Introduce IUON students to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.

1. Guide to Nursing Resources
EBN : Accessing the Research

2. Learning Objectives
Introduce student to evidence-based
nursing literature and effective
strategies for searching for and
accessing evidence-based research in
nursing.

3. 6/5/2013 IUON - Library Research 3
What is EBM?
“Evidence based medicine is the
conscientious, explicit, and judicious use of
current best evidence in making decisions
about the care of individual patients. The
practice of evidence based medicine means
integrating individual clinical expertise with
the best available external clinical evidence
from systematic research.”
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson
WS. Evidence based medicine: what it is and what it isn't.
BMJ. 1996 Jan 13; 312 (7023): 71-2.

4. Evidence Based Medicine
EBM Decision Model:
"Evidence-based medicine (EBM) is the
integration of best research evidence
with clinical expertise and patient
values."
EBM Cycle:
Ask, Acquire, Appraise, Apply and Act

5. Primary Evidence
Primary evidence includes the original
reports of research studies and are
included in journal citation databases:
 MEDLINE: randomized controlled trials
 CINAHL: research
 EMBASE
 SCIRUS

6. Secondary Evidence
Secondary evidence is the analysis of
research 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

7. Information „Pyramid‟
6/5/2013 IUON - Library Research 7
EBM journals
Cochrane DB systemic reviews
Clinical Practice Guidelines
primary research articles
CINAHL, Medline
Assoc. websites,
textbooks
Google
Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514

8. Evolution of Literature
Evidence Pyramid
The base of the pyramid is where information
usually starts with an idea or laboratory
research. As these ideas turn into drugs and
diagnostic tools they are tested in
laboratories models, then in animals, and
finally in humans. The human testing may
begin with volunteers and go through
several phases of clinical trials before the
drug or diagnostic tool can be authorized for
use within the general population.
Randomized controlled trials are then done
to further test the effectiveness and efficacy
of a drug or therapy.
As you move up the pyramid the amount
of available literature decreases, but
increases in its relevance to the
clinical setting.
Type of Study
 Meta-
Analysis
 Systematic
Review
 Randomized
Controlled Trial
 Cohort studies
 Case Control studies
 Case Series/Case Reports
 Animal research/Laboratory
studies

9. Evolution of EB Information
6/5/2013 IUON - Library Research 9
Systems [computerized decision support]
& Summaries [EB textbooks]
Synopses [EB journal abstracts]
Syntheses [systematic reviews]
Studies [original
journal articles]
Based on: Haynes, Brian. “Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information
services for evidence-based healthcare decisions”/ Evidence based medicine. 2006 Dec. 11(6):162-4.

10. Medical Databases
 CINAHL
 EBSCOhost
http://support.epnet.com/
training/tutorials.php
 CINAHL.com
 Online training
http://www.cinahl.com
/library/library.htm
 Medline
 EBSCOhost
 PubMed
 Online training
http://www.nlm.nih.go
v/bsd/disted/pubme
d.html

11. Evidence in MEDLINE
Searching for evidence in MEDLINE
includes several steps:
 formulate a clinical question
 run a subject search
 Ex. heart disease and aspirin
 select a strategy to retrieve literature
related to therapy, diagnosis,
prognosis, harm/etiology.

12. Evidence in CINAHL
 formulate a clinical
question
 run a subject search
 use the Research limit
on the Main Search
Page.
 This is a very effective way to
limit retrieval to research studies
in CINAHL.
 Tutorial:
http://www.hscl.ufl.edu/help/C
INAHL/index.htm

13. Cochrane Database of Systemic
Reviews
 includes the full text of the
regularly updated systematic
reviews of the effects of
healthcare
 prepared by The Cochrane
Collaboration
 can be searched by combing
keywords or phrases.
 The Browse Topics icon
retrieves a list of Cochrane
Groups who prepare and
maintain the reviews in
respective clinical areas, such
as nursing.
 http://www.cochrane.org/index.htm

14. Database of Reviews of Effectiveness (DARE)
Database of Reviews of Effectiveness (DARE) a full text database
with critical structured abstracts of studies reported in various
medical journals.

15. What is Systemic Review?
 Systematic reviews are known as the highest level
of evidence in clinical research.
 Developed countries are developing their medical
guidelines based on the information provided by
systematic reviews of effectiveness.
 Therefore, it is mandatory for all professionals
involved in the delivery of healthcare, to reach to
a good understanding about systematic reviews.
 This web site offers information about what
systematic reviews are, and how to conduct them.
http://ssrc.tums.ac.ir/SystematicReview/

16. The National Guidelines Clearinghouse
includes evidence-based practice guidelines from various health
centers and organizations. It can be searched by disease,
treatment or organization. The Clearinghouse includes a feature
comparing attributes of two or more guidelines.

17. HealthWeb
The Evidence-Based Health Care
section of HealthWeb includes a
wealth of information about EB
organizations, databases and
publications.
The Tools and Tutorials has many
helpful links including the EBM Tool
Kit and EBM Toolbox.

