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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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  • 1. 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
  • 2. How many questions do you ask yourself at the end of a busy clinical day?
    What % you look up?
    What % you answer?
  • 3. Objectives
    Differences between primary & secondary sources of evidence
    Overview of popular secondary sources
  • 4. 5A
  • 5. 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
  • 6. Studies(Primary Sources)
  • 7. Primary Sources
    Original articles
    Through databases: MEDLINE, EMBASE
    Using: PubMed, OVID
    You have to retrieve and appraise the articles
    Strength (pyramid) of evidence
  • 8.
  • 9.
  • 10. MeSH (Medical Subject Headings)
  • 11. 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
  • 12.
  • 13.
  • 14.
  • 15. 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
  • 16. 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
  • 17. Pyramid of Evidence
    http://library.downstate.edu/EBM2/2100.htm 
  • 18.
  • 19. Tough Job
    Emergency medicine
    Family medicine
    Internal medicine
    Pediatrics
  • 20. Don’t say there is “no evidence”
    Instead Weak evidence
    You might not have looked thorough enough
  • 21. Absence of evidence is
    not
    the evidence of absence
  • 22. 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.
  • 23. 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.
  • 24.
  • 25.
  • 26. Secondary Sources
  • 27. Syntheses(Systematic Reviews)
  • 28. 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
  • 29. How to search for “Syntheses”?
    Same databases: MEDLINE, EMBASE
    Cochrane Library
  • 30. PubMed
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37. Are all syntheses good?
    You still have to appraise the quality of these systematic reviews and meta-analyses
    It’s time consuming
  • 38.
  • 39. Synopses(Critically Appraised Abstracts)
  • 40. 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
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49. DAREDatabase of Abstracts of Reviews of Effects
  • 50.
  • 51.
  • 52.
  • 53.
  • 54. SummariesEBM TextbooksEBM Guidelines
  • 55. EBM Textbooks
    UpToDate
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61. Guidelines
    Types of guidelines:
    Consensus
    Evidence-based
    Use the limiting features in the website
  • 62. Guidelines
    NICE: National Institute for Health & Clinical Excellence
    SIGN: Scottish Intercollegiate Guidelines Network
    NGC: National Guideline Clearinghouse
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71.
  • 72. Are all guidelines good quality?
  • 73.
  • 74.
  • 75.
  • 76.
  • 77.
  • 78.
  • 79.
  • 80.
  • 81. Systems
  • 82. Systems
    This is the ultimate goal
    Computerized decision support
    Too sophisticated for us to think about now
  • 83.
  • 84.
  • 85.
  • 86.
  • 87.
  • 88. Paid Services
    DynaMed
    EvidenceMatters
    EssentialEvidence Plus
  • 89. DynaMed
  • 90.
  • 91.
  • 92.
  • 93.
  • 94.
  • 95.
  • 96.
  • 97.
  • 98.
  • 99.
  • 100. EvidenceMatters
  • 101.
  • 102.
  • 103.
  • 104.
  • 105.
  • 106.
  • 107.
  • 108.
  • 109.
  • 110.
  • 111.
  • 112.
  • 113.
  • 114.
  • 115.
  • 116. EssentialEvidencePlus
  • 117.
  • 118.
  • 119.
  • 120.
  • 121.
  • 122.
  • 123.
  • 124.
  • 125.
  • 126. Meta Search (Many-in-one)
    NHS Evidence
    TripDatabase
    Google Scholar
  • 127. NHS Evidence
  • 128.
  • 129.
  • 130.
  • 131.
  • 132. TRIPDatabase
  • 133.
  • 134.
  • 135.
  • 136.
  • 137.
  • 138.
  • 139.
  • 140.
  • 141. Google Scholar
  • 142.
  • 143. Broad Term  Lots of irrelevant results
  • 144.
  • 145. They will email you when new article cites this article
  • 146. 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

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