Evidence Based Medicine: Searching the Literature

1. Evidence Based Medicine: Searching the Literature Samantha Johnson Academic Support Librarian

2. Objectives This session and online tutorial should: • Make your literature searching more evidence based • Provide an understanding of the importance of critical appraisal • Identify the key evidence based resources • Enable you to undertake an evidence based search in Medline and The Cochrane Library

3. EBM Tutorial • http://www2.warwick.ac.uk/services/library/main/tealea/sciences/medicine/evidence • Explains the main points of evidence based literature searching • Provides an opportunity to: • try the different evidence based resources • search The Cochrane Library • complete a PICO search using Medline

4. EBM Tutorial • Pre-assessment quiz: • if you score 8 or more out of 10, completion of the tutorial is optional • if you score less than 8 you need to complete the tutorial • can only attempt the quiz once • Need to enter name when you have completed the quiz and the full tutorial • Allow 1 hour • Deadline for completion: Friday 17th December 2010

5. Evidence Based Medicine “Evidence based medicine is the ..use of current best evidence in making decisions about the care of individual patients…[it] means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” David Sackett et al, 1996

6. Where to search? • Key Resources for Evidence Based Medicine at http://go.warwick.ac.uk/lib-medicine • NHS Evidence • Clinical Evidence • Clinical Knowledge Summaries • Cochrane Library

7. Searching Medline • You need to evaluate / critically appraise the quality of the research: • Who? • Why? • How? • When? • Do the results seem valid? • Do the conclusions stack up?

8. Benefits of EBM resources • Research has been evaluated and critically appraised • Presented in an easily readable format: • Digests • Reviews • Structured abstracts • Easier to search: • Smaller, focused resources • Able to browse by clinical category

9. Evidence Based LiteratureSearching • Finding the best level of evidence available: • Systematic review? • Clinical trial? • Cohort study? • Don’t believe everything you read • Not all research is good research • Just because an article is published, it doesn’t mean it is accurate

10. Why are we concerned? • Studies suggest that: • 30% - 40% of patients don’t receive treatments of proven effectiveness • 20% - 25% have treatments that are unnecessary or potentially harmful

11. Too much to read, too little time • 30kg of guidelines per family doctor per year • 25,000 biomedical journals in print • 8,000 articles published per day • 95% of studies cannot reliably guide clinical decisions

12. Barriers between research and practice • Gap between available research evidence and current medical practice • Evidence being generated by medical researchers isn’t getting to practitioners • Over 2,000,000 research articles added to the world’s health care literature each year

13. How can EBM help? • Provides clinicians with better tools and information resources with which to evaluate medical literature • More efficient and effective decision making • Bridges the gap between clinician’s knowledge and current research • Ensures patients are receiving care that fits their need/s

14. Why the best evidence is important • Dr Spock: “Baby and child care” • 1st printing (May 1946) • 165th printing (October 1966) • Advocated laying babies on front • 1990’s SIDS Campaign: deaths reduced from 3/1000 to 0.5/1000 in 6 months • Failure to test original theory in a controlled trial

15. Searching for Evidence Based Literature • Four steps to finding the best evidence: 1. Ask an answerable question (PICO) 2. Create an effective search strategy 3. Search for the best level of evidence 4. Appraise and interpret the evidence in relation to your specific question

16. The PICO method Another method of thinking about the concepts you want to search for A more evidence-based approach • Patient / Population – who and what? • Intervention – how? • Comparison (if appropriate) – what is the main alternative? • Outcome – what are you hoping to accomplish, measure, improve, affect?

17. So how does this work inpractice? An adult has been diagnosed with chronic low back pain. The normal treatment is a course of non- steroidal anti-inflammatory agents but the GP has heard that acupuncture may be a successful treatment. However, the GP wants to get his facts right, so searches the literature

18. PICO in practice • Patient/Population: Chronic low back pain • Intervention: Acupuncture • Comparison: NSAID’s • Outcome: Improved pain management

19. Additional keywords

20. An EBM search via Medline? • References retrieved from Medline are not critically appraised – so you will have to do it • Short cut: Check to see if DARE has reviewed your article • Make your search more EBM focused by using a “Clinical queries” filter

21. Searching Medline: limiting to clinical queries • EBP searching: 2-stage process: • normal subject/keyword search • use a clinical query limit option to retrieve EBM research • Clinical Queries Therapy ) Diagnosis ) Sensitivity Prognosis ) Specificity Reviews ) Optimized Etiology ) Costs )

22. EBP Limits • Sensitivity: will retrieve the most relevant articles but probably some less relevant ones • Specificity: will retrieve mostly relevant articles but probably omitting a few • Optimized:the combination of terms that optimizes the trade-off between sensitivity and specificity

23. Support and help Email: samantha.a.johnson@warwick.ac.uk Telephone: 024 765 22427 or ext 22427