Searching For The Evidence


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Searching For The Evidence

  1. 1. Searching for the Evidence DNP BOUND
  2. 2. Evidence Based Practice <ul><li>What is EBP? </li></ul><ul><ul><li>Most commonly cited definition is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” </li></ul></ul><ul><ul><ul><ul><li>Sackett, et al. </li></ul></ul></ul></ul>
  3. 3. The EBP cycle <ul><li>Identify/define the problem </li></ul><ul><li>Formulate a focused clinical question </li></ul><ul><li>Identify the appropriate resources </li></ul><ul><li>Search for valid and relevant information </li></ul><ul><li>Critically appraise/review this information </li></ul><ul><li>Implement in practice </li></ul><ul><li>Clinical audit </li></ul>
  4. 4. Formulate a Question <ul><li>Ask a focused, answerable question: </li></ul><ul><li>NOT </li></ul><ul><li>Are febrile seizures in babies dangerous? </li></ul><ul><li>INSTEAD </li></ul><ul><li>Does a febrile seizure in a 6- month old infant increase the likelihood that s/he will develop epilepsy? </li></ul>
  5. 5. Formulate a Question <ul><li>What is the effect of ( the Intervention or predictor variable) </li></ul><ul><li>On ( the Outcome or given characteristic) </li></ul><ul><li>For ( the group or patient characteristics) </li></ul>
  6. 6. Formulate a Question <ul><li>Use the PICO framework: </li></ul><ul><li>P – patient/problem </li></ul><ul><li>I – intervention </li></ul><ul><li>C – comparison </li></ul><ul><li>O – outcome </li></ul>
  7. 7. P <ul><li>Population </li></ul><ul><li>Disease or condition </li></ul><ul><li>Stage of disease </li></ul><ul><li>Gender </li></ul><ul><li>Age group </li></ul><ul><li>Socioeconomic group </li></ul><ul><li>Healthcare setting </li></ul>
  8. 8. I <ul><li>Intervention </li></ul><ul><li>What is being done? </li></ul><ul><li>Drug therapy, surgery, radiotherapy </li></ul><ul><li>Level of intervention: frequency, dosage </li></ul><ul><li>Stage of intervention: prevention, secondary prevention; advanced </li></ul><ul><li>Delivery of intervention: self-medication etc. </li></ul>
  9. 9. C <ul><li>Comparison </li></ul><ul><li>What could be done instead? </li></ul>
  10. 10. O <ul><li>Outcome </li></ul><ul><li>What happened to P as a result of I? </li></ul><ul><li>Patient oriented: quality of life; reduction in severity of symptoms; adverse effects </li></ul><ul><li>Provider oriented: cost-effectiveness </li></ul>
  11. 11. Is acupuncture effective in inducing labor? P Pregnant, >40 weeks, age? I Acupuncture: duration of treatment, frequency C No intervention O + - onset of labor? - adverse effects?
  12. 12. Exercise or antidepressants for depression? P Depression: severity? Socioeconomic factors; healthcare setting I Exercise: how strenuous? How often? C Antidepressants: type? Dose? Frequency? Duration? O + Cure? Symptom reduction? Quality of life? -Adverse effects
  13. 13. What is Evidence? <ul><li>Hierarchy of research evidence </li></ul><ul><ul><li>Systematic reviews </li></ul></ul><ul><ul><li>Randomized controlled trials </li></ul></ul><ul><ul><li>Non-randomized controlled trials </li></ul></ul><ul><ul><li>e.g. cohort studies, case-control studies </li></ul></ul><ul><ul><li>Consensus statements from respected authorities </li></ul></ul><ul><ul><li>Individual/expert knowledge </li></ul></ul><ul><ul><li>Anecdotal evidence </li></ul></ul>
  14. 14. Finding the Evidence <ul><li>Where is the evidence? </li></ul><ul><li>New generation EBP resources </li></ul><ul><ul><li>e.g. The Cochrane Library </li></ul></ul><ul><li>Large scale, traditional databases </li></ul><ul><ul><li>e.g. MEDLINE, CINAHL </li></ul></ul>
  15. 15. Resources <ul><li>Primary Databases </li></ul><ul><ul><li>CINAHL </li></ul></ul><ul><ul><li>MEDLINE </li></ul></ul><ul><ul><li>Cochrane Library </li></ul></ul><ul><li>Point of Care/Clinical </li></ul><ul><ul><li>DynaMed </li></ul></ul><ul><ul><li>Essential Evidence Plus </li></ul></ul>
  16. 16. Resources <ul><li>Search Engines </li></ul><ul><ul><li>SUMsearch </li></ul></ul><ul><ul><li>TRIP database </li></ul></ul><ul><li>Guidelines </li></ul><ul><ul><li>National Guideline Clearinghouse </li></ul></ul>
  17. 17. Medical vs. Nursing Concerns <ul><li>Medical </li></ul><ul><ul><li>Abnormalities of joint ( Xrays, tests) </li></ul></ul><ul><ul><li>Medication </li></ul></ul><ul><ul><li>Surgical intervention </li></ul></ul><ul><li>Nursing </li></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><li>ADLs </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Sleep problems </li></ul></ul>
