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Ebp for the ebp
This document provides an overview of evidence-based practice resources for healthcare practitioners. It discusses search strategies including developing PICO questions and using keywords, Boolean operators, truncation and wildcards. It also summarizes key databases for finding evidence including the National Guidelines Clearinghouse, Cochrane Database of Systematic Reviews, PubMed, and CINAHL. Tips are provided for evaluating search results and choosing appropriate study designs and evidence levels.
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Ebp for the ebp
- 1. EBP for the EBP (Extremely Busy Practitioner) Susan Fowler, MLIS Medical Librarian Fowler@wustl.edu 314‐362‐8092 pg: 314‐360‐1069
- 2. Outline • Search Strategy • Pulling Keywords from Your PICO Question • Boolean, Truncation, and Wild Cards • Hierarchy of Evidence and Study Design • National Guidelines Clearinghouse • Cochrane Database of Systematic Reviews • PubMed (MEDLINE) • CINAHL
- 3. Choosing Appropriate Evidence Higher Percentage of Quality Meta‐ the Literature analyses Systematic reviews Randomized controlled trials Prospective blind comparisons Cohort studies Case‐control studies Case series and case reports Animal and laboratory research Will Olmstadt, MS, MPH
- 4. PICO • Patient or problem ‐How would I describe a group of patients similar to mine? • Intervention ‐ Which main intervention, prognostic factor, or exposure am I considering? • Comparison ‐ What is the main alternative to compare with the intervention? • Outcome ‐ What can I hope to accomplish, measure, improve or affect? Will Olmstadt, MS, MPH
- 5. The Search Strategy • Develop PICO question • Identify keywords and terms from PICO • Identify standardized subject headings • Combine subject headings and keywords to narrow or broaden your search • Evaluate your search results • Revise the search in light of your results
- 6. Pulling Keywords fromYour PICO Question • What are the main topics of your PICO? • Brainstorm – what other words could you use to describe your topic? • What are some synonyms for the words you’ve come up with?
- 7. Evaluate the SearchResults Don’t be afraid if you have zero (0) or thousands of results, play around with search strategies – you wont break anything! – Read the titles and abstracts of “hits” in your search to get a feel for their relevance – Identify relevant MeSH and Keywords used to index particularly relevant “hits” – If your search yields too many or too few hits, modify it and try again
- 8. Revise the Searchin Light of your Results • Narrow the search by combining search terms and applying limits • Broaden the search if the results are too limited by removing keywords and limits
- 9.
- 10. Boolean strawberry AND AND chocolate Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from http://www.ithaca.edu/library/course/expert.html.
- 11. Boolean strawberry OR OR chocolate Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from http://www.ithaca.edu/library/course/expert.html.
- 12. Boolean and Nesting (strawberry OR NOT chocolate Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from http://www.ithaca.edu/library/course/expert.html.
- 13. Truncation and WildCards • Truncation is a searchable shortened form of a word. – adolescen* will include • adolescence • adolescent • adolescents, etc… • Wild card characters are useful because of alternate spellings and other quirks in the English language. – behavio?r, will include • behaviour • behavior – Wom*n, will include • women • woman
- 14.
- 15. National Guidelines Clearinghouse • http://www.guideline.gov/ • Freely accessible database of evidence‐based clinical practice guidelines and related documents. • Initiated by the AHRQ in partnership with the American Medical Association and America's Health Insurance Plans. • Now maintained by the Agency for Healthcare Research and Quality (AHRQ) and the U.S. Department of Health and Human Services. • If you have developed a good practice guideline consider submitting it to the NGC
- 16.
- 17. NGC Detailed Search Enter Keywords Sort Results by Publication Date
- 18. NGC Detailed Searchcont… Limit search to age of target population.
- 19. NGC Pros –Freely accessible practice guidelines that have undergone rigorous acceptance standards by the AMA, AHIP, AHRQ, and the U.S. Department of Health and Human Services Cons – Limited content – Limited search capabilities
- 20. Cochrane Database of Systematic Reviews • http://www.cochrane.org/ • “Gold Standard” for systematic reviews • Free database, but requires paid subscription to access most content
- 21.
- 22. Cochrane Search Example Question: Does the use of Echinacea really prevent the common cold? You are only interested in Cochrane Reviews
- 23. Cochrane Search Examplecont… You are only interested in Cochrane Reviews Click “Record” to view details of review and access full text if available.
- 24. Cochrane Systematic Reviews Pros – Compiled through rigorous standards – Review process has already been done so you don’t have to Cons – Limited content – Limited search capabilities – Access to most full‐text content requires paid subscription
- 25. PubMed (MEDLINE) • www.pubmed.gov • Created and maintained by the National Institute of Health (NIH) and the National Library of Medicine (NLM) • 17 million citations back to 1950s • Free database of citations with some content available for free
- 26. MeSH = MedicalSubject Headings Choose MeSH from Pull Down Menu
- 27.
