The Journey to EvidenceManaging the information infrastructure

Wendy McDonald RN MPH&TM

Searching for External EvidenceThe best evidence to answer the PICOT question.Time is important Evidence that has already been appraised for the

quality of study methodology & reliability is desirable. Preappraised literature can range from Meta-analytic systemic reviews to synopsis of a single

study.

Determine Your Resources

Know the databases that are available to you to collect the best evidence to answer the PICOT question.

The PICOT question will determine which databases you will need to search.

PICOTCarefully formulate the PICOT question.Using unambiguous, nonjargon terms to

describe the PICOT question components will assist in obtaining the best search in the shortest time.

Keyword Searching KWKeyword searching is searching using basic language. Must include all synonyms such as research,

evidence, studies, study, Investigation, or items will be missed.

Keyword Search continuedIn data bases - yields evidence if there is a match

between the keyword entered and what is found in the title and/or abstract.

Evidence may be missed, if a different term is entered.

you get only articles that match terms you put in the search.

may include unrelated articles due the word searched (many words have more than one meaning).

Controlled VocabularyA Controlled vocabulary is Medical Subject Headings

(MeSH) - the content of articles indexed in MEDLINE. If a MeSH term is searched all the articles would contain

information about the term searched.

Combining & Limiting Searches AND and OR are used when combining keyword or

controlled vocabulary AND to combined terms to appear in the final record.AND is a restrictive word so both words must appear in

the article – reduces the number of studies retrieved OR - keyword searching of synonyms

Resources for Searching

The Cochrane LibraryTo scan many types of information pre-filtered for qualityIncludes the Cochrane Database of Systematice Reviews

(Cochrane Reviews), Database of Abstracts of Reviews of Effectiveness (DARE), Cochrane Controlled Trials Register (Clinical Trials) &othersSystematic reviews aggregate randomized controlled trialsReview process is labor intensive, so not all topics are

coveredSmall databaseCochrane library http://www.cochrane.co.uk

CINANLDates back to 1981Contains more than a million recordsIndexes almost 3,000 journalsSearchable cited references for more than 1,200 journalsFull text for 71 journalsCovers nursing, biomedicine, health science librarianship,

alternative/complementary medicine, consumer health and 17 allied health disciplines

Now features Clinical Query Functionality

PubMed/MEDLINECitations and Abstracts Includes over 4600 journals worldwideMore than 17 million citationsApproximately 1/3 full text articles availableUses MeSH controlled vocabularyUpdated dailyAvailable anywhere, anytimeSearching help availableMust do one’s own quality filteringMust learn how to search the database

www.pubmed.gov

* Means any other letters

AND means both terms required

Check the question type

Check the emphasis

Critical AppraisalCritical reviews of published studies

ACP Journal ClubInfoPOEMSClinical Inquiries

High quality evidence with commentaryHigh specificityAbstracts accompanied by commentary Incomplete coverage of literatureSmall databases

Trip Data BaseTurning Research Into Practice Data Base Plus

(TRIP) Simultaneously searches evidence-based

sources of systematic reviews, practice guidelines, and critically-appraised topics and articles

Searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.

TRIP Database allows a limited number of free searches.

Specialized JournalsACP Journal ClubEvidence Based MedicineEvidence Based Nursing

For more InformationCentre for Evidence-Based Medicinehttp://cebm.jr2.ox.ac.uk/Health Information Research Unit Evidence-

Based Health Informatics http://hiru.mcmaster.ca/

Exploring the evidence base

http://clinicallibraian.wordpress.com/2008/08

Evidence-based nursing resources

http:muhc.ebn.mcgill.ca/EBN_tools.htm

Managing citations of interestOnce a search is completed each data base will

provide options for dealing with the citations you are interested in.

Saving Searches Saving the method of searching – how you went about

the search - is imperative to repeat the search or communicate the search to someone else.

Save the search details when you conduct the initial search so it can be replicated.

Each search engine offers different ways for saving the search.

Organizing SearchesOrganize the evidence found.Teams can use bibliographic management software

(BMS) – web-base password protected folders. Allows all team members quick access to the

resources.

Other Resources That Support EBPClinical Practice Guidelines National Guideline

Clearinghousehttp://www.guidelines.gov

Health Services/Technology Assessment Text (HSTAT)

http://text.nlm.nih.gov

The Best Evidence Database http://evidence-basedmedicine.com

Searching made easy

Conduct rapid critical appraisal of studies found in the search- keep the valid and reliable studies-Evaluate the keeper studies-synthesis the evidence from the keeper studies

Skills Required for EBP Clearly identify practice problem or new

knowledge (innovation)Find research literatureCritically evaluate research findingsApply to practice through change process

Things that help EBPdevelopment of strategies for efficiently tracking down

and appraising evidence creation of systematic reviews of the effects of health

carecreation of evidence-based journals of secondary

publicationscreation of information systems/decisionsupport systems/answering servicesapplication of effective strategies for lifelong learning and

for improving clinical performance

McNabb C., Descriptive Research Methodologies. (power point) Pangea.tec.selu.edu/~cmcnabb/philosop/power.ppt

Institute of Medicine, (US)Greiner, A. & Knebel, E., (Eds.) (2003) Health Professions Education: A bridge to quality, The National Academies Press, 45-74

Ireland M. C.(2010) Evidence -Based Practice What does it mean? Innovations and Perspectives Virginia Department of Education. 1,2

Bio medical library University of Minnesota, Evidence Practice (power point) http://hsl.lib.umn.edu/learn/ebp/modo1/pico.html

Beyea S.C. , Slattery M.J.(2006)Evidence-Based Practice in Nursing a guide to successful implementation Marblehead MA: HCPro ,Inc

Royle J., Blythe J.(1998) Promoting research utilisation in nursing: the role of the individual, organisation, and environment Evidence-Based Nursing,1:71-72

Malloch, K., Poter-OGrady, T., (2006)Introduction to Evidence -Based Practice in Nursing and Healthcare . Sudbury, MA, .Jones and Bartlet

Glasziou P. Introduction to EBM 2010(power point) www.cebm.net/index.aspx?0=1382