L16 rm (systematic review and meta-analysis)-samer
Eidm level1 fall2014mm
1. EIDM and the 6S Pyramid
NURS 1G03
Laura Banfield
School of Nursing Librarian
January 2012
2. Learning Objectives
• Review the definition and model of Evidence
Informed Decision Making
• Become familiar with the components of the
6S Pyramid
• Practice searching resources from the 6S
Pyramid
3. EIDM was originally called Evidence-
Based Practice (EBP)
EBP is:
“The integration of best research evidence
with clinical expertise and patient values
to facilitate clinical decision making”
(Sackett et al., 2000)
4. Best decision…all things considered
Clinical state,
setting, and
circumstances
Patient
preferences
and actions
Research
evidence
Health care
resources
CCllininiiccaall E Exxppeerrttiissee
5. Steps of EIDM
1. Construct a relevant, answerable question from
a clinical case. *clinical uncertainty*
2. Search the literature to retrieve the best
evidence.
3. Critically appraise the literature (evidence) for
validity and applicability.
4. Apply the evidence to your clinical practice.
5. Evaluate the outcome or performance.
*From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2),
36-7.
6. Sample foreground question
Are silver dressings more
effective than standard
gauze dressings for
promoting healing of leg
ulcers in an elderly woman?
7. Clinical questions ?????
• Background questions
• Need to be answered first
• Can be answered by books or general
Websites
• Foreground questions (use 6S pyramid)
• Need to be very focused
• Can be answered by research published in
journal articles
10. Systems
“Support clinical decision making through linking all
relevant best research evidence about a clinical
situation directly to a patient’s record.”
(Haynes 2008)
Sources of Systems
• Integrative Electronic Patient Records
*Note: We will not be using Systems.
11. Summaries
“Summaries integrate best available evidence from
lower layers … to provide a full range of evidence
concerning management options for a given
health problem.”
(Haynes, 2007)
Sources of Summaries
• Clinical Practice Guidelines
• Evidence Based Texts
12. Synopses
Synopses condense and highlight the key points of a
study or systematic review and comment on their
application to patient care. They are often written in
the form of an abstract.
Sources of Synopses
• Database of Abstracts of Reviews of Effects
(DARE) – intervention focus
• health-evidence.ca – public health focus
• evidence-based abstract journals
13. Syntheses:
Systematic Reviews
Consolidate the literature on a specific topic:
• comprehensive identification of best studies
• review of study relevance
• evaluation of quality of research methodology
• extraction and analysis of data
• draw conclusions
Sources of Syntheses:
• The Cochrane Library (the “gold” standard)
• Health care journals
Discuss the steps of EIDM. Emphasis on the first two.
Consider reflective practice and where EIDM fits.
All of the patient’s information, demographics (age, gender, etc), details regarding their condition/s, information from current visit (symptoms, HR. BP etc), combined with information to support clinical decision making about their case.
Provides the best evidence for an entire clinical topic (e.g. childhood asthma)
Refer back to other levels and their relevance, but do not go into detail!
e.g. We’ve just discussed the upper levels of the 6S pyramid which deal more with what we call pre-appraised evidence. Some of these resources have been purposely produced for clinical application and hence most of the work of determining whether or not they contain sound information has been done. However, it is up to you to still check these things, but also, to make sure that what you find in these resources does apply to your clinical setting or scenario (e.g. something which talks about managing fevers in elderly people may not apply to managing fevers in toddlers).
The two remaining levels in the pyramid which we haven’t looked at, synopses of single studies and single studies, will be covered in a later course. For these two levels, you need to know a little more about critical appraisal, statistics and research design. It is possible that for some of your other courses you may have to use resources from these levels to find single studies – perhaps in psychology or biology.
Advantages
Search multiple levels of evidence at the same time
Fewer results
Disadvantages
Reduced set of resources being searched
Reliance on what others consider as best/criteria and vocabulary not as transparent
Information may exist on your topic, but not be found
Decreased power in searching
