Evidence-based searching for health librarians


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The 1st class on EBM sources of information and using 'filters' to refine your results

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  • Dr. Gordon Guyatt, a professor of medicine and clinical epidemiology and biostatistics at McMaster University is credited for creating the term evidence-based medicine in a 1992 editorial in the Journal of the American Medical Association. The BMJ hailed the development of evidence-based medicine as one of the 15 most important medical breakthroughs of the last 200 years The foundation of evidence based medicine is linked to the changes in medical research in the last 50 years. In 1960, the randomized clinical trial was a rarity. It is now accepted that virtually no drug can be used to treat a patient without passing the test of clinical trials. The challenge for health librarians is to determine what our role is in this new paradigm and to excel at it.
  • So we are now entering the second module which we are calling FILTER Tonight we will be asking ourselves and each other : what is evidence based medicine? We will also be asking ourselves, what roles can I as a health librarian assume in EBM? We will have a break at some point as we usually do And then the other part of tonight’s class will focus on sources of evidence, we’ll do some search exercises and have an opportunity to discuss the challenges of searching for evidence
  • The phrase and the approach to practicing medicine -- using evidence to treat patients -- is now mentioned in the same breath as other medical milestones such as the development or antibiotics, vaccines and the fact that smoking causes lung cancer. Dr. David Sackett who is also a pioneer of evidence-based medicine in Canad who founded the first department of clinical epidemiology in 1967 at McMaster says in the article that I had you read…… His work was also cited when he was admitted to the Canadian Medical Hall of Fame in 2000. Question: Practising evidence-based medicine (EBM) involves finding the evidence, critically appraising and acting on it. Five step model is key!
  • Some of you have been asking about evidence-based searching at PEP . It was integrated in a way that I, as a health librarian and information specialist , really appreciated. Dr. Kent Stobart’s discussion of PICO was one of the best I’ve heard – clear, concise, practical. He tucked PICO in nicely into Step I of EBM’s five steps : Step One = converting the need for information into an answerable question; defining the questions in a way that allows clear answers; PICO-S or PICO-D: P – patient, population, and/or problem being addressed I – intervention or exposure C – co-intervention 0 – outcome S – study design D – domain (diagnosis, etiology, prognosis, therapy) From here, we discussed step (2) two and tracking down the best evidence with which to answer the question, and the concepts behind efficient searching.
  • Patient (group or problem) Can I describe the population I am studying? Intervention What is the main intervention (drug), prognosis or exposure? Comparison What is the prognosis for the disease I am researching? Outcome What is the preferred outcome? Symptom Improvement? Cure?
  • Evidence-based searching for health librarians

    1. 1. <ul><li>LIBR534 – Health information sources & services </li></ul><ul><li>Evidence-based medicine – Module II ’Filter’ </li></ul><ul><li>January 28 th , 2010 </li></ul><ul><li>Greg Rowell & Dean Giustini, SLAIS Adjunct faculty </li></ul>“ A new paradigm for medical practice is emerging…” (1992) Canadian Dr. Gordon Guyatt [ personal website ] 1992 JAMA article
    2. 2. <ul><li>Agenda </li></ul><ul><li>Module II </li></ul><ul><li>What is evidence based medicine (EBM)? </li></ul><ul><li>Health librarian roles in EBM </li></ul><ul><li>~ Break 7:15pm~ </li></ul><ul><li>Sources of information in EBM </li></ul><ul><ul><ul><li>Exercises </li></ul></ul></ul><ul><li>Searching in EBM </li></ul><ul><ul><ul><li>Examples </li></ul></ul></ul>Rowell-Giustini – LIBR534
    3. 3. Rowell-Giustini – LIBR534 Classic definition of EBM “… EBM is the conscientious, explicit and judicious use of current best evidence in making clinical decisions about the care of individual patients.“ David Sackett (1996) - McMaster University In your own words: What is evidence-based medicine ’about’? How would you explain its ’steps’ to someone?