- 28. PubMed - MeSHcont… Choose the most applicable MeSH terms
- 29. PubMed - MeSHcont… Send to Search Box
- 30. PubMed ‐ MeSHcont… Click “Search PubMed”
- 31. PubMed – AdvancedSearch
- 32. PubMed – AdvancedSearch Enter search numbers and combine using Boolean operators.
- 33.
- 34. PubMed - Limitscont… For the most clinically applicable articles, limit to “Humans,” “English,” and “Type of Article”
- 35. PubMed – Limitto Type of Article Tier 1 Tier 2 • Clinical Trial • Meta‐Analysis • Clinical Trial, Phase I • Practice Guideline • Clinical Trial, Phase II • Clinical Trial, Phase III • Randomized Controlled • Clinical Trial, Phase IV Trial • Comparative Study • Controlled Clinical Trial • Review • Research Support, N.I.H., Extramural • Research Support, N.I.H., Intramural • Guideline • Research Support, Non‐U.S. Gov't • Research Support, U.S. Gov't, Non‐P.H.S. • Multicenter Study • Research Support, U.S. Gov't, P.H.S.
- 36. Accessing Full‐Text Articles Avoid clicking on publisher icons unless they explicitly state that they are free or unless you are willing to pay $ 35.00 ‐65.00 dollars per article.
- 37. Accessing Full‐Text Articles cont… It is likely that your institution’s library has facilitated link‐out in PubMed to link you directly to articles from journals to which they subscribe to. It is also likely that your institution’s library has an Inter‐Library Loan service that will “borrow” the article you want from another library for you for a small charge (certainly less then $35.00!) or for free. Contact your librarian and find out what services are available and how to use them.
- 38. PubMed - SendTo From “Send to” drop down menu, choose “E‐mail” You can email your results to yourself and your colleagues.
- 39. PubMed - SearchHistory Don’t forget to save your search history!
- 40. PubMed (MEDLINE) PubMed advantages PubMed disadvantages – Free to search – Still have to appraise articles – No username/password once located – Searches same content as Ovid MEDLINE – Links to free full‐text sometimes available
- 41. CINAHL • Cumulative Index to Nursing & Allied Health Literature • Indexes over 3,000 journals plus additional materials (book chapters, dissertations) back to 1937 • Requires a paid subscription to access • CINAHL has its own headings similar to MeSH (70%)
- 42. CINAHL - SearchExample Click box for Subject Terms
- 43. CINAHL - SubjectTerms Choose the most applicable terms
- 44. CINAHL - History Combine searches from Search History
- 45. CINAHL – Historycont… 1. Click “Clear” 3. Click “Add” 2. Choose searches to combine.
- 46. CINAHL – ReviseSearch DO NOT look at your results until you have revised your search!
- 47. CINAHL – ReviseSearch cont… Publication Types •Care Plan •Clinical Trial •Evidence‐ Based Care Sheet •Practice Guidelines •Review •Standards •Systematic Review
- 48. CINAHL – Results Scroll down to view your results.
- 49. CINAHL – Displaying Results Scroll all the way to the bottom. Choose the number of results that Choose “Detailed” to see as much will allow you to look at all your information in one glance about results in one continuous list. each article. BERNARD BECKER MEDICAL LIBRARY
- 50. CINAHL – YourFolder Add articles you want to look at, save, or request to your folder.
- 51. CINAHL – YourFolder cont… Look at your saved citations in the Folder View.
- 52. CINAHL – YourFolder From here you can print, email, save, and export to a citation managers.
- 53. CINAHL – Emailing A nice option when you are emailing your results is that you can choose to have them formatted into the citation style you will need later.
- 54. CINAHL CINAHL advantages CINAHL disadvantages – Nursing and allied health – Subscription product content – Content is limited compared – Includes content MEDLINE to MedLine does not – EBP limiters are limited – Searching CINAHL is expected in many evidence settings – CINAHL headings
- 55. Good Database SearchingRules Following these rules will improve your results… 1. Use standardized subject headings like MeSH and CINAHL Subject Terms. 2. Apply Limits like “English” and “Humans.” 3. Limit “Publications Types” to – Meta‐analysis – Practice Guidelines – Randomized Controlled Trials – Reviews 4. Keep a copy of your search history. 5. If it takes you longer then 20 minutes – ask your librarian for help.
- 56. Library Locations • 660 S. Euclid • St. Louis Children’s Hospital 314‐362‐7085 Lauren Yaeger, 314‐454‐2768 Susan Fowler, 314‐362‐8092 yaegerl@wustl.edu Pg: 314‐360‐1069 fowler@wustl.edu • BJ North, Rothschild Medical Library Reka Kozak, 314‐454‐7208 kozakr@wustl.edu