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Exeter Full 2509

Exeter Full 2509

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  • 1. Finding the Evidence Pragmatic Information Retrieval in the of Context of Evidence-based Healthcare Exeter September 2010 Kate Boody Reinhard Wentz
  • 2.  
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  • 7.  
  • 8. “ It’s publish or perish – and he didn’t publish!”
  • 9. Just One Definition of EBHC: <ul><li>An approach to health care practice </li></ul><ul><li>in which the clinician is aware of the </li></ul><ul><li>evidence in support of his/her </li></ul><ul><li>clinical practice, and the strength of </li></ul><ul><li>that evidence </li></ul><ul><li>Postgraduate Medical Journal 1996;72:1 </li></ul>
  • 10. Preconditions for Successful EBHC <ul><li>Start with a focused, answerable question </li></ul><ul><li>Select a high-yield database </li></ul><ul><li>Formulate a simple search </li></ul>
  • 11. Preconditions for Successful EBHC <ul><li>Start with a focused, answerable question </li></ul><ul><li>Select a high-yield database </li></ul><ul><li>Formulate a simple search </li></ul>
  • 12. Unfocused (unanswerable) Questions <ul><li>Is health promotion a good thing? </li></ul><ul><li>How to treat diabetes in pregnancy? </li></ul><ul><li>Is physiotherapy useful? </li></ul><ul><li>Why is Mrs. Gupta depressed? </li></ul>
  • 13. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup? </li></ul>
  • 14. Answerable question <ul><li>Does the presence of a </li></ul><ul><li>Doula reduce caesarean </li></ul><ul><li>section rates? </li></ul>
  • 15. Answerable question <ul><li>How effective is aspirin in </li></ul><ul><li>preventing DVT in patients </li></ul><ul><li>following hip-replacement? </li></ul>
  • 16. Answerable question <ul><li>What is the predictive value of </li></ul><ul><li>PCR compared to routine </li></ul><ul><li>blood culture in the </li></ul><ul><li>treatment of neonatal sepsis? </li></ul>
  • 17. Answerable question <ul><li>How effective is </li></ul><ul><li>acupuncture in smoking </li></ul><ul><li>cessation programs? </li></ul>
  • 18. Aspects of the ‘Answerable Question’ <ul><li>P atient or P roblem </li></ul><ul><li>I ntervention or exposure </li></ul><ul><li>C omparison </li></ul><ul><li>O utcome </li></ul><ul><li>= PICO </li></ul>
  • 19. Preconditions for Successful EBHC <ul><li>Start with a focused, answerable question </li></ul><ul><li>Select a high-yield database </li></ul><ul><li>Formulate a simple search </li></ul>
  • 20. High-yield Databases Extracting · Evaluative · Synthesizing Databases <ul><li>PubMed (especially Clinical Queries Option) </li></ul><ul><li>Cochrane Library </li></ul><ul><li>Google Scholar </li></ul><ul><li>NHS Evidence </li></ul><ul><li>TRIP </li></ul><ul><li>Quality Sites on the Web etc. </li></ul>
  • 21. Preconditions for Successful EBHC <ul><li>Start with a focused, answerable question </li></ul><ul><li>Select a high-yield database </li></ul><ul><li>Formulate a simple search </li></ul>
  • 22. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup? </li></ul>
  • 23. Suggested Search Strategy <ul><li>Think ‘Telegram’ </li></ul><ul><li>? </li></ul>
  • 24. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup? </li></ul>
  • 25. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup ? </li></ul>
  • 26. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup ? </li></ul>
  • 27. Answerable question <ul><li>How effective is a single dose </li></ul><ul><li>of dexamethasone in </li></ul><ul><li>outpatient croup ? </li></ul>
  • 28. The search-formulation ‘telegramme’ (here: on PubMed)
  • 29.  
  • 30. Answerable question <ul><li>How effective is aspirin in </li></ul><ul><li>preventing DVT in patients </li></ul><ul><li>following hip-replacement? </li></ul>
  • 31. Answerable question <ul><li>How effective is aspirin in </li></ul><ul><li>preventing DVT in patients </li></ul><ul><li>following hip-replacement ? </li></ul>
  • 32. Answerable question <ul><li>How effective is aspirin in </li></ul><ul><li>preventing DVT in patients </li></ul><ul><li>following hip-replacement ? </li></ul>
  • 33. Answerable question <ul><li>How effective is aspirin in </li></ul><ul><li>preventing DVT in patients </li></ul><ul><li>following hip-replacement ? </li></ul>
  • 34.  
  • 35.  
  • 36.  
  • 37.  
  • 38. Archie Cochrane 1909-1988 Cochrane AL. Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972 All effective treatment must be free! A. Cochrane circa 1935
  • 39. Archie Cochrane 1909-1988 All effective treatment must be free! A. Cochrane circa 1935
  • 40. Answerable question <ul><li>How effective is </li></ul><ul><li>acupuncture in smoking </li></ul><ul><li>cessation programs? </li></ul>
  • 41.  
  • 42.  
  • 43. <ul><li>To recap … </li></ul>
  • 44. Preconditions for Successful EBHC <ul><li>Start with a focused, answerable question </li></ul><ul><li>Select a high-yield database </li></ul><ul><li>Formulate a simple search </li></ul>
  • 45. And finally ... <ul><li>Start with a subject to which </li></ul><ul><li>you know the answer: </li></ul><ul><li>calibrate your skills (why?) </li></ul>
  • 46. The curtain closes, only questions remain Brecht: The good woman of Szechwan The End
  • 47. And finally, again ... <ul><li>Start with a subject to which </li></ul><ul><li>you know the answer: </li></ul><ul><li>calibrate your skills (why?) </li></ul>
  • 48. Calibrate your skills! <ul><li>How effective are stockings to </li></ul><ul><li>prevent DVT in long-haul </li></ul><ul><li>airline passengers? </li></ul>

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