  18. 18. EBP Search Demonstration <ul><li>Subject Headings </li></ul><ul><li>EBP Filters </li></ul><ul><li>Limiters </li></ul><ul><li>Question: </li></ul><ul><li>What should the NP do to prevent pressure ulcers in the elderly? </li></ul>
  19. 19. EBP Search Strategy <ul><li>What is the effect of Nursing Care/Intervention –Intervention is the predictor variable </li></ul><ul><li>On – Preventing pressure ulcers – this is the given characteristic or outcome </li></ul><ul><li>For – the elderly – the specific group of patients or population characteristic </li></ul>
  20. 20. Subject Headings <ul><li>Specific words or phrases selected from a controlled vocabulary that describe a work </li></ul><ul><ul><li>MEDLINE = MeSH </li></ul></ul><ul><ul><li>CINAHL = CINAHL Headings </li></ul></ul>
  21. 21. Research Filters <ul><li>Research filters are pre-designed search strategies </li></ul><ul><li>Useful for finding the right kind of research within large databases </li></ul><ul><ul><li>ADEPT: Clinical questions are usually about Diagnosis, Aetiology, Prognosis, Therapy </li></ul></ul><ul><ul><li>Clinical Queries in MEDLINE </li></ul></ul><ul><ul><li>Netting the Evidence – EBP pages </li></ul></ul>
  22. 22. Limiters <ul><li>Parameters for your search </li></ul><ul><ul><li>MEDLINE limiters include: </li></ul></ul><ul><ul><ul><li>Age group </li></ul></ul></ul><ul><ul><ul><li>Publication type </li></ul></ul></ul><ul><ul><ul><li>Language </li></ul></ul></ul><ul><ul><ul><li>Dates </li></ul></ul></ul>
  23. 23. Summary : EBP Search Strategy Subject Headings Limiters CINAHL Pressure Ulcers/ Pressure Ulcer Nursing: Prevention and control EBP ( specific Interest category) TR group Systematic review Research Aged MEDLINE Pressure Ulcer/nursing: prevention and control Nursing Subset Aged Systematic review(subset) Practice guidelines Clinical queries
  24. 24. Useful limits for EB searching CINAHL PUBMed/MEDLINE Translation literature Care plan or clinical innovations or critical path or practice guideline or protocol or standards or algorithm or EB care sheet, optional CEU Practice guideline or clinical protocol or critical pathway or decision tree or standards Evidence summaries Systematic review Commentary Research or review Systematic and review or meta-analysis Primary research research Clinical trails Validations studies Has abstract PubMed Clinical Queries Or SUMsearch
  25. 25. Critical Appraisal <ul><li>Translation literature </li></ul><ul><li>Evidence summaries </li></ul><ul><li>Discovery or primary research </li></ul>
  26. 26. Qualitative Research <ul><li>CINAHL </li></ul><ul><ul><li>Heading for “Qualitative Studies” </li></ul></ul>
  27. 27. Access <ul><li>Ways to access at FSMFN </li></ul>
  28. 28. In EBSCOhost <ul><li>Select CINAHL Headings from the blue bar across the top of the screen, and browse for the term &quot;osteoarthritis,&quot; setting your results to be &quot;relevancy ranked.&quot; You will see this display: </li></ul>
  29. 30. In EBSCOhost <ul><li>Click on the term &quot;Osteoarthritis&quot; and you will see a hierarchical, or tree view of the term, showing how it relates to other terms. You will also see subheadings, a scope note, which indicates the term’s intended use, and any synonyms or related terms. </li></ul>
  30. 33. Now lets search! <ul><li>Case 1 </li></ul><ul><li>Mary is a nurse midwife practicing in an large city in the Midwest. She has noticed an increase in the number of pregnant teens who are addicted to heroin. The drug treatment facilities near by will not take pregnant teens. Mary wants to know what she should include in her prenatal plan for these teens? </li></ul>
  31. 34. <ul><li>What is the question? </li></ul><ul><li>Is it clear or does it need to be tweaked? </li></ul>
  32. 35. <ul><li>What is the effect of (predictor variable)? </li></ul><ul><li>On? (Outcome) </li></ul><ul><li>For? ( Patient Charateristics) </li></ul>
  33. 36. <ul><li>Results? </li></ul>
  34. 37. <ul><li>Mark is a nurse practitioner in a pain management clinic. He is looking for alternative ways to treat chronic pain in adjunct with medication and injection. He wants to know what alternative therapies are available for patients with chronic back pain? </li></ul>
  35. 38. <ul><li>What is the question? </li></ul><ul><li>Is it clear or does it need to be tweaked? </li></ul>
  36. 39. <ul><li>What is the effect of (predictor variable)? </li></ul><ul><li>On? (Outcome) </li></ul><ul><li>For? ( Patient Charateristics) </li></ul>
  37. 40. <ul><li>Where will you search? </li></ul>
  38. 41. <ul><li>Results? </li></ul>
  39. 42. Questions? <ul><li>Library web site: </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Phone: (859)253-3637, x5019 </li></ul>