More simply put – we will be focusing on the ‘Acquire’ part
Raw evidence – qualitative study, or raw data – quantitative study
Cumulative Index to Nursing and Allied Health Literature is a database of citations to the literature of nursing and allied health. IUON subscribes via EBSCOhost ~ includes @70 full-text included.
IUON can access this important database through PAHO – in your future careers this is a key source and will no doubt be available to you whereever you may work as nurses.
Nursing Research Resources
Guide to Nursing ResourcesEBN : Accessing the Research
Learning ObjectivesIntroduce student to evidence-basednursing literature and effectivestrategies for searching for andaccessing evidence-based research innursing.
6/5/2013 IUON - Library Research 3What is EBM?“Evidence based medicine is theconscientious, explicit, and judicious use ofcurrent best evidence in making decisionsabout the care of individual patients. Thepractice of evidence based medicine meansintegrating individual clinical expertise withthe best available external clinical evidencefrom systematic research.”Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, RichardsonWS. Evidence based medicine: what it is and what it isnt.BMJ. 1996 Jan 13; 312 (7023): 71-2.
Evidence Based MedicineEBM Decision Model:"Evidence-based medicine (EBM) is theintegration of best research evidencewith clinical expertise and patientvalues."EBM Cycle:Ask, Acquire, Appraise, Apply and Act
Primary EvidencePrimary evidence includes the originalreports of research studies and areincluded in journal citation databases: MEDLINE: randomized controlled trials CINAHL: research EMBASE SCIRUS
Secondary EvidenceSecondary evidence is the analysis ofresearch studies and is found in: MEDLINE: meta-analysis, practice guidelines,consensus development conferences CINAHL: meta-analysis, practice guidelines,research based nursing practice Cochrane Database of Systematic Reviews Database of Reviews of Effectiveness (DARE) National Guidelines Clearinghouse
Information „Pyramid‟6/5/2013 IUON - Library Research 7EBM journalsCochrane DB systemic reviewsClinical Practice Guidelinesprimary research articlesCINAHL, MedlineAssoc. websites,textbooksGoogleAdapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514
Evolution of LiteratureEvidence PyramidThe base of the pyramid is where informationusually starts with an idea or laboratoryresearch. As these ideas turn into drugs anddiagnostic tools they are tested inlaboratories models, then in animals, andfinally in humans. The human testing maybegin with volunteers and go throughseveral phases of clinical trials before thedrug or diagnostic tool can be authorized foruse within the general population.Randomized controlled trials are then doneto further test the effectiveness and efficacyof a drug or therapy.As you move up the pyramid the amountof available literature decreases, butincreases in its relevance to theclinical setting.Type of Study Meta-Analysis SystematicReview RandomizedControlled Trial Cohort studies Case Control studies Case Series/Case Reports Animal research/Laboratorystudies
Evolution of EB Information6/5/2013 IUON - Library Research 9Systems [computerized decision support]& Summaries [EB textbooks]Synopses [EB journal abstracts]Syntheses [systematic reviews]Studies [originaljournal articles]Based on: Haynes, Brian. “Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of informationservices for evidence-based healthcare decisions”/ Evidence based medicine. 2006 Dec. 11(6):162-4.
Evidence in MEDLINESearching for evidence in MEDLINEincludes several steps: formulate a clinical question run a subject search Ex. heart disease and aspirin select a strategy to retrieve literaturerelated to therapy, diagnosis,prognosis, harm/etiology.
Evidence in CINAHL formulate a clinicalquestion run a subject search use the Research limiton the Main SearchPage. This is a very effective way tolimit retrieval to research studiesin CINAHL. Tutorial:http://www.hscl.ufl.edu/help/CINAHL/index.htm
Cochrane Database of SystemicReviews includes the full text of theregularly updated systematicreviews of the effects ofhealthcare prepared by The CochraneCollaboration can be searched by combingkeywords or phrases. The Browse Topics iconretrieves a list of CochraneGroups who prepare andmaintain the reviews inrespective clinical areas, suchas nursing. http://www.cochrane.org/index.htm
Database of Reviews of Effectiveness (DARE)Database of Reviews of Effectiveness (DARE) a full text databasewith critical structured abstracts of studies reported in variousmedical journals.
What is Systemic Review? Systematic reviews are known as the highest levelof evidence in clinical research. Developed countries are developing their medicalguidelines based on the information provided bysystematic reviews of effectiveness. Therefore, it is mandatory for all professionalsinvolved in the delivery of healthcare, to reach toa good understanding about systematic reviews. This web site offers information about whatsystematic reviews are, and how to conduct them.http://ssrc.tums.ac.ir/SystematicReview/
The National Guidelines Clearinghouseincludes evidence-based practice guidelines from various healthcenters and organizations. It can be searched by disease,treatment or organization. The Clearinghouse includes a featurecomparing attributes of two or more guidelines.
