Evidence-based searching for health librarians

LIBR534 – Health information sources & services
Evidence-based medicine – Module II ’Filter’
January 28 th , 2010
Greg Rowell & Dean Giustini, SLAIS Adjunct faculty
“ A new paradigm for medical practice is emerging…” (1992) Canadian Dr. Gordon Guyatt [ personal website ] 1992 JAMA article

Agenda
Module II
What is evidence based medicine (EBM)?
Health librarian roles in EBM
~ Break 7:15pm~
Sources of information in EBM
Exercises
Searching in EBM
Examples
Rowell-Giustini – LIBR534

Rowell-Giustini – LIBR534 Classic definition of EBM “… EBM is the conscientious, explicit and judicious use of current best evidence in making clinical decisions about the care of individual patients.“ David Sackett (1996) - McMaster University In your own words: What is evidence-based medicine ’about’? How would you explain its ’steps’ to someone?

Rowell-Giustini – LIBR534 … the health librarian’s role is to explain what knowledge and skills he brings to the clinical team Health librarians – The Five Steps of EBM see EBM tutorial , University of California

Rowell-Giustini – LIBR534 Lead to the evidence - when you can…
Haiti guide
http://hlwiki.slais.ubc.ca/index.php/Haiti_earthquake_-_disaster_relief_information_sources
e.g., Cochrane Library - disease prevention & coping skills
Improving water quality & hand washing
Psychological treatment
H1N1 guide
http://hlwiki.slais.ubc.ca/index.php/H1N1_(Human_Swine_Flu)_in_Canada_-_Information_Sources
DynaMed
http://www.ebscohost.com/dynamed/h1n1/
MDConsult
http://www.mdconsult.com/recommended-results/H1N1Influenza.lp
UpToDate
http:// www.uptodate.com/home/content/topic.do?topicKey =pulm_inf/19054
Other observations re: searching for evidence?

Rowell-Giustini – LIBR534 But first – is question ‘background’?
First, let’s make distinction - background vs foreground questions
Background questions are posed by novices looking for general knowledge or “facts”
who, what, when, why , which
What is H1N1? What is influenza?
How can H1N1 be diagnosed?
Which treatments are available for it?
Best answered in textbooks or databases like MDConsult & UpToDate
The novice has more background questions than the expert…

Or a foreground question?
Foreground questions are asked by experts
Answers found by searching Medline but there are many tools
PICO to structure foreground Qs:
P atient/ P opulation/ P roblem
I ntervention
C omparison/ C ontrol
O utcome
‘ Therapy’ …. most common domain
PubMed’s Clinical Queries to filter
http:// www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical
Rowell-Giustini – LIBR534 Reference: “Laikas MedLibLog” http://laikaspoetnik.wordpress.com/2009/09/

Rowell-Giustini – LIBR534 … and PICO to structure question Exercise – Jonesy, a 68 yr old male with…. What is the desired outcome or effect for the patient? Outcomes Do you want a placebo comparison or a drug comparison? Comparison What main intervention (or treatments) will be considered for him? Intervention Can I describe my patient or problem? Let’s start by framing the question… Patient Population Problem

Rowell-Giustini – LIBR534 … where is the evidence?
Should newborns be vaccinated against chicken pox if mothers have been exposed to the virus?
What are the effects of Prozac for someone who is depressed?
Does psychological counselling alleviate symptoms of Post Traumatic Stress Disorder (PTSD)?
Are cox-II inhibitors effective in treating osteoarthritis in a geriatric population?

Rowell-Giustini – LIBR534 Strategy: filtered sources first
EBM up-to-date textbooks
UpToDate, BMJ Clinical Evidence, First Consult, etc
‘ Pre’ Filtered resources
ACP Journal Club
Cochrane Database of Systematic Reviews
SumSearch & TRIP Database
Primary research
Medline (OvidSP, Pubmed) is unfiltered
EMBASE, CINAHL, PsycINFO, etc
But, some filtered information in databases

Rowell-Giustini – LIBR534 Roles for health librarians in evidence-based practice
Explain health librarian’s role to clinical team
R espond to individual needs as appropriate
‘ Frame’ or formulate clinical question in reference interview
Break question into categories, facets or ‘pearls’
Teach search techniques
Explain indexing practices in databases
How to limit for methodology i.e. publication types
Check search strategies
Collaborate on research & publication

Split into groups of 2
Pick one category or question at a time
Listen to the “answer” being read
Determine correct “question” for answer
Try to get the most points
Build your EBM knowledge
Welcome to EBM Jeopardy for LIBR534

Rowell-Giustini – LIBR534 What is evidence-based medicine?

Rowell-Giustini – LIBR534 “… Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making clinical decisions about the care of individual patients.“ David Sackett (1996) - McMaster University

Rowell-Giustini – LIBR534 Name the four parts of PICO…

PICO stands for:
P atient/ P opulation/ P roblem
I ntervention
C omparison/ C ontrol
O utcome
What are the four parts of PICO?

Rowell-Giustini – LIBR534 What is a systematic review & meta-analysis?

Rowell-Giustini – LIBR534 A meta-analysis is… … a study design that attempts to have greater statistical power by pooling the results from many studies like RCTs … the search strategies for a SR or a meta-analysis must be reproducible …

Rowell-Giustini – LIBR534 What is a tree structure?

Rowell-Giustini – LIBR534 A tree structure…. … is how broader and narrower terms are displayed along sixteen (16) categories in the MeSH hierarchy
Anatomy
Organisms
Diseases
Chemical and Drugs
Analytical, Diagnostic and Therapeutic Techniques and Equipment
Psychiatry and Psychology
Phenomena and Processes
Disciplines and Occupations
Anthropology, Education, Sociology and Social Phenomena
Technology, Industry, Agriculture
Humanities
Information Science
Named Groups
Health Care
Publication Characteristics
Geographic Locations

Rowell-Giustini – LIBR534 What is the Cochrane Library?

Rowell-Giustini – LIBR534 The Cochrane Library is … a collection of six databases of high-quality evidence to help health professionals make clinical decisions. (See also Cochrane Collaboration ). In addition to Cochrane's database of systematic reviews, the CL provides access to other sources such as technology assessments, evaluations and clinical trials. Two commercial products that provide access: OVID's Evidence-based medicine reviews (EBMR) and Wiley's Cochrane Library

Rowell-Giustini – LIBR534 What is the ‘Clinical Queries’ feature in PubMed?

Rowell-Giustini – LIBR534 … a quick and efficient way to filter along four domains using pre-defined search strategies or ‘search filters’ that have been created by Brian Haynes and Ann McKibbon at McMaster University…. http:// www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical The ‘Clinical Queries’ feature in PubMed is…

Evidence-based searching for health librarians

by Dean Giustini on Jan 29, 2010

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Evidence-based searching for health librarians Presentation Transcript