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Using secondary sources for evidence-based clinical practice
 

Using secondary sources for evidence-based clinical practice

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This presentation was given as part of a searching workshop in the 6th GCC Evidence-Based Healthcare & Knowledge Translation in Riyadh, December 11-12, 2010. Organized by Sheikh Abdullah S Bahamdan ...

This presentation was given as part of a searching workshop in the 6th GCC Evidence-Based Healthcare & Knowledge Translation in Riyadh, December 11-12, 2010. Organized by Sheikh Abdullah S Bahamdan Research Chair, at King Saud University. The presentation assumes prior knowledge of EBM principles. It goes over the hierarchy of information sources & how to get the information effectively & efficiently.

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    Using secondary sources for evidence-based clinical practice Using secondary sources for evidence-based clinical practice Presentation Transcript

    • SearchingSecondary Sources
      SohailBajammal, MBChB, MSc, FRCS(C), PhD(c)
      ssbajammal@uqu.edu.sa
      Assistant Professor of Orthopaedics, Faculty of Medicine
      Vice Dean, Academic Development, Faculty of Dentistry
    • How many questions do you ask yourself at the end of a busy clinical day?
      What % you look up?
      What % you answer?
    • Objectives
      Differences between primary & secondary sources of evidence
      Overview of popular secondary sources
    • 5A
    • 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
    • Studies(Primary Sources)
    • Primary Sources
      Original articles
      Through databases: MEDLINE, EMBASE
      Using: PubMed, OVID
      You have to retrieve and appraise the articles
      Strength (pyramid) of evidence
    • MeSH (Medical Subject Headings)
    • 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
    • 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
    • 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
    • Pyramid of Evidence
      http://library.downstate.edu/EBM2/2100.htm 
    • Tough Job
      Emergency medicine
      Family medicine
      Internal medicine
      Pediatrics
    • Don’t say there is “no evidence”
      Instead Weak evidence
      You might not have looked thorough enough
    • Absence of evidence is
      not
      the evidence of absence
    • 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.
    • 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.
    • Secondary Sources
    • Syntheses(Systematic Reviews)
    • 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
    • How to search for “Syntheses”?
      Same databases: MEDLINE, EMBASE
      Cochrane Library
    • PubMed
    • Are all syntheses good?
      You still have to appraise the quality of these systematic reviews and meta-analyses
      It’s time consuming
    • Synopses(Critically Appraised Abstracts)
    • 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)
      ACP Journal Club
      Evidence-based sections in many journals
      Others: DynaMed, EvidenceMatters, EssentialEvidence
    • DAREDatabase of Abstracts of Reviews of Effects
    • SummariesEBM TextbooksEBM Guidelines
    • EBM Textbooks
      UpToDate
    • Guidelines
      Types of guidelines:
      Consensus
      Evidence-based
      Use the limiting features in the website
    • Guidelines
      NICE: National Institute for Health & Clinical Excellence
      SIGN: Scottish Intercollegiate Guidelines Network
      NGC: National Guideline Clearinghouse
    • Are all guidelines good quality?
    • Systems
    • Systems
      This is the ultimate goal
      Computerized decision support
      Too sophisticated for us to think about now
    • Paid Services
      DynaMed
      EvidenceMatters
      EssentialEvidence Plus
    • DynaMed
    • EvidenceMatters
    • EssentialEvidencePlus
    • Meta Search (Many-in-one)
      NHS Evidence
      TripDatabase
      Google Scholar
    • NHS Evidence
    • TRIPDatabase
    • Google Scholar
    • Broad Term  Lots of irrelevant results
    • They will email you when new article cites this article
    • 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