Nursing Leadership Institute Presentation
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Nursing Leadership Institute Presentation

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Discusses free resources available for EBP and how to conduct a good search.

Discusses free resources available for EBP and how to conduct a good search.

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  • It ties you to controlled vocabulary, filters you to the most relevant terms

Nursing Leadership Institute Presentation Nursing Leadership Institute Presentation Presentation Transcript

  • EBP & Database BasicsRoy Brown, MLISEducation and Research LibrarianTompkins-McCaw Library, VCU Libraries
  • CONFIDENCE IN YOURSEARCHING SKILLS
  • Objectives:By the end of this class you will :• Be aware of the process for doing effective research & whereit falls in the practice of EBP• Understand the difference between keyword and subjectheading searching• Know how to use Boolean operators & limits• Be able to identify appropriate databases for different informationneedsEffective Searching = Less Time & Reading
  • • In order to keep up with what’s new in the literature, youwould have to read 43 articles a day for 365 days a year!!Why do you need to search efficiently?
  • WHAT IS EVIDENCEBASED PRACTICE?
  • PatientValuesClinicalData/KnowledgeResearchEvidenceOptimalDecision• What does the patientwant?• What are they willing todo?• What does yourexperience tell you?• What has been theexperience of yourcolleagues?What does theresearch say?
  • Evidence Based Practice Inquiry ProcessBox 4FocusthequestionBox 6Adequateevidence?Box R2Assign /FindmentorBox R3IRBproposalBox R4DatacollectionBox R5DataanalysisBox 7DisseminateBox R6Impactand/oroutcomeBox 1InitialquestionBox 2UnitordepartmentresourceBox E2Assesstranslationof evidenceintopracticesettingBox E3CreateactionplanandimplementchangeBox E4Evaluateoutcomeand/orimpactBox E1Finalize teammembershipand scheduleconferencesBox E5Reportresultstodecision-makersBox E6Adoptchangeandidentifynext stepsBox R1Contact ResearchAdvisory CouncilorGroup (If Applicable)Box 6AppraisalofliteratureBox 3AssembleinitialprojectteamIf answer is yes,proceed to EBPProject.If answer is no,proceed to researchprojectBox 5ConsultLibrarianAdapted from VCUHS Nursing Inquiry Process Diagram
  • Levels of Evidence PracticeGuideline
  • Practice GuidelineAdvantagesCreated by panels of expertsBased on professional publishedliteraturehttp://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.htmlStatement produced by a panel of experts that outlines current bestpractice to inform health care professionals and patients in makingclinical decisions. Where Can They Be Found?o PubMedo CINAHLo National Guidelines ClearinghouseDisadvantages Slow to change or be updated Not always available, espeicallyon controversial topics Recommendations might beaffected by the type oforganization creating theguideline
  • Review ArticlesReview Articles• Provide Overview of a field or subject• Synthesize Previous Research• Useful when you need background information and additional referencesSystematic Review• Evidence based search and review of the literature on a topic by anestablished method.Meta-Analysis• A systematic method that takes data from a number of independent studiesand integrates them using statistical analysis (Dorland’s Medical Dictionary for HealthConsumers)
  • Research Articles• Present new and original scientific findings• Explain research methodology and provide dataRandomized Controlled Trials (RCT’s)Cohort StudiesCase-Controlled StudiesStudies that randomly assign individuals toan intervention group or to a control group,in order to measure the effects of theintervention.Study in which a particular outcome, such asdeath from a heart attack, is compared in groupsof people who are alike in most ways but differby a certain characteristicStudy that compares patients who have a diseaseor outcome of interest (cases) with patients whodo not have the disease or outcome (controls),and looks back retrospectively to compare howfrequently the exposure to a risk factor is presentin each group to determine the relationshipbetween the risk factor and the disease.Types of Research ArticlesCause & Effect
