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Searching for the Evidence. Workshop with Diana Blackwood & Sandra Pullman 15 th February 2008. Session outcomes. Enhanced awareness of the range of useful EB information sources for health professionals
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Searching for the Evidence Workshop with Diana Blackwood & Sandra Pullman 15th February 2008
Session outcomes • Enhanced awareness of the range of useful EB information sources for health professionals • Increased expertise in searching the mountains of websites and publications to find the best evidence.
EBP – what it really is Evidence-based practice (EBP) is an approach to decision-making that integrates the best available evidence with clinical expertise and patient values. Taken from Monash University, Medicine Nursing & Health Sciences www.mihsr.monash.org/cce/ebdm.html
What is the best way to … manage fever in a child? promote leg ulcer healing in a diabetic? prevent DVTs in post-op patients? assist elderly people to remember to take their medications at home? screen for prostate cancer? help people stop smoking?
5 steps of EBP decision making Taken from Monash University, Medicine Nursing & Health Sciences www.mihsr.monash.org/cce/ebdm.html
Levels of evidence Systematic reviews, or meta-analysis of multiple controlled studies Individual experimental study Individual quasi-experimental study Systematic review of multiple non-experimental studies Individual non-experimental study (includes qualitative) Case report, or systematically obtained, verifiable quality/programme evaluation data Respected authorities/Expert committees “Someone told me about it” Adapted from Clinical Practice Model Resource Centre
How do I start? Secondary sources - expert summaries e.g. Cochrane Library, Joanna Briggs, clinical practice guidelines, NICE, NICS, CATbank, Bandolier, Best Evidence & other commentary journals, Dynamed, Nursing Reference Center, BMJ Clinical Evidence Primary sources - journal literature e.g. Medline, CINAHL,PsycINFO, AMED. ScienceDirect, Social Work Abstracts, Proquest, Embase. Free resources on the web for busy practitioners e.g. special tools like TRIP, SUMsearch, Google the Evidence (SCHARR), PEDRO plus many resource lists, tutorials
Remember these are mostly full text reviews Not all have subject headings Try restricting your search words to title, keywords & abstract For a “mini” search, limit from PubMed Medline via the tag 1469-493X[jour] Tips for the Cochrane Library
limit by publication type e.g. RCT, Clinical Trial, Meta-analysis use study design subject headings use expert strategies/filters (see your handouts for CINAHL & MEDLINE) try the Clinical Queries filter in PubMed Hot search tips for databases
Examples of “expert” EBP filters for Medline DIAGNOSIS (sensitivity or predictive value).tw. CAUSE (risk or cohort).tw. or case-control studies/ THERAPY clinical trial.pt. or (double blind$ or placebo$).tw. PROGNOSIS exp cohort studies/ or prognosis/ or survival analysis/ N.B. available via automatic filtering on PubMed
Tools for the busy practitioner TRIP (Turning Research into Practice) www.tripdatabase.com Google the Evidence (SCHARR) http://tinyurl.com/2poh3a Evidence Australia (Royal Melbourne Hospital) http://mh1.mh.org.au/library/eds/ea.htm SUMSearch http://sumsearch.uthscsa.edu/ CATbank http://cebm.jr2.ox.ac.uk/docs/catbank.html
Many free EBM tutorials and sites on the Web See your handout for a list of resources Ask a librarian for help More information?