    4. 4. Rowell-Giustini – LIBR534 … the health librarian’s role is to explain what knowledge and skills he brings to the clinical team Health librarians – The Five Steps of EBM see EBM tutorial , University of California
    5. 5. Rowell-Giustini – LIBR534 Lead to the evidence - when you can… <ul><li>Haiti guide </li></ul><ul><li>http://hlwiki.slais.ubc.ca/index.php/Haiti_earthquake_-_disaster_relief_information_sources </li></ul><ul><li>e.g., Cochrane Library - disease prevention & coping skills </li></ul><ul><li>Improving water quality & hand washing </li></ul><ul><li>Psychological treatment </li></ul><ul><li>H1N1 guide </li></ul><ul><li>http://hlwiki.slais.ubc.ca/index.php/H1N1_(Human_Swine_Flu)_in_Canada_-_Information_Sources </li></ul><ul><li>DynaMed </li></ul><ul><li>http://www.ebscohost.com/dynamed/h1n1/ </li></ul><ul><li>MDConsult </li></ul><ul><li>http://www.mdconsult.com/recommended-results/H1N1Influenza.lp </li></ul><ul><li>UpToDate </li></ul><ul><li>http:// www.uptodate.com/home/content/topic.do?topicKey =pulm_inf/19054 </li></ul>Other observations re: searching for evidence?
    6. 6. Rowell-Giustini – LIBR534 But first – is question ‘background’? <ul><li>First, let’s make distinction - background vs foreground questions </li></ul><ul><li>Background questions are posed by novices looking for general knowledge or “facts” </li></ul><ul><ul><ul><li>who, what, when, why , which </li></ul></ul></ul><ul><ul><ul><li>What is H1N1? What is influenza? </li></ul></ul></ul><ul><ul><ul><li>How can H1N1 be diagnosed? </li></ul></ul></ul><ul><ul><ul><li>Which treatments are available for it? </li></ul></ul></ul><ul><li>Best answered in textbooks or databases like MDConsult & UpToDate </li></ul><ul><ul><ul><li>The novice has more background questions than the expert… </li></ul></ul></ul>
    7. 7. <ul><li>Or a foreground question? </li></ul><ul><li>Foreground questions are asked by experts </li></ul><ul><li>Answers found by searching Medline but there are many tools </li></ul><ul><li>PICO to structure foreground Qs: </li></ul><ul><ul><ul><li>P atient/ P opulation/ P roblem </li></ul></ul></ul><ul><ul><ul><li>I ntervention </li></ul></ul></ul><ul><ul><ul><li>C omparison/ C ontrol </li></ul></ul></ul><ul><ul><ul><li>O utcome </li></ul></ul></ul><ul><li>‘ Therapy’ …. most common domain </li></ul><ul><ul><ul><li>PubMed’s Clinical Queries to filter </li></ul></ul></ul><ul><li>http:// www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical </li></ul>Rowell-Giustini – LIBR534 Reference: “Laikas MedLibLog” http://laikaspoetnik.wordpress.com/2009/09/
    8. 8. Rowell-Giustini – LIBR534 … and PICO to structure question Exercise – Jonesy, a 68 yr old male with…. What is the desired outcome or effect for the patient? Outcomes Do you want a placebo comparison or a drug comparison? Comparison What main intervention (or treatments) will be considered for him? Intervention Can I describe my patient or problem? Let’s start by framing the question… Patient Population Problem
    9. 9. Rowell-Giustini – LIBR534 … where is the evidence? <ul><li>Should newborns be vaccinated against chicken pox if mothers have been exposed to the virus? </li></ul><ul><li>What are the effects of Prozac for someone who is depressed? </li></ul><ul><li>Does psychological counselling alleviate symptoms of Post Traumatic Stress Disorder (PTSD)? </li></ul><ul><li>Are cox-II inhibitors effective in treating osteoarthritis in a geriatric population? </li></ul>
    10. 10. Rowell-Giustini – LIBR534 Strategy: filtered sources first <ul><li>EBM up-to-date textbooks </li></ul><ul><ul><ul><li>UpToDate, BMJ Clinical Evidence, First Consult, etc </li></ul></ul></ul><ul><li>‘ Pre’ Filtered resources </li></ul><ul><ul><ul><li>ACP Journal Club </li></ul></ul></ul><ul><ul><ul><li>Cochrane Database of Systematic Reviews </li></ul></ul></ul><ul><ul><ul><li>SumSearch & TRIP Database </li></ul></ul></ul><ul><li>Primary research </li></ul><ul><ul><ul><li>Medline (OvidSP, Pubmed) is unfiltered </li></ul></ul></ul><ul><ul><ul><li>EMBASE, CINAHL, PsycINFO, etc </li></ul></ul></ul><ul><ul><ul><li>But, some filtered information in databases </li></ul></ul></ul>
