EBD Course: Lecture 4 Secondary Sources

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  • 1. Searching
    SohailBajammal
    October 9, 2011
  • 2. Objectives
    Previous lecture
    Differences between primary & secondary sources of evidence
    Overview of popular secondary sources
  • 3. Previous Lecture
  • 4. Steps of Evidence-Based Dentistry

    • Before we go into the “Acquire” and searching, we need to know “what” we are looking for?
    • 5. Then “where” & “how” to look for it.
  • Pyramid of Evidence
    http://servers.medlib.hscbklyn.edu/ebm/2100.htm
  • 6. Today’s Lecture
  • 7. 5A
  • 8. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164
    Computerized decision support system
    Evidence-Based
    Guidelines & Textbooks
    Secondary
    Critically-Appraised
    Journal Articles & Abstracts
    Systematic Reviews
    RCTs, Cohort, Case control, Case series
    Primary
    Expert Opinion: Classical Textbooks
  • 9. Searching for evidence
    Case report, Case series, Case-Control, Cohort, Randomized Trial
    DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009
  • 10. Studies(Primary Sources)
  • 11. Primary Sources
    Original articles
    Through databases: MEDLINE, EMBASE
    Using: PubMed, OVID
    You have to retrieve and appraise the articles
    Strength (pyramid) of evidence
  • 12. PubMed
  • 13.
  • 14. MeSH(Medical Subject Headings)
  • 15. It is a “strategy”
    Low Back Pain
    Treatment
    OR
    OR
    Low Back Ache
    Management
    Acute
    OR
    OR
    Low Backache
    Therapy
    AND
    AND
    OR
    OR
    "Low Back Pain"[Mesh]
    Surgery
  • 16.
  • 17.
  • 18.
  • 19. We will talk more aboutSEARCH STRATEGYin the coming few weeks
  • 20. PubMed Tutorials
    20
  • 21.
  • 22.
  • 23. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13
  • 24. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13
  • 25. Pyramid of Evidence
    http://library.downstate.edu/EBM2/2100.htm 
  • 26.
  • 27.
  • 28.
  • 29. This what we will be doing the coming few weeks
  • 30. Tough Job
    If you have to do the critical appraisal for every single article you read  Tough
    BUT You need to learn about it in details for the sake of research
  • 31. Don’t say there is “no evidence”
    Instead Weak evidence
    You might not have looked thorough enough
  • 32. Absence of evidence is
    not
    the evidence of absence
  • 33. Satisficing
    ‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience”
    Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.
  • 34. Usefulness of information
    Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.
  • 35.
  • 36. Secondary Sources
  • 37. Syntheses(Systematic Reviews)
  • 38. Syntheses
    The authors have done the work for you
    Hopefully:
    They asked a good question
    They searched the literature systematically (keywords & MeSH)
    They identified the studies and assessed their quality
    This is called Systematic Review
    If they did statistical combination of results, this is called Meta-analysis
  • 39. How to search for “Syntheses”?
    Same databases: MEDLINE, EMBASE
    Cochrane Library
  • 40. PubMed
  • 41.
  • 42. Available at UQU
  • 43.
  • 44.
  • 45.
  • 46.
  • 47. Are all syntheses good?
    You still have to appraise the quality of these systematic reviews and meta-analyses
  • 48.
  • 49. Synopses(Critically Appraised Abstracts)
  • 50. Synopses
    Physicians with training in research methodology:
    Read the articles
    Assess their quality
    Summarize them for you
    Many sources:
    Database of Abstracts of Reviews of Effects (DARE)
    Evidence-based Dentistry
    Journal of Evidence-Based Dental Practice
    Critically Appraised Topics (CATs)
    Evidence-based sections in many journals
    Others: DynaMed, EvidenceMatters, EssentialEvidence
  • 51.
  • 52. DAREDatabase of Abstracts of Reviews of Effects
    Free
  • 53.
  • 54.
  • 55.
  • 56.
  • 57. Evidence-Based Dentistry Journal
    Available at UQU
  • 58.
  • 59. Journal of Evidence Based Dental Practice
  • 60.
  • 61. Critically Appraised Topics (CATs)
  • 62.
  • 63.
  • 64. SummariesEBM TextbooksEBM Guidelines
  • 65. EBM Textbooks
    UpToDate
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71. Guidelines
  • 72. Guidelines
    Types of guidelines:
    Consensus
    Evidence-based
    Use the limiting features in the website
  • 73. Guidelines
    NICE: National Institute for Health & Clinical Excellence
    SIGN: Scottish Intercollegiate Guidelines Network
    NGC: National Guideline Clearinghouse
  • 74.
  • 75.
  • 76.
  • 77.
  • 78.
  • 79.
  • 80.
  • 81.
  • 82.
  • 83. Are all guidelines good quality?
  • 84.
  • 85.
  • 86.
  • 87.
  • 88.
  • 89.
  • 90.
  • 91.
  • 92. Systems
  • 93. Systems
    This is the ultimate goal
    Computerized decision support
    Too sophisticated for us to think about now
  • 94.
  • 95.
  • 96.
  • 97.
  • 98.
  • 99. Paid Services
    DynaMed
    EvidenceMatters
    EssentialEvidence Plus
  • 100. Available at UQU
    DynaMed
  • 101.
  • 102.
  • 103.
  • 104.
  • 105.
  • 106.
  • 107.
  • 108.
  • 109.
  • 110.
  • 111. Evidence Matters
  • 112.
  • 113.
  • 114.
  • 115.
  • 116.
  • 117.
  • 118.
  • 119.
  • 120.
  • 121.
  • 122.
  • 123.
  • 124.
  • 125.
  • 126.
  • 127. EssentialEvidencePlus
  • 128.
  • 129.
  • 130.
  • 131.
  • 132.
  • 133.
  • 134.
  • 135.
  • 136. Meta Search (Many-in-one)
    NHS Evidence
    TripDatabase
    Google Scholar
  • 137. NHS Evidence
  • 138.
  • 139.
  • 140.
  • 141.
  • 142. TRIPDatabase
  • 143.
  • 144.
  • 145.
  • 146.
  • 147.
  • 148.
  • 149.
  • 150.
  • 151. Google Scholar
  • 152.
  • 153. Broad Term  Lots of irrelevant results
  • 154.
  • 155. They will email you when new article cites this article
  • 156. Searching for evidence
    DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009
  • 157. The Remaining of the Course
    Primary Sources
    Critical Appraisal of:
    Therapy
    Systematic Review
    Diagnosis
    Prognosis
  • 158. Assignment 3
    What are the secondary sources available for dental students and dentists to practice evidence-based dentistry? Categorize them according to the 5S/6S model
    Visit these sites & describe in your words what are they & what do you think of them.
    If you find other sources, you can add them
    Type at least 2 lines describing each secondary source (size 12 font)
    Assignment due October 18
    Send the assignment to my email (email subject & Word document: EBD3 your name)