EBP & Health Sciences Librarianship


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From a presentation to McGill's School of Information Studies course on Health Sciences Information

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EBP & Health Sciences Librarianship

  1. 1. Evidence Based Practice & Health Sciences Librarianship Lorie Kloda MLIS, PhD Student October 15, 2008 Health Sciences Information School of Information Studies McGill University
  2. 2. Objectives 1. Definition and evolution of EBP 2. EBP process 3. Question framing 4. Levels of evidence 5. Sources of evidence 6. Critical appraisal 7. Health sciences librarians and EBP Oct. 15, 2008 EBP 2
  3. 3. Definition & History of EBM Evidence-based medicine (EBM) “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ, 312, 71-72. (p.71) “…a new paradigm for medical practice is emerging.” Evidence-Based Medicine Working Group (1992). Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA: The Journal of the American Medical Association, 268, 2420-2425. (p. 2420) Oct. 15, 2008 EBP 3
  4. 4. Definition of EBM Components Oct. 15, 2008 EBP 4
  5. 5. Definition of EBP The Sicily Statement “Evidence-based practice (EBP) 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.” Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K. et al. (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5. Oct. 15, 2008 EBP 5
  6. 6. EBP Process Oct. 15, 2008 EBP 6
  7. 7. Question Framing or, Asking Answerable Questions Patient, population, or problem Intervention, prognostic factor, or exposure Comparison Outcomes to measure or be achieved Oct. 15, 2008 EBP 7
  8. 8. Question Framing Exercise 1 As part of your nursing practice, infants and children with fever are often given tepid baths to lower their temperature. A parent asks you whether or not this actually makes a difference in reducing the child’s fever. You decide to look at the literature to substantiate the intervention. Oct. 15, 2008 EBP 8
  9. 9. Question Framing Question & Study Types (Quant) Types of clinical questions: Types of studies: Therapy RCT; cohort; case control Diagnosis Blind comparison to gold standard Prognosis Cohort; case control Harm/Etiology Cohort; case control Oct. 15, 2008 EBP 9
  10. 10. Question Framing Question & Study Designs (Qual) Research Question Qualitative Approach What is the meaning attached to this Phenomenology phenomenon? What is life like for this group? Ethnography What is happening? Grounded theory Why is it happening? What are they communicating? How are they Discourse analysis communicating? Gibson, B. E. & Martin, D. K. (2003). Qualitative research and evidence-based physiotherapy practice. Physiotherapy, 89, 350-358. Oct. 15, 2008 EBP 10
  11. 11. Levels of Evidence Evidence Hierarchy (SUNY Downstate Medical Center, Medical Research Library of Brooklyn, n.d.) Oct. 15, 2008 EBP 11
  12. 12. Levels of Evidence Systematic Reviews Systematic Review Nonsystematic Review Question • Usually narrow question • Usually broad question Search • Explicitly stated • Not stated Strategy • May be performed in duplicate Study • Criteria explicitly stated • Not stated Identification • May be performed in duplicate Methods • Methods & outcomes of interest • Not stated explicitly stated • May include study quality assessment, sensitivity analyses Presentation • Typically by study characteristics so • Typically by study of Results that equivalent components are compared Conclusions • Typically confined to what the data • May include personal approaches, could infer opinions not supported by data Wong R. Systematic reviews and the Cochrane Collaboration. Oncology Rounds, Dec 2003;5(10). [Available from Oct. 15, 2008 EBP 12 www.oncologyrounds.ca].
  13. 13. Levels of Evidence Systematic Reviews vs. Meta-analyses Systematic Review applies scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific clinical question. Meta Analysis is a type of systematic review that uses statistical methods to combine and summarize the results of several primary studies. Oct. 15, 2008 EBP 13
  14. 14. Levels of Evidence for Question of Therapy Level of Evidence Type of Study 1a Systematic reviews of randomized controlled trials (RCTs) 1b Individual RCTs with narrow confidence interval 2a Systematic reviews of cohort studies 2b Individual cohort studies and low-quality RCTs 3a Systematic reviews of case-control studies 3b Case-control studies 4 Case series and poor quality cohort and case-control studies 5 Expert opinion Levels of evidence (2001). Centre for Evidence Based Medicine. Retrieved 26 Aug 2008 from http://www.cebm.net/index.aspx?o=1025 Oct. 15, 2008 EBP 14
  15. 15. Question Framing Exercise 2 You have recently begun working as a physical therapist in a rehabilitation centre. Your most recent patient is an 8-year-old girl with spastic cerebral palsy. Her parents heard that a weight-bearing physical activity program may be beneficial. You decide to search the literature for evidence to substantiate the claim. Oct. 15, 2008 EBP 15
  16. 16. Question Framing Exercise 3 As a nurse in a primary health care practice, you see many adult patients with asthma. The primary health care team wants to discuss strategies to improve care for these patients. They are particularly interested in whether both regular review by a health practitioner and patient education should be continued or whether giving patients written materials is just as effective. You offer to search the literature on the topic and report back at the next team meeting. Oct. 15, 2008 EBP 16
  17. 17. Question Framing Exercise 4 You are a public health nurse who has been visiting an elderly man with Alzheimer’s disease who is living at home. His daughter is his primary caregiver. As his condition deteriorates, she is increasingly worried about his safety and finds the situation physically and emotionally draining. The daughter is experiencing anguish and guilt as she realizes that her father will soon need to be placed in a special care unit. She asks you whether others in this situation have similar feelings and what she can expect to fell once he is placed in the special care unit. Oct. 15, 2008 EBP 17
  18. 18. Question Framing Exercise 5 Your first new patient in general medicine clinic is a 68 year old male who comes in for a routine physical examination. You find that he is hypertensive and decide to prescribe nifedipine, (a calcium antagonist) to control his high blood pressure. The patient discovers that nifedipine is a calcium channel blocker and remembers that there was something in the news several years ago about this group of drugs causing cancer. He calls you and wants to know if these drugs can cause cancer. Oct. 15, 2008 EBP 18
  19. 19. Question Framing Exercise 6 You are working in an urban community hospital. The head of the infectious disease department and the community outreach officer are trying to set up a pilot program to improve the screening and counseling process for identifying and helping AIDS infected people within the community. One of the problems is that the results of the standard test for AIDS, which are very accurate, are not available for up to three weeks. You have read about a new rapid assay test that provides results within ten minutes. You wonder if this test is as accurate. Oct. 15, 2008 EBP 19
  20. 20. Sources of Evidence The 5S Model Haynes, B. (2006). Of studies, syntheses, synopses, summaries, and systems: The quot;5Squot; evolution of information services for evidence-based health care decisions. ACP Oct. 15, 2008 Journal Club, 145, A-8-A-10. EBP 20
  21. 21. Critical Appraisal Assessing the validity of the research (using guidelines or checklists), e.g., • Guidelines for Critical Review: Qualitative Studies (qualitative studies) • JAMA Users’ Guides to the Medical Literature (medicine) • PEDro scale (physical & occupational therapy) Determining clinical significance Oct. 15, 2008 EBP 21
  22. 22. Health Sciences Librarians & EBP What roles can the health sciences librarian play in teaching and promoting EBP? To fulfill these roles, what skills do we need? Oct. 15, 2008 EBP 22