Finding Evidence on the Web Through HEAL-WA: Only a Click Away

1. Finding Evidence on the Web Through HEAL-WA: Only a Click Away

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3. What is evidence-based medicine? Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett DL et al. Evidence based medicine: what it is and what it isn't. BMJ 1996 Jan 13; 312 (7023): 71-2. 3 Evidence-based practice uses the results of scientific studies whenever possible and expert opinion and extensive experience when data are lacking. Evidence-based practice uses the results of scientific studies whenever possible and expert opinion and extensive experience when data are lacking.

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5. What makes good evidence? Based on scientific research RCT Systematic review Meta-analysis Clinical guidelines Expert opinion Consensus Because it�s been done this way for 100 years 5 What info qualifies as evidence-based? Evidence-based sources contain information that has been consistently and systematically identified, evaluated, selected and synthesized. Based on solid scientific research Synthesized to increase the validity of the conclusions What is not evidence? A journal article about one study � an RCT or a case study � isn�t necessarily �evidence� on its own. However, that article can be added to a number of other articles investigating the same question and included in a synthesis of the research. That evaluation and synthesis is the key to what informs evidence-based summary resources. What info qualifies as evidence-based? Evidence-based sources contain information that has been consistently and systematically identified, evaluated, selected and synthesized. Based on solid scientific research Synthesized to increase the validity of the conclusions What is not evidence? A journal article about one study � an RCT or a case study � isn�t necessarily �evidence� on its own. However, that article can be added to a number of other articles investigating the same question and included in a synthesis of the research. That evaluation and synthesis is the key to what informs evidence-based summary resources.

6. EBP Implications for Nursing Are U.S. nurses ready for evidence-based practice? Many don�t understand or value research Many have little of no training to help find evidence on which to base their practice Pravikoff DS, Tanner AB, Pierce ST. Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing 2005 Sep;105(9): 40-52. Failure to use evidence results in lower quality, less effective and more expensive care. Berwick DM. Disseminating innovations in health care. JAMA 2003 Apr 16;289(15):1969-75. 6 Are nurses ready for evidence-based practice? Results in better pt outcomes Barriers to nurses using EBP: -Lack of time -Lack of value of research in practice -Lack of understanding of electronic databases -Lack of computer skills -Difficulty understanding research articles Are nurses ready for evidence-based practice? Results in better pt outcomes Barriers to nurses using EBP: -Lack of time -Lack of value of research in practice -Lack of understanding of electronic databases -Lack of computer skills -Difficulty understanding research articles

7. Levels and Grades of Evidence 7

8. Searching for Evidence Categories 8

9. Where can you find evidence only one click away?

10. heal-wa.org Began January 2009 Website offering online access to a collection of health information resources Who has access? selected health care providers in Washington YES, NURSES ! Funded by: license fees Its mission: to provide evidence-based information to support patient care 10 MANDATED BY WASHINGTON STATE LEGISLATUREMANDATED BY WASHINGTON STATE LEGISLATURE

11. What is included in HEAL-WA? Resources: electronic databases, online texts, and e-journals Includes information resources specific to nurses, such as CINAHL and the Nursing Reference Center Other excellent resources: MEDLINE, DynaMed, Cochrane, Natural Standard Gives practitioners access to timely, evidence-based answers to patient care Q�s 11 HEAL-WA gives you access to the latest available evidence-based information. Many of these resources are updated daily HEAL-WA gives you access to the latest available evidence-based information. Many of these resources are updated daily

12. How do I access HEAL-WA? Site address: heal-wa.org Use the �Getting Started� links to set up your UW NetID and password You will need your RN license number in order to set up your UW NetID (even if you hold an advanced practice license) 12

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14. 14 Toolkits for convenience Can access anything on HEAL-WAToolkits for convenience Can access anything on HEAL-WA

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16. Search for the Best Evidence to answer the Question

17. Search Databases Efficiently for Research Journal Articles Primary literature: MEDLINE/PubMed or CINAHL References to original journal articles on a topic Some with full-text links Most with abstracts You will see same interface when searching MEDLINE or CINAHL (or Cochrane) on HEAL-WA 17

18. CINAHL or [CINAHL Plus]  Cumulative Index to Nursing and Allied Health Literature Provides coverage from 1982 [1937] to date, of nursing and 17 allied health disciplines literature 1700+ [3800+] journals indexed including virtually all English-language nursing journals Can easily search for Research articles 18

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20. CINAHL Publication Type Limits Clinical trial Critical path Practice guidelines Research Standards Systematic review 20

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23. MEDLINE [on HEAL-WA] or PubMed MEDLINE (1940�s+) is included on PubMed Indexes 5,000 biomedical journals Covers all aspects of biosciences and healthcare 75%-80% of citations have abstracts Updated 5x/week 23

24. 2 MEDLINE/PubMed Strategies for Finding Evidence-Based Citations Use Publication Type limits Randomized Controlled Trial Meta-Analysis Practice Guideline Clinical Trial Consensus Development Conference Use Clinical Queries 24