    11. 11. Rowell-Giustini – LIBR534 Roles for health librarians in evidence-based practice <ul><li>Explain health librarian’s role to clinical team </li></ul><ul><ul><li>R espond to individual needs as appropriate </li></ul></ul><ul><li>‘ Frame’ or formulate clinical question in reference interview </li></ul><ul><ul><li>Break question into categories, facets or ‘pearls’ </li></ul></ul><ul><li>Teach search techniques </li></ul><ul><ul><li>Explain indexing practices in databases </li></ul></ul><ul><ul><li>How to limit for methodology i.e. publication types </li></ul></ul><ul><li>Check search strategies </li></ul><ul><ul><li>Collaborate on research & publication </li></ul></ul>
    12. 12. Rowell-Giustini – LIBR534 <ul><li>Split into groups of 2 </li></ul><ul><li>Pick one category or question at a time </li></ul><ul><li>Listen to the “answer” being read </li></ul><ul><li>Determine correct “question” for answer </li></ul><ul><li>Try to get the most points </li></ul><ul><li>Build your EBM knowledge </li></ul>Welcome to EBM Jeopardy for LIBR534
    13. 13. Rowell-Giustini – LIBR534 What is evidence-based medicine?
    14. 14. Rowell-Giustini – LIBR534 “… Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making clinical decisions about the care of individual patients.“ David Sackett (1996) - McMaster University
    15. 15. Rowell-Giustini – LIBR534 Name the four parts of PICO…
    16. 16. Rowell-Giustini – LIBR534 <ul><li>PICO stands for: </li></ul><ul><li>P atient/ P opulation/ P roblem </li></ul><ul><li>I ntervention </li></ul><ul><li>C omparison/ C ontrol </li></ul><ul><li>O utcome </li></ul>What are the four parts of PICO?
    17. 17. Rowell-Giustini – LIBR534 What is a systematic review & meta-analysis?
    18. 18. Rowell-Giustini – LIBR534 A meta-analysis is… … a study design that attempts to have greater statistical power by pooling the results from many studies like RCTs … the search strategies for a SR or a meta-analysis must be reproducible …
    19. 19. Rowell-Giustini – LIBR534 What is a tree structure?
    20. 20. Rowell-Giustini – LIBR534 A tree structure…. … is how broader and narrower terms are displayed along sixteen (16) categories in the MeSH hierarchy <ul><li>Anatomy </li></ul><ul><li>Organisms </li></ul><ul><li>Diseases </li></ul><ul><li>Chemical and Drugs </li></ul><ul><li>Analytical, Diagnostic and Therapeutic Techniques and Equipment </li></ul><ul><li>Psychiatry and Psychology </li></ul><ul><li>Phenomena and Processes </li></ul><ul><li>Disciplines and Occupations </li></ul><ul><li>Anthropology, Education, Sociology and Social Phenomena </li></ul><ul><li>Technology, Industry, Agriculture </li></ul><ul><li>Humanities </li></ul><ul><li>Information Science </li></ul><ul><li>Named Groups </li></ul><ul><li>Health Care </li></ul><ul><li>Publication Characteristics </li></ul><ul><li>Geographic Locations </li></ul>
    21. 21. Rowell-Giustini – LIBR534 What is the Cochrane Library?
    22. 22. Rowell-Giustini – LIBR534 The Cochrane Library is … a collection of six databases of high-quality evidence to help health professionals make clinical decisions. (See also Cochrane Collaboration ). In addition to Cochrane's database of systematic reviews, the CL provides access to other sources such as technology assessments, evaluations and clinical trials. Two commercial products that provide access: OVID's Evidence-based medicine reviews (EBMR) and Wiley's Cochrane Library
    23. 23. Rowell-Giustini – LIBR534 What is the ‘Clinical Queries’ feature in PubMed?
    24. 24. Rowell-Giustini – LIBR534 … a quick and efficient way to filter along four domains using pre-defined search strategies or ‘search filters’ that have been created by Brian Haynes and Ann McKibbon at McMaster University…. http:// www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical The ‘Clinical Queries’ feature in PubMed is…