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Novel Tools and Resources for an Evidence Based Practice

Novel Tools and Resources for an Evidence Based Practice . Barbara Walker, Ph.D. walkerb@njhealth.org. Best available research evidence. Clinical Expertise. Patient’s situation and circumstances. Clinical Expertise. The Framework. CD. EBP begins and ends with the patient.

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Novel Tools and Resources for an Evidence Based Practice

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  1. Novel Tools and Resources for an Evidence Based Practice Barbara Walker, Ph.D. walkerb@njhealth.org

  2. Best available research evidence Clinical Expertise Patient’s situation and circumstances Clinical Expertise The Framework CD

  3. EBP begins and ends with the patient

  4. Types of Clinical Questions Diagnosis Therapy Harm Etiology Prognosis Cost-effectiveness Background Foreground By Content By Format THIS SLIDE COURTESY OF SUE LONDON RUTH LILLY LIBRARY

  5. background foreground

  6. Background questions Foreground questions Amount of experience

  7. Background Questions • What are the criteria for diagnosing …? • What are the known risks associated with… • What is the cost-effectiveness of … • What is the prognosis for… • What treatments have been found to be most effective for…?

  8. P = Patient Population or Problem I = Intervention C = Comparison O = Outcome Foreground Questions

  9. Formulating a Foreground Question(PICO) In middle aged women with migraine headache Is there any evidence that acupuncture Compared to sham treatment, Relaxation training, Biofeedback training, and/or Cognitive Behavioral Therapy Decrease frequency, intensity, and/or severity of migraines • Patient or Population • Intervention • Compared to… • Outcome you would like to measure or achieve

  10. Why formulate questions so carefully?

  11. …QUESTIONS DRIVE THE SEARCH WHAT to look for ? WHERE to look? HOW to search?

  12. High Sensitivity THIS SERIES COURTESY OF SUE LONDON IUPUI LIBRARY

  13. High Specificity WHAT: Synthesized literature WHERE: Specialized databases HOW: Specialized search strategies/filters

  14. SECONDARY LITERATURE: papers that synthesize original studies SYSTEMATIC REVIEWS EB Meta-analyses EB Guidelines Traditional reviews PRIMARY LITERATURE

  15. Systematic vs. Traditional Reviews • Focus on a clear clinically relevant question. • End with a clinical bottom-line. • Specific, pre-determined method and format. • Research on research. • Search for all relevant studies. • Avoid bias • Goal is replication

  16. Traditional reviews SECONDARY LITERATURE Guidelines EVIDENCE-BASED PRIMARY LITERATURE Systematic reviews

  17. What are we looking for? Evidence that has already been scientifically synthesized for us A new type of literature Systematic reviews Evidence-based guidelines Others

  18. Where and how ?

  19. Start at the top You can search specifically for one thing or…

  20. Databases that contain these: TRIP

  21. www.tripdatabase.com high-quality open-access material to support EBP

  22. USE ADVANCED SEARCH and read the search tips

  23. Databases that contain these: TRIP

  24. TRIP Advantages: • It’s free public access • It contains ONLY evidence-based material Disadvantages • Searches are broad • May not contain exactly what you need • Everything in TRIP is evidence-based but there is evidence-based literature NOT in TRIP.

  25. http://clinicalevidence.bmj.com/ceweb/index.jsp

  26. UPTODATE DYNAMED

  27. ESTs from Div 12 http://www.psychology.sunysb.edu/eklonsky-/division12/

  28. www.therapyadvisor.org

  29. With a subscription you can obtain detailed reviews or you can access summaries free on www.cochrane.org.

  30. Medline and PsycINFO • EBP techniques

  31. Cochrane / others PSYCINFO MEDLINE IT IS IMPORTANT TO SEARCH BOTH You may miss some of the best EB resources by searching only PsycINFO Adapted from Shahram Yazdani, 2002

  32. MEDLINE PSYCINFO DATABASES contain the articles

  33. VENDORS Create interfaces to bring the articles to you MEDLINE PSYCINFO DATABASES

  34. VENDORS MEDLINE PsycINFO PUBMED free CSA ILLUMINA OVID $$$$$$$$ EBSCO

  35. PubMed • Clinical Queries • Keywords vs. Controlled vocabulary

  36. CLINICAL QUERIES http://www.ncbi.nlm.nih.gov/pubmed/

  37. Interested in finding articles about acupuncture as a treatment?

  38. Why not just type keywords? Keywords look for that exact word in the article. Acupuncture Acupressure Behavior Behaviour Tension headache Muscle contraction headache Depression Major depressive disorder

  39. Controlled Vocabulary Librarians “tag” each article with labels based on the concepts in the article. These labels are standardized. This allows the user to retrieve information that uses different terminology for the same concept. Medline: MeSH terms

  40. Why : We need to find the relevant scientific evidence quickly and efficiently to inform our practice What: A newer literature (pre-appraised) Where and How: (work your way down the pyramid) • Uptodate / Dynamed / emedicine • Clinical Evidence • Evidence-based guidelines • EB journals (EBMH) • ESTs

  41. The evidence can come to you: Alerts?

  42. Alerts • Individual journals and databases • Medline and PsycINFO: • save your search • automatic email • Ask within your own field… • Librarians are your friends…

  43. EBP begins and ends with the patient

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