  • Selecting the Right Resource• Research Guides• Nursing Research Guide• Important Databases• PubMed/Medline (Free)• CINAHL• APA PsycNet/PsychInfo• Cochrane Library• TRIP Database (Free)• National GuidelinesClearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)PracticeGuidelinehttp://guides.library.vcu.edu/nursing
  • THE SEARCH PROCESS
  • The Search Process Search Steps2.5. Evaluatethe Results6. Good Results = Use the Data• Bad = Start Over3. Choose the appropriatedatabase(s) or resource foryour topic4. Perform theSearch1. Problem/ ConstructQuestionImage: http://evidencebasedhealth.blogspot.com/Formulate Your SearchStrategy• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits
  • Starting Your Search……..Step 1Starts with aProblem or Needfor Information
  • The Problem……….• Helping a patient to dealwith the pain/issues offibromyalgia• Improve Quality of LifeQuestion - Brings Focus to Search of the Literature
  • Formulate Your QuestionQuestionIs therapeutic touch or guidedimagery more effective whentreating a patient withfibromyalgia?P I C O T T
  • Type of Question/ Best Type of StudyType of Question Best Type of StudyTherapyHow to select treatments to offer patients that do moregood than harm and that are worth the efforts and costs ofusing themRandomized Control Trial (RCT)PreventionHow to prevent a disease or conditionRCT/ Cohort Study / Case ControlPrognosisHow to estimate the patients likely clinical course overtime and anticipate likelycomplications of diseaseCohort Study/ Case Control/ Case Series or Case ReportDiagnosisHow to select and interpret diagnostic testsBlind RCT Compared to the Gold Standard(best treatment/test for diagnosis)Etiology/HarmHow to identify causes for diseaseRCT/ Cohort Study /Case ControlCost analysisEconomic costs of all facets of a intervention or diseasetreatmentEconomic AnalysisSearch Process Checklist
  • PICO & Breaking Search Into ConceptsMain ConceptsBreak Search in Groups/Concepts20Fibromyalgia | Guided Imagery & Therapeutic TouchThese concepts will be used to search the databasesFind Synonyms/ Related Terms for ConceptsP I C O T TPatient withFibromyalgiaTherapeuticTouchGuidedImageryAlleviatingthesymptoms ofFibromyalgiaTherapyRCT
  • What are some alternative terms…• Guided Imagery• Fibromyalgia• Therapeutic Touch
  • Fibromyalgia Therapeutic Touch Guided Imagery
  • Fibromyalgia Therapeutic Touch Guided Imagery"Fibromyalgia"[Majr] OR"Fatigue Syndrome,Chronic"[Majr]OR "Diffuse MyofascialPain Syndrome" OR"Fibromyalgia" OR"Fibromyalgia-FibromyostitisSyndrome" OR "ChronicFatigue Syndrome" OR"Chronic Fatigue andImmune DysfunctionSyndrome" OR"Postviral FatigueSyndrome""Massage"[Mesh]) AND"TherapeuticTouch"[Mesh:NoExp]OR “Therapeutic Touch”OR “Laying-on-of-Hands” OR “Reiki” OR“Massage” OR ZoneTherap* OR Bodywork*OR Reflexology("Imagery(Psychotherapy)"[Mesh]OR Imagery OR"Guided Imagery" OR"Directed ReverieTherapy" OR HypnosesOR Mesmerism) OR"Hypnosis"[Mesh:NoExp]
  • Background Information• Good Sources:1. Point-of-Care Tools2. Government Sites3. Google ScholarTerm/Concept Mining
