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Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
Using secondary sources for evidence-based clinical practice
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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<br />SohailBajammal, MBChB, MSc, FRCS(C), PhD(c)<br />ssbajammal@uqu.edu.sa<br />Assistant Professor of Orthopaedics, Faculty of Medicine<br />Vice Dean, Academic Development, Faculty of Dentistry<br />
  • 2. How many questions do you ask yourself at the end of a busy clinical day?<br />What % you look up?<br />What % you answer?<br />
  • 3. Objectives<br />Differences between primary & secondary sources of evidence<br />Overview of popular secondary sources<br />
  • 4. 5A<br />
  • 5. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 <br />Computerized decision support system<br />Evidence-Based <br />Guidelines & Textbooks<br />Secondary<br />Critically-Appraised <br />Journal Articles & Abstracts<br />Systematic Reviews<br />RCTs, Cohort, Case control, Case series<br />Primary<br />Expert Opinion: Classical Textbooks<br />
  • 6. Studies(Primary Sources)<br />
  • 7. Primary Sources<br />Original articles<br />Through databases: MEDLINE, EMBASE<br />Using: PubMed, OVID<br />You have to retrieve and appraise the articles<br />Strength (pyramid) of evidence<br />
  • 8.
  • 9.
  • 10. MeSH (Medical Subject Headings)<br />
  • 11. It is a “strategy”<br />Low Back Pain<br />Treatment<br />OR<br />OR<br />Low Back Ache<br />Management<br />Acute<br />OR<br />OR<br />Low Backache<br />Therapy<br />AND<br />AND<br />OR<br />OR<br />"Low Back Pain"[Mesh]<br />Surgery<br />
  • 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<br />
  • 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<br />
  • 17. Pyramid of Evidence<br />http://library.downstate.edu/EBM2/2100.htm <br />
  • 18.
  • 19. Tough Job<br />Emergency medicine<br />Family medicine<br />Internal medicine<br />Pediatrics<br />
  • 20. Don’t say there is “no evidence”<br />Instead Weak evidence<br />You might not have looked thorough enough<br />
  • 21. Absence of evidence is <br />not <br />the evidence of absence<br />
  • 22. Satisficing<br />‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience”<br />Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.<br />
  • 23. Usefulness of information<br />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.<br />
  • 24.
  • 25.
  • 26. Secondary Sources<br />
  • 27. Syntheses(Systematic Reviews)<br />
  • 28. Syntheses<br />The authors have done the work for you<br />Hopefully:<br />They asked a good question<br />They searched the literature systematically (keywords & MeSH)<br />They identified the studies and assessed their quality<br />This is called Systematic Review<br />If they did statistical combination of results, this is called Meta-analysis<br />
  • 29. How to search for “Syntheses”?<br />Same databases: MEDLINE, EMBASE<br />Cochrane Library<br />
  • 30. PubMed<br />
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37. Are all syntheses good?<br />You still have to appraise the quality of these systematic reviews and meta-analyses<br />It’s time consuming<br />
  • 38.
  • 39. Synopses(Critically Appraised Abstracts)<br />
  • 40. Synopses<br />Physicians with training in research methodology:<br />Read the articles<br />Assess their quality<br />Summarize them for you<br />Many sources: <br />Database of Abstracts of Reviews of Effects (DARE)<br />ACP Journal Club<br />Evidence-based sections in many journals<br />Others: DynaMed, EvidenceMatters, EssentialEvidence<br />
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49. DAREDatabase of Abstracts of Reviews of Effects<br />
  • 50.
  • 51.
  • 52.
  • 53.
  • 54. SummariesEBM TextbooksEBM Guidelines<br />
  • 55. EBM Textbooks<br />UpToDate<br />
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61. Guidelines<br />Types of guidelines:<br />Consensus<br />Evidence-based<br /> Use the limiting features in the website<br />
  • 62. Guidelines<br />NICE: National Institute for Health & Clinical Excellence<br />SIGN: Scottish Intercollegiate Guidelines Network<br />NGC: National Guideline Clearinghouse<br />
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71.
  • 72. Are all guidelines good quality?<br />
  • 73.
  • 74.
  • 75.
  • 76.
  • 77.
  • 78.
  • 79.
  • 80.
  • 81. Systems<br />
  • 82. Systems<br />This is the ultimate goal<br />Computerized decision support<br />Too sophisticated for us to think about now<br />
  • 83.
  • 84.
  • 85.
  • 86.
  • 87.
  • 88. Paid Services<br />DynaMed<br />EvidenceMatters<br />EssentialEvidence Plus<br />
  • 89. DynaMed<br />
  • 90.
  • 91.
  • 92.
  • 93.
  • 94.
  • 95.
  • 96.
  • 97.
  • 98.
  • 99.
  • 100. EvidenceMatters<br />
  • 101.
  • 102.
  • 103.
  • 104.
  • 105.
  • 106.
  • 107.
  • 108.
  • 109.
  • 110.
  • 111.
  • 112.
  • 113.
  • 114.
  • 115.
  • 116. EssentialEvidencePlus<br />
  • 117.
  • 118.
  • 119.
  • 120.
  • 121.
  • 122.
  • 123.
  • 124.
  • 125.
  • 126. Meta Search (Many-in-one)<br />NHS Evidence<br />TripDatabase<br />Google Scholar<br />
  • 127. NHS Evidence<br />
  • 128.
  • 129.
  • 130.
  • 131.
  • 132. TRIPDatabase<br />
  • 133.
  • 134.
  • 135.
  • 136.
  • 137.
  • 138.
  • 139.
  • 140.
  • 141. Google Scholar<br />
  • 142.
  • 143. Broad Term  Lots of irrelevant results<br />
  • 144.
  • 145. They will email you when new article cites this article<br />
  • 146. Searching for evidence<br />DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009<br />

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