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Evidence-based Practice Resources for HINARI Users

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  • This module explains why HINARI users might want to start by searching evidence-based resources and highlights HINARI, as well as, freely available resources that support evidence-based practice.
  • Evidence from research constitutes the knowledge component of decision making. Practitioners must also take into account local conditions/resources/constraints as well as the preferences of individuals or populations.
  • Much of the work in evidence-based practice started with clinical medicine, and the definition here is often quoted.
  • Evidence-based resources are relatively new. They are attempts to bring to the fore the current knowledge on a specific topic to answer important clinical and other questions. Systematic Reviews are an attempt to provide an overview, and often a synthesis, of all methodologically valid studies on a topic, often with an evaluation and commentary. Specifically EBM resources are a good place to start an efficient search for the “best evidence.”
  • Although we will focus on using HINARI resources to find the best evidence, the EBM process includes other, important steps shown on this slide.
  • Four learning resources are available.
  • Most of the evidence-based resources deal with clinical questions so we will look at those first. Later, we’ll look at resources useful to public health practitioners. Of course, there is some overlap between the two areas of interest. We’ll start by looking at the resource called Clinical Evidence.
  • Take a minute to look at the various features of this resource. Note that there are 3 ways to search, by general section (e.g., Infectious Diseases), Full review (browse titles of individual reviews, e.g., AIDS: Tuberculosis in people with HIV), and Search (use keywords here). Note also, the availability of a Userguide.
  • Searching the term tuberculosis results in 73 matches. Perhaps we should limit our search to be more specific.
  • Adding HIV to the Search box results in 56 matches. You can keep adding terms, with , of course, the possibility of missing some useful articles.
  • Next we are going to look at one of the first and most respected evidence-based information resources, The Cochrane Library. Also, technically the Reference Sources drop down, no?
  • Take a minute to review the main page of the Cochrane Library. Note in the upper right you can browse Cochrane Reviews and there are other sources as well, such as individual clinical trials. There is a search box and field options for searching. One can also click on Advanced Search to construct a search by filling in boxes and making selections.
  • Here we see the Advanced Search box and search for items that discuss both diarrhea AND children. Note the ability to put a wildcard * at the end of child to search for child, children.
  • Note that we retrieved more than 400 Systematic Reviews and it might be smart to further restrict the search with more terms, realizing that you might miss some good articles. For our purposes, though, let’s look at the record about oral zinc (note that variations of the spelling of diarrhoea are accounted for).
  • This is the information about who did the systematic review and when it was last updated. If we click on Summary, we’ll see the following .
  • Summary which gives a good overview of purpose, methodology, results, conclusions and a plane language summary (next slide).