HealthWebThe Evidence-Based Health Caresection of HealthWeb includes awealth of information about EBorganizations, databases andpublications.The Tools and Tutorials has manyhelpful links including the EBM ToolKit and EBM Toolbox.
Steps to answering Clinical Questionsusing the Medical LiteratureThe Anatomy of the ClinicalQuestion:1. Formulate a clinical question("PICOT" approach):Patient characteristicsIntervention being consideredComparison intervention (if any)Outcome of clinical interestTimeframe
2. Run your subject search.3. Select the MEDLINE strategy toanswer the question:Therapy, Diagnosis, Prognosis,Harm/Etiology.(including study design/article type)
For Quick SearchesA question of...TherapyLimit search to Publication Type -Randomized Controlled Trial pt
In-depth EBM Searches:Therapyexp research design/ or exp clinical trials/ orcomparative study/ or placebos/ or multicenterstudy.pt. or clinical trial$1.pt. Or random$.ti,ab. or(single blind$ or double blind$ or tripleblind$3).ti,ab. or placebo$1.ti,ab. or (clinicaladjtrial$1).ti,ab. or exp epidemiologic researchdesign/ or (controlled clinical trial or randomizedcontrolled trial).pt. or practice guideline.pt. Orfeasibility studies/ or clinical protocols/ or exptreatment outcome/ or double blind method/
For Quick SearchesA question of...DiagnosisCombine subject search with searchfor exp "sensitivity andspecificity"
In-depth EBM Searches:Diagnosisexp "sensitivity and specificity"/ or false negativereactions/ or false positive reactions/ or(sensitivity or specificity).ti,ab. or (predictive adjvalue$1).ti,ab. or (likelihood adj ratio$1).ti,ab. or(false adj (negative$1 or positive$1)).ti,ab. or(randomized controlled trial or controlled clinicaltrial).pt. or double blind method/ or single blindmethod/ or practice guideline.pt. Or consensusdevelopment conference$.pt. or random$.ti,ab. orrandom allocation/ or (single blind$3 or doubleblind$3 or triple blind$3).ti,ab.
For Quick SearchesA question of...PrognosisCombine subject search with searchfor exp cohort studiesor exp risk
In-depth EBM Searches:Prognosisexp cohort studies/ or prognosis/ or expmortality/ or exp morbidity/ or (natural adjhistory).ti,ab. or prognos$.ti,ab. orcourse.ti,AB or predict$.ti,ab. or exp"outcome assessment (health care)"/ oroutcome$1.ti,ab. or (inception adjcohort$1).ti,ab. or disease progression/ orexp survival analysis/
For Quick SearchesA question of...Harm/EtiologyCombine subject search with searchfor exp cohort studies OR exp risk
In-depth EBM Searches:Harm/Etiologyrandom$.ti,ab. or exp epidemiologicalstudies/ or odds ratio/ or cohort$.ti,ab. or(case$1 adj control$).ti,ab. or risk$.ti,ab.or (odds adj ratio$1).ti,ab. or causa$.ti,ab.or (relative$1 adj risk$).ti,ab. orpredispos$.ti,ab. or (randomized controlledtrial or controlled clinical trial).pt. or exprisk/ or practice guideline.pt. or exp case-control studies/ or exp cohort studies/
For Quick Searches4. Locate other sources of evidence asnecessary.5. Examine the evidence, criticallyappraise/evaluate the literature.6. Apply the evidence + clinicalexperience + the patientspreferences.7. Evaluate patient outcomes.
In-depth EBM Searches4. Once copied, paste it into the searchbox in MEDLINE.5. Click "Perform Search."6. Combine this set with your originalsearch using AND (i.e. 1 AND 2).(EBM filters developed by the Miner Library atthe University of Rochester Medical Center)http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf
NoteYou can save each of these EBM filters as a separate searchin MEDLINE so that they can be run as needed whensearching MEDLINETo do this: Authenticate to a new MEDLINE session with a blanksearch history. Copy and paste one EBM filter. Click "Perform Search." After retrieving search results, click "Save SearchHistory." Select "Permanent," and name the search (ex. EBMTherapy or Therapy Filter).
To use save searches: Run your subject search. Click "Run Saved Search." Select the EBM filter to run based onthe type of question being asked(Therapy, Diagnosis, Prognosis, orHarm/Etiology). Combine the two searches usingAND.
Evidence Based MedicineToolkits & TutorialsFor further clarification and practice check out more online training„EBM Toolkit‟ based on the series in JAMA:http://www.med.ualberta.ca/ebm/ebm.htmORFrom Duke University Medical Center:http://www.hsl.unc.edu/services/tutorials/EBM/welcome.htm