  • Google vs. Google Scholar main purpose of is tohunt for text in Webpages Displays results basedon Page Rank Does not really coverinformation contained inlibrary catalogs, officialgovernment documents,phone books, etc.• Indexes the full text ofscholarly literature across anarray of publishing formatsand disciplines• Includes most peer-reviewed online journals ofEurope and Americaslargest scholarly publishers• Tends to put weight oncitation counts whendisplaying search resultsFalagas, M. E., Pitsouni, E. I., Malietzis, G. A., & Pappas, G. (2008). Comparison of PubMed, scopus, web of science, and google scholar: Strengths and weaknesses The FASEB Journal :Official Publication of the Federation of American Societies for Experimental Biology, 22(2), 338-342. doi:10.1096/fj.07-9492LSFVine, #., & Rita. (2006). Google scholar Journal of the Medical Library Association, 94(1), 97–9.Wikipedia contributors.Google search Retrieved, 2012,
  • Step 2: Formulate Your Search Strategy
  • The Search Process Search Steps2.5. Evaluatethe Results6. Good Results = Use the Data• Bad = Start Over3. Choose the appropriatedatabase(s) or resource foryour topic4. Perform theSearch1. Problem/ ConstructQuestionImage: http://evidencebasedhealth.blogspot.com/Formulate Your SearchStrategy• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits
  • DESCRIBE THEFOLLOWING ITEM
  • Keyword• Also called natural language searching• Search for words or phrases found in title, abstract, orother parts of articles• Keyword searching used for• New terminology• Rare terms• Other terms that have no related subject heading• Spelling variations• Truncation - Train*• Trained, Trainer, Training, etc.• Grouping Using “Guided Imagery”• Use Quotation Marks• Without Quotes – AND Terms TogetherPerspectiveSynonyms
  • All searched when searching bykeyword
  • All Places that are searched whendoing a keyword search in PubMed
  • Pepsi CokePopSoda SodaPopSubject Headings/ Controlled Vocabulary• Controlled Vocabulary – Thesaurus• Help to return results that directlyapply to subject of the search• Hierarchy – Tree Structure• Broad –Specific• Minor / Major Heading• Major Heading - Focuses your searchresults to returning articles thatspecifically address the topic• PubMed – have stars beside them• CINAHL – Divided into Major & MinorHeadings• Scope Note – Term DefinitionSoftDrink
  • May need to move backward in order to moveforward……
  • Searched when searching with SubjectHeadings/ Controlled Vocabulary
  • Subject heading field in PubMed
  • Fibromyalgia Therapeutic Touch Guided Imagery"Fibromyalgia"[Majr] OR"Fatigue Syndrome,Chronic"[Majr]OR "Diffuse MyofascialPain Syndrome" OR"Fibromyalgia" OR"Fibromyalgia-FibromyostitisSyndrome" OR "ChronicFatigue Syndrome" OR"Chronic Fatigue andImmune DysfunctionSyndrome" OR"Postviral FatigueSyndrome""Massage"[Mesh]) AND"TherapeuticTouch"[Mesh:NoExp]OR “Therapeutic Touch”OR “Laying-on-of-Hands” OR “Reiki” OR“Massage” OR ZoneTherap* OR Bodywork*OR Reflexology("Imagery(Psychotherapy)"[Mesh]OR Imagery OR"Guided Imagery" OR"Directed ReverieTherapy" OR HypnosesOR Mesmerism) OR"Hypnosis"[Mesh:NoExp]Good Search – Combination of SubjectHeadings and Keywords
  • Boolean Operators - AND• Combines concepts• Relationship• Retrieves records thatcontain BOTH termsenteredSoda Pop WeightGain
  • Boolean Operators - OR• Combines synonyms orlike concepts• No RelationshipNecessary• Retrieves records thatcontain EITHER termenteredCoke Pepsi
  • When Searching………..Combining Terms TogetherGroup 1CombineTerms with ORGroup 2Combine Termswith ORAND ANDGroup 3Combine Termswith OR
  • When Searching………..Combining Terms TogetherFibromyalgia(SH/KW)ORChronicFatigueSyndrome(SH/KW)TherapeuticTouch (SH/KW)ORMassage (KW)AND ANDGuidedImagery(SH/KW)ORHypnotism(KW)
  • Ways to Expand Your Results Ways to Focus Your Results• Explode Your Terms• Keyword Searching• Look At Related or CitingArticles• Major Concept/Subject• Subheadings• LimitsKeep in Mind……
  • Keep in Mind……Break Your Search into Concepts –Don’t Marry Early/ Let Them Date!!!!Start Your Search Broad and Then Focus –Don’t Put Blinders on the Horse Too Soon !!Be sure to come up with alternative orrelated terms for your topicAlways search in at least two databases.