Transcript

  • 1. Evidence-based Practice Resources for HINARI Users
  • 2. Evidence-based Practice Resources for HINARI Users
    • Instructions - This part of the:
    • course is a PowerPoint demonstration intended to introduce you to Evidence-based Practice and related HINARI resources.
    • module is off-line and is intended as an information resource for reference use.
  • 3. Table of Contents
    • Evidence-based Medicine (EBM) definition, background and resources
    • Clinical Evidence
    • Cochrane Library
    • EBM Guidelines
    • HINARI EBM Journals
    • Searching for EBM articles in
      • a specific journal (Science Direct)
      • HINARI/PubMed’s Clinical Queries
    • Summary
  • 4. What is evidence-based health care?
    • Using the best available evidence (research) to answer questions and support decision making
    Research Evidence Practitioner’s Experience Local Conditions Patient/Community Preferences & Values
  • 5. Evidence-based Practice Definition
    • "Evidence-Based Practice requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources."
    • Sicily statement on evidence-based practice . BMC Medical Education, 2005 Jan 5;5(1):1
  • 6. Evidence-based Medicine (EBM) Definition
    • "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
    • Sackett, D. et al. Evidence-based Medicine - What it is and what it isn't. BMJ 1996;312(7023):71 (13 January) 1996.
  • 7. Why use Evidence-based Resources?
    • Aims to locate current clinical knowledge on a topic
    • Can save time finding ‘the best’ information
    • Identifies Systematic Reviews¹
    • Often contains commentary about validity
    • A good ‘first place’ to start your search
    • ¹A systematic review involves the application of scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific clinical question.
    • Cook DJ, Mulrow CD, Haynes RB. Annals of Internal Medicine March 1, 1997; 126 (5) 376 .
  • 8. Evidence-based Practice Process
    • Formulate answerable questions
    • Find the best evidence
    • Critically evaluate the evidence
    • Integrate the evidence, using patient values, in the decision-making process
    • Evaluate performance
  • 9. If you are interested in learning more about EBM, go to the online tutorial Introduction to Evidence-Based Medicine from the Health Sciences Library, University of North Carolina (USA): http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm
  • 10. From the HINARI Reference Sources drop down menu, we also can find tutorials for learning more about EBM. In this example, we will link to BMJ Learning .
  • 11. From the BMJ Learning’s Browse our modules listing, we have clicked on Clinical Epidemiology and located four EBM-related tutorials.
  • 12. Logging on to HINARI 1 To access the HINARI Evidence-based Medicine resources , we must Login to the HINARI website using the URL http://www.who.int/hinari/
  • 13. Logging into HINARI 2 We will need to enter our HINARI User Name and Password in the appropriate boxes, then click on the Login button. Note: If you do not properly sign on, you will not have access to Evidence-based Medicine resources that are located in the Reference Sources drop down menu.
  • 14. From the Reference Sources drop down menu, there are three valuable EBM- related sites. First, we will click on the Clinical Evidence link, a resource for informing treatment decisions and improving patient care . It is published by the BMJ Publishing group.
  • 15. In the Clinical Evidence site, you can search by Sections, Full review list or (keyword) Search this site . Also note that there is a Clinical Evidence Userguide in multiple languages and links to the Latest updated reviews .
  • 16. Using the Search this site option, we have completed a keyword search for tuberculosis and identified 73 documents . The links include clinical evidence Guidelines, Keypoints, Interventions and Updates about this topic.
  • 17. We have further limited this search by combining tuberculosis and HIV . This has resulted in 56 documents. We will click on the link to Tuberculosis in people with HIV .
  • 18. The initial page of HIV: treating tuberculosis initially displays Interventions based on clinical questions . Note that also you have access to Key points, About this condition, Updates, Guidelines and References . We will click on the Guidelines hyperlink.
  • 19. The Guidelines page contains the title, name of organization and hyperlink to 10 documents from key health agencies. The guidelines have been sourced from the National Guidelines Clearinghouse (USA).
  • 20. We have clicked on the Full review list option and displayed the topics under the A alphabetical list. This A-Z subject access contains an extensive list of topics and clinical evidence material.
  • 21. From the Reference Sources drop down menu, we now will click on the Cochrane Library link. The Cochrane Library contains high-quality, independent evidence including reliable evidence from Cochrane and other systematic reviews and clinical trials. It is published by John Wiley. Note the full-text reviews are available to Band 1 only while Abstracts can be accessed by all users.
  • 22. Besides a keyword and other options Search engine, you can search by the Advanced Search option, complete a MeSH Search , look at your Search History or Saved Searches . Also from the initial page, there are links to the Cochrane Journal Club and sections for Clinicians, Researchers, Patients and Policy Makers .
  • 23. We have opened the Advanced Search option where you can specify search fields and have the ability to combine terms using AND/OR/NOT operators. In this text Advanced Search, we have combined diarrhea AND child * using the Search All Text option with the wildcard (*) used to locate the terms child and children.
  • 24. The Advanced Search results for diarrhea AND child* has retrieved 444 records from the Cochrane Database of Systematic Reviews. You have the option to Export All Results (save). Note: if the results of your search are too many, you can narrow it by limiting the keyword search to Title instead of Search All Text.
  • 25. The initial screen displays the Abstract of the f irst systematic review listed in the search - Oral zinc for treating diarrhoea in children. To access the full-text review, click on the Full PDF hypertext link in the left column. Other options are Summary and Standard . Also note the hypertext links to the entire systematic review.
  • 26. We have displayed the Abstract of the systematic review that includes the Background, Objectives, Search strategy, Selection criteria, Data collection and analysis and Main Results .
  • 27. The final section of the Abstract is titled Plain language summary . This section is useful for disseminating the results to groups of health workers and patients. Also note the Main results and author’s conclusions (the ‘bottom line’) as these sections discuss the review’s results and how they should be used.
  • 28. We have displayed the PDF Full version of the Oral zinc for treating diarrhoea in children systematic review. Other options include Summary and Standard files. Note: The url that contains http://hinari-gw.who.int/whalecom ... shows that we have logged in to HINARI properly and will have access to the full-text version of this review.