18. Other
Search Engines
 Medstory
 SearchMedica
 Google Scholar
 MammaHealth
 MedlinePlus
 OminiMedicalSearch
Databases
 Nursing Reference Center
 DynaMed
 Up-to-Date
 MosbyNursingIndex
 NurseConsult
 InfoPOEMS

19. Steps to answering Clinical Questions
using the Medical Literature
The Anatomy of the Clinical
Question:
1. Formulate a clinical question
("PICOT" approach):
Patient characteristics
Intervention being considered
Comparison intervention (if any)
Outcome of clinical interest
Timeframe

20. 2. Run your subject search.
3. Select the MEDLINE strategy to
answer the question:
Therapy, Diagnosis, Prognosis,
Harm/Etiology.
(including study design/article type)

21. For Quick Searches
A question of...
Therapy
Limit search to Publication Type -
Randomized Controlled Trial pt

22. In-depth EBM Searches:
Therapy
exp research design/ or exp clinical trials/ or
comparative study/ or placebos/ or multicenter
study.pt. or clinical trial$1.pt. Or random$.ti,ab. or
(single blind$ or double blind$ or triple
blind$3).ti,ab. or placebo$1.ti,ab. or (clinical
adjtrial$1).ti,ab. or exp epidemiologic research
design/ or (controlled clinical trial or randomized
controlled trial).pt. or practice guideline.pt. Or
feasibility studies/ or clinical protocols/ or exp
treatment outcome/ or double blind method/

23. For Quick Searches
A question of...
Diagnosis
Combine subject search with search
for exp "sensitivity and
specificity"

24. In-depth EBM Searches:
Diagnosis
exp "sensitivity and specificity"/ or false negative
reactions/ or false positive reactions/ or
(sensitivity or specificity).ti,ab. or (predictive adj
value$1).ti,ab. or (likelihood adj ratio$1).ti,ab. or
(false adj (negative$1 or positive$1)).ti,ab. or
(randomized controlled trial or controlled clinical
trial).pt. or double blind method/ or single blind
method/ or practice guideline.pt. Or consensus
development conference$.pt. or random$.ti,ab. or
random allocation/ or (single blind$3 or double
blind$3 or triple blind$3).ti,ab.

25. For Quick Searches
A question of...
Prognosis
Combine subject search with search
for exp cohort studies
or exp risk

26. In-depth EBM Searches:
Prognosis
exp cohort studies/ or prognosis/ or exp
mortality/ or exp morbidity/ or (natural adj
history).ti,ab. or prognos$.ti,ab. or
course.ti,AB or predict$.ti,ab. or exp
"outcome assessment (health care)"/ or
outcome$1.ti,ab. or (inception adj
cohort$1).ti,ab. or disease progression/ or
exp survival analysis/

27. For Quick Searches
A question of...
Harm/Etiology
Combine subject search with search
for exp cohort studies OR exp risk

28. In-depth EBM Searches:
Harm/Etiology
random$.ti,ab. or exp epidemiological
studies/ or odds ratio/ or cohort$.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. or
predispos$.ti,ab. or (randomized controlled
trial or controlled clinical trial).pt. or exp
risk/ or practice guideline.pt. or exp case-
control studies/ or exp cohort studies/

29. For Quick Searches
4. Locate other sources of evidence as
necessary.
5. Examine the evidence, critically
appraise/evaluate the literature.
6. Apply the evidence + clinical
experience + the patient's
preferences.
7. Evaluate patient outcomes.

30. In-depth EBM Searches
4. Once copied, paste it into the search
box in MEDLINE.
5. Click "Perform Search."
6. Combine this set with your original
search using AND (i.e. 1 AND 2).
(EBM filters developed by the Miner Library at
the University of Rochester Medical Center)
http://www.urmc.rochester.edu/hslt/miner/digital_lib
rary/tip_sheets/Cinahl_eb_filters.pdf

31. Note
You can save each of these EBM filters as a separate search
in MEDLINE so that they can be run as needed when
searching MEDLINE
To do this:
 Authenticate to a new MEDLINE session with a blank
search history.
 Copy and paste one EBM filter.
 Click "Perform Search."
 After retrieving search results, click "Save Search
History."
 Select "Permanent," and name the search (ex. EBM
Therapy or Therapy Filter).

32. To use save searches:
 Run your subject search.
 Click "Run Saved Search."
 Select the EBM filter to run based on
the type of question being asked
(Therapy, Diagnosis, Prognosis, or
Harm/Etiology).
 Combine the two searches using
AND.

33. Evidence Based Medicine
Toolkits & Tutorials
For further clarification and practice check out more online training
„EBM Toolkit‟ based on the series in JAMA:
http://www.med.ualberta.ca/ebm/ebm.htm
OR
From Duke University Medical Center:
http://www.hsl.unc.edu/services/tutorials/EBM/welcome.htm

34. EBM Jeopardy

35. Thank you
Ann Celestine, BA MLS AHIP
Library Director