  • CHOOSING THE RIGHTRESOURCE
  • The Search Process Search Steps2.5. Evaluatethe Results6. Good Results = Use the Data• Bad = Start Over3. Choose the appropriatedatabase(s) or resourcefor your topic4. Perform theSearch1. Problem/ ConstructQuestionImage: http://evidencebasedhealth.blogspot.com/Formulate Your SearchStrategy• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits
  • Selecting the Right Resource• Research Guides• Nursing Leadership Institute:Evidence Based Practice• Important Databases• PubMed/Medline (Free)• TRIP Database (Free)• National GuidelinesClearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)• CINAHL• APA PsycNet/PsychInfo• Cochrane Library
  • TRIP – TURNING RESEARCHINTO PRACTICE
  • TRIP – Turning Research into PracticeFree database free clinical search engine that searches several databases atonce. Primary function is to help identify the best available evidence when itcomes to patient care.Resultsdisplayed byhierarchy ofevidenceResultsdisplayedchronologicallyClinical AreasLinks toClinicalTrials.Gov &PubMedClinicalQueries
  • PUBMED CLINICALQUERIES
  • Pub MedClinical QueriesTools that allow clinicians toquickly and easily search forrelevant clinical literature onetiology, prognosis, diagnosis andtherapy of diseases anddiagnostics.Not intended to becomprehensive!!Direct Link:http://www.ncbi.nlm.nih.gov/pubmed/clinicalPubMed HomepageClick here to access but notbefore performing your searchin PubMed.
  • Categories of Queries:• There are five study categories orfilters to choose from based on yourclinical question:• Etiology - information addressingcausation/harm of disease• Diagnosis - information addressingdisease diagnosis• Prognosis - information addressingdisease prognosis• Clinical prediction guidelines -data addressing the likelihood ofdisease presence or absence• Therapy - information addressingthe treatment of disease *Note:therapy is the search default.Two scope categories or filtersare provided:• narrow, specific search -- will getmore precise, relevant citations butless retrieval• broad, sensitive search -- includesrelevant citations but probably someless relevant; will get more retrievalPlace the last number ofyour search strategy hereor you can usecombination of keywordsStudy Categories/ScopeDisplays citations forsystematic reviews,meta-analyses,reviews of clinicaltrials, evidence-basedmedicine, consensusdevelopmentconferences, andguidelinesStudyResults
  • • Health Topics• Medical Encyclopedia• Interactive Health Tutorials• Drugs, Supplements, & HerbalInformation• Current Health News• Dictionary• Multiple Languages - links to healthinformation in over 40 languages• Directories - locations andcredentials of doctors, dentists andhospitalshttp://www.nlm.nih.gov/medlineplus/
  • • Specializes in reviews of clinicaleffectiveness research• What Works in Medical Care?• Reviews based on systematicreviews of clinical trials• Information partners:• Agency for Health Care Research and Quality(US) (AHRQ)• Centre for Reviews and Dissemination (CRD)• The Cochrane Collaboration (CC)• German Institute for Quality and Efficiency inHealth Care (IQWiG)• National Cancer Institute (NCI)• National Institute for Health and ClinicalExcellence guidelines program (NICE)• National Institute for Health Research (NIHR)Health Technology Assessment Programme(NIHR HTA)• Oregon Health and Science Universitys DrugEffectiveness Review Project (DERP)• Department of Veterans Affairs Evidence-based Synthesis Program from the VeteransHealth Administration R&D (VA ESP)http://www.ncbi.nlm.nih.gov/pubmedhealth/
  • If You Need Help……..• Get in touch with Me…..Roy Brown, MLISEducation and Research LibrarianTompkins-McCaw Library, VCU Librariesrebrown2@vcu.edu / Ph. 804-828-1592