The journey to evidence 2 1

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  • 1. Managing the information infrastructure Wendy McDonald RN MPH&TM
  • 2. Searching for External Evidence The best evidence to answer the PICOT question. Time is important Evidence that has already been appraised for the quality of study methodology & reliability is desirable. Preappraised literature can range fromMeta-analytic systemic reviews to synopsis of a single study.
  • 3. Determine Your Resources Know the databases that are available to you to collect the best evidence to answer the PICOT question. The PICOT question will determine which databases you will need to search.
  • 4. PICOT Carefully formulate the PICOT question. Using unambiguous, nonjargon terms to describe the PICOT question components will assist in obtaining the best search in the shortest time.
  • 5. Keyword Searching KW Keyword searching is searching using basic language. Must include all synonyms such as research, evidence, studies, study, Investigation, or items will be missed.
  • 6. Keyword Search continued In data bases - yields evidence if there is a match between the keyword entered and what is found in the title and/or abstract. Evidence may be missed, if a different term is entered. you get only articles that match terms you put in the search. may include unrelated articles due the word searched (many words have more than one meaning).
  • 7. Controlled Vocabulary A Controlled vocabulary is Medical Subject Headings (MeSH) - the content of articles indexed in MEDLINE.If a MeSH term is searched all the articles would contain information about the term searched.
  • 8. Combining & Limiting Searches AND and OR are used when combining keyword or controlled vocabulary AND to combined terms to appear in the final record. AND is a restrictive word so both words must appear in the article – reduces the number of studies retrieved OR - keyword searching of synonyms
  • 9. Resources for Searching
  • 10. The Cochrane LibraryTo scan many types of information pre-filtered for quality Includes the Cochrane Database of Systematice Reviews (Cochrane Reviews), Database of Abstracts of Reviews of Effectiveness (DARE), Cochrane Controlled Trials Register (Clinical Trials) &others  Systematic reviews aggregate randomized controlled trials  Review process is labor intensive, so not all topics are covered  Small database  Cochrane library http://www.cochrane.co.uk
  • 11. CINANL Dates back to 1981 Contains more than a million records Indexes almost 3,000 journals Searchable cited references for more than 1,200 journals Full text for 71 journals Covers nursing, biomedicine, health science librarianship, alternative/complementary medicine, consumer health and 17 allied health disciplines Now features Clinical Query Functionality
  • 12. PubMed/MEDLINE Citations and Abstracts Includes over 4600 journals worldwide More than 17 million citations Approximately 1/3 full text articles available Uses MeSH controlled vocabulary Updated daily Available anywhere, anytime Searching help available Must do one’s own quality filtering Must learn how to search the database  www.pubmed.gov
  • 13. Check the question type Check the emphasisAND means both terms required * Means any other letters
  • 14. Critical AppraisalCritical reviews of published studies  ACP Journal Club  InfoPOEMS  Clinical Inquiries  High quality evidence with commentary  High specificity  Abstracts accompanied by commentary  Incomplete coverage of literature  Small databases
  • 15. Trip Data Base Turning Research Into Practice Data Base Plus (TRIP) Simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically- appraised topics and articles Searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets. TRIP Database allows a limited number of free searches.
  • 16.  Specialized Journals  ACP Journal Club  Evidence Based Medicine  Evidence Based Nursing
  • 17. For more Information Centre for Evidence-Based Medicine http://cebm.jr2.ox.ac.uk/ Health Information Research Unit Evidence-Based Health Informatics http://hiru.mcmaster.ca/ Exploring the evidence base http://clinicallibraian.wordpress.com/2008/08 Evidence-based nursing resources http:muhc.ebn.mcgill.ca/EBN_tools.htm
  • 18. Managing citations of interest Once a search is completed each data base will provide options for dealing with the citations you are interested in.
  • 19. Saving Searches Saving the method of searching – how you went about the search - is imperative to repeat the search or communicate the search to someone else. Save the search details when you conduct the initial search so it can be replicated. Each search engine offers different ways for saving the search.
  • 20. Organizing Searches Organize the evidence found. Teams can use bibliographic management software (BMS) – web-base password protected folders. Allows all team members quick access to the resources.
  • 21. Other Resources That Support EBP Clinical Practice Guidelines National Guideline Clearinghouse  http://www.guidelines.gov Health Services/Technology Assessment Text (HSTAT)  http://text.nlm.nih.gov The Best Evidence Database http://evidence-basedmedicine.com
  • 22. Searching made easy 
  • 23. Conduct rapid critical appraisal of studies foundin the search - keep the valid and reliable studies -Evaluate the keeper studies -synthesis the evidence from the keeper studies
  • 24. Skills Required for EBP Clearly identify practice problem or new knowledge (innovation) Find research literature Critically evaluate research findings Apply to practice through change process
  • 25. Things that help EBP development of strategies for efficiently tracking down and appraising evidence creation of systematic reviews of the effects of health care creation of evidence-based journals of secondary publications creation of information systems/decision support systems/answering services application of effective strategies for lifelong learning and for improving clinical performance
  • 26.  McNabb C., Descriptive Research Methodologies. (power point) Pangea.tec.selu.edu/~cmcnabb/philosop/power.ppt Institute of Medicine, (US)Greiner, A. & Knebel, E., (Eds.) (2003) Health Professions Education: A bridge to quality, The National Academies Press, 45-74 Ireland M. C.(2010) Evidence -Based Practice What does it mean? Innovations and Perspectives Virginia Department of Education. 1,2
  • 27.  Bio medical library University of Minnesota, Evidence Practice (power point) http://hsl.lib.umn.edu/learn/ebp/modo1/pico.html Beyea S.C. , Slattery M.J.(2006)Evidence-Based Practice in Nursing a guide to successful implementation Marblehead MA: HCPro ,Inc Royle J., Blythe J.(1998) Promoting research utilisation in nursing: the role of the individual, organisation, and environment Evidence-Based Nursing,1:71-72
  • 28.  Malloch, K., Poter-OGrady, T., (2006)Introduction to Evidence -Based Practice in Nursing and Healthcare . Sudbury, MA, .Jones and Bartlet Glasziou P. Introduction to EBM 2010(power point) www.cebm.net/index.aspx?0=1382