Click Search


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Click ACP Journal Club


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Click Expand


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Click to Select All

Click Remove Selected


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Step 3

Appraise the Evidence

L l f E id


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Levels of Evidence

* Medical evidence or recommendations can vary in quality

* Sources of evidence range from:

1. small laboratory studies to

2. well-designed large clinical studies with minimized bias

* Is a recommendation is strong or weak?

* Can you be confident in the recommendation?

* Grading by strength of recommendations is a systematicapproach which can minimize bias and aid interpretation

* Quality of evidence can be categorized as high, moderate,low, or very low

(The GRADE Working Group, 2005)

Strength of Recommendation


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gRecommendations to administer, or not administer, an intervention, should be basedon the tradeoffs between benefits on the one hand, and risks, burden and,potentially, costs on the other. If benefits outweigh risks and burden, experts willrecommend that clinicians offer a treatment to typical patients. The uncertaintyassociated with the tradeoff between the benefits and risks and burdens willdetermine the strength of recommendation. (The GRADE Working Group, 2005)

*Patient-oriented evidence measures outcomes that matter to patients: morbidity,

mortality, symptom improvement, cost reduction, and quality of life. Disease-

oriented evidence measures: immediate, physiologic, or surrogate end points that

may or may not reflect improvements in patient outcomes (e.g. blood pressure, blood

chemistry, physiologic function, pathologic findings).

Code Definition

A

B

C

Consistent, good-qualitypatient-oriented evidence *

Inconsistent or limited-qualitypatient-oriented evidence *

Consensus, disease-oriented evidence *: usual practice, expert opinion,

or case series for studies of diagnosis, treatment, prevention, or screening

StrengthOfRecommendationTaxonomy(SORT)

(Essential Evidence Plus EBM Guidelines Editorial Team, 2010)

G di f R d ti A t D l t d E l ti


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GradingofRecommendations,Assessment, Development, and Evaluation-

GRADE

(Essential Evidence Plus EBM Guidelines Editorial Team, 2010)

A High

B

C

D

Moderate

Low

Very Low

Further research is very unlikely to change our

confidence in the estimate of effect.

Several high-quality studies with consistent results

In special cases: one large, high-quality multi-

center trial

Further research is likely to have an important impact

on our confidence in the estimate of effect and may

change the estimate.

One high-quality study Several studies with some limitations

Further research is very likely to have an important

impact on our confidence in the estimate of effect

and is likely to change the estimate.

One or more studies with severe limitations

Any estimate of effect and is very uncertain.

Expert opinion

No direct research evidence

One or more studies with severe limitations

Code Quality of Evidence Definition


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EBM ToolkitEnterand click Google Search.


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http://www.ebm.med.ualberta.ca/


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Mouse over

Domains,

Study Category,

Look at Calculations.

Then look at

Systematic Review.

and select Worksheet.


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Step 4

Apply the Results

Step 5

Assess the Outcome

Step 6 Integrate with clinicalexpertise and patients values

Pl t t t


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Please con tac t us at:

Lubbock(806) 743-2200

Amarillo(806) 354-5448

El Paso(915) 545-6652

Odessa(432) 335-5171


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