Evidence Based Surgical Nursing – Reviewing the Evidence

Carl Thompson

Dept of Health Sciences, University of York.

What is Evidence Based Health Care?

Evidence from research

Clinical experience

Patient preferences

Available resources

EVIDENCE BASED

DECISION

How do you focus your question?

Need to identify 3 things:

Who it is you are interested in - Population

What it is you are interested in - Intervention

What you are hoping for -

Outcome

An example….

In patients with opioid induced nausea and vomiting which is the most effective anti-emetic, metoclopramide or haloperidol

Population

Intervention

(Counter-intervention)

Outcome

Patients with opioid induced

nausea and vomiting

Metoclopramide

(Consider route of administration )

Haloperidol

(Consider route of administration )

Reduction in nausea/vomiting

(Consider how this might be monitored)

TYPE OFQUESTION

EXAMPLE BEST DESIGN

Effectiveness ofTreatment/Prevention;adverse effects oftreatments

Does compressionbandaging increase thehealing of venous leg ulcerscompared with nocompression?

Randomisedcontrolled trials(RCTs)

Causation Are people who have had adeep vein thrombosis morelikely to get a leg ulcer thanpeople who have not?

Cohort Study

Feelings;understanding;perceptions

How do people with venousleg ulcers feel about theirhealth and their lifestyle?

Qualitativetechniques

SEARCH EVIDENCE BASED JOURNALs FOR A PRE-APPRAISEDSYSTEMATIC REVIEW

SEARCH THE COCHRANE LIBRARY FOR A SYSTEMATIC REVIEW

SEARCH EVIDENCE BASED JOURNALs FOR APPRAISED PRIMARYRESEARCH eg. RCTs

SEARCH MEDLINE, CINAHL, COCHRANE LIBRARY (CochraneControlled Trials Register) FOR PRIMARY RESEARCH

No?

If you find one, rememberto appraise its quality

If you find some research,you need to appraise itsquality – use a checklist!

Finding good quality systematic reviews

The Cochrane Library Evidence based nursing Evidence based medicine Evidence based … ACP Journal Club Best Evidence (ACP

Journal Club and Evidence Based Medicine)

The Cochrane Library

completed reviews (CDSR) complete text of reviews,

updated as new research becomes available

reviews in progress (CDSR)Cochrane reviews in progress

quality assessed reviews (DARE)systematic reviews identified

by CRD and assessed according to quality criteria

Effectiveness information in accessible forms

Effective Healthcare Bulletins Effectiveness Matters Clinical Evidence Health Evidence Bulletins

Wales regional and national (e.g.

Bandolier http://www.jr2.ox.ac.uk:80/Bandolier/)

subject or special interest focused

Translating terms into a search

Need to know features of databases; indexes

Subject indexing - MeSH Truncation/wild cards Combination Sophisticated or basic

interfaces

Need to know features of databases; indexes

Subject indexing - MeSH Truncation/wild cards Combination Sophisticated or basic

interfaces

Example search, using MEDLINE subject headings

#1 substance use disorders/#2 exp substance dependence/#3 drug adj addiction#4 or/1-3#5 exp child/#6 teenager? or adolescent? or

young adj people#7 or/5-6#8 exp health promotion/#9 prevent? adj (campaign? or

program? or activit?)#10 or/8-9#11 4 and 7 and 10

What’s the effect of focussing?

Medline Cinahl Cochrane

Pressure sores and pressure relief

(1175)

28

(1211)

95

(9) 12

Diabetes and insulin injection

(147212)

447

(9493)

39

(6707) 281

Oxygen therapy and myocardial infarction

(8004) 193

(1033)

17

(3289) 281

Pre operative smoking cessation

Search on Cochrane library and find review of pre operative smoking cessation (no trials – check for updates in the future)

Find a review of nurse led smoking cessation (some based in hospital)

Rice VH, Stead LF. Nursing interventions for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.

Making sense of a review

Is it valid?

What do the results mean?

How (can?) I apply it to my patients?

Screening.

SCREENING QUESTIONS

Is there a clearly focused question?

Did the authors look for the appropriate sort of research?

Detailed questions

Do you think the important, relevant studies were included?

Did the review’s authors do enough to assess the quality of the included studies?

If the results of the review have been combined, was it reasonable to do so?

What are the results?

What is the overall result of the review?

How precise are the results?

Will the results help locally?

Can the results be applied to the local population?

Were all the important outcomes considered?

Are the benefits worth the harms and costs?