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27. 27 Can easily limit your search to: Age groups Human or Animal studies Language Research or Review articles Subsets, such as Core Clinical Journals or CAM Can easily limit your search to: Age groups Human or Animal studies Language Research or Review articles Subsets, such as Core Clinical Journals or CAM

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30. 30 Add screen shot of Clinical queries hereAdd screen shot of Clinical queries here

31. 31 Advantage to short clips: 40 seconds to 3 � minutes long easy to rerecord, update � example, MeSH Browser not MeSH Database change, easy to rerecord. Worth the time, since reaches more people, on and off site Usage stats: Advantage to short clips: 40 seconds to 3 � minutes long easy to rerecord, update � example, MeSH Browser not MeSH Database change, easy to rerecord. Worth the time, since reaches more people, on and off site Usage stats:

32. CINAHL vs MEDLINE/PubMed CINAHL Coverage: 1982+ Indexes 1700 journals Focuses on nursing and allied health literature CINAHL Thesaurus with more nursing terms Has peer-reviewed limit Includes cited references at end of many refs MEDLINE Coverage: late 1940�s+ Indexes 5000 journals Focuses on biomedical literature Uses MeSH as its controlled vocabulary No peer-reviewed limit No cited references 32

33. Locating E-Journals Check with your library for access to full-text e-journals For UW Affiliates: use the Proxy service to access full-text e-journals from off-campus healthlinks.washington.edu/howto/connect Use HEAL-WA Includes CINAHL and MEDLINE links to full-text articles A-Z Journals: 2,600 full-text journals 33 Open access: pubmed central December 2007 law Policy made permanent March 2009 all investigators funded by NIH submit to NLM�s PubMed Central an electronic version of their final, peer-reviewed manuscripts upon acceptance for publication to be made publicly available no later than 12 months after the official date of publication Open access: pubmed central December 2007 law Policy made permanent March 2009 all investigators funded by NIH submit to NLM�s PubMed Central an electronic version of their final, peer-reviewed manuscripts upon acceptance for publication to be made publicly available no later than 12 months after the official date of publication

34. Journals A-Z2,600 full-text health-related journals 34

35. Information Overload! 2 million articles published in biomedical journals each year considering everything of potential biomedical importance would require perusing about 6,000 articles per day� If you only read 2 articles a day, at the end of year you would be 60 centuries behind. 35

36. Email Alerts for Keeping Current Deliver current citations into your email Based on a search strategy you create In most cases, abstracts of the articles are provided May provide links to full-text articles 36 Why use email alerts? Keep abreast of new literature in your field Receive automatic updates View tables of contents from your home or office Some free, some via UW Why use email alerts? Keep abreast of new literature in your field Receive automatic updates View tables of contents from your home or office Some free, some via UW

37. Alerting Services healthlinks.washington.edu/howto/alerts.html 37 Deliver current citations or the tables of contents of selected journals into your email Based on a search strategy you create In most cases, abstracts of the articles are provided Many provide links to PubMed and full-text articles Deliver current citations or the tables of contents of selected journals into your email Based on a search strategy you create In most cases, abstracts of the articles are provided Many provide links to PubMed and full-text articles

38. 38 Your personal space on the NLM computer system for storing search strategies to generate updates Free registration required Recent PubMed citations sent automatically to your emailYour personal space on the NLM computer system for storing search strategies to generate updates Free registration required Recent PubMed citations sent automatically to your email

39. Search for Evidence Summaries DynaMed [on HEAL-WA] Evidence-based clinical resource providing summaries of 3000+ diseases and conditions Nursing Reference Center [on HEAL-WA] Comprehensive point-of-care resource for nurses that includes Evidence-based Care Sheets 39

40. DynaMed [on HEAL-WA] Provides summaries of the best evidence for over 3,000 clinical topics Can quickly browse and find key recommendations Updated daily Links out to full-text articles HEAL-WA has access to Download available for PDA and iPhones 40 More in-depth information about diseases and conditions, drugs and medications The monographs are longer and more detailed than those in NRC Not as directed toward nursing diagnoses and practices More in-depth information about diseases and conditions, drugs and medications The monographs are longer and more detailed than those in NRC Not as directed toward nursing diagnoses and practices

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44. Nursing Reference Center [on HEAL-WA] Evidence-based summaries Diseases & Conditions Evidence-based Care Sheets Quick Lessons Information about drugs and medicationsa Skills & Procedures Patient Education 44 Evidence-based summaries on key topics incorporating the best available evidence through rigorous systematic surveillance)Evidence-based summaries on key topics incorporating the best available evidence through rigorous systematic surveillance)

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47. Nursing Reference Center 47

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50.  National Guideline Clearinghouse guideline.gov PubMed/MEDLINE CINAHL/CINAHL Plus 50 Systematically developed statements of appropriate care designed to assist the practitioner and patient make decisions about appropriate health care for specific clinical circumstances Usually based on the most current available research if from reputable organizations Developed using widely varying standards Cost may be considered as well as health outcomes or politics Systematically developed statements of appropriate care designed to assist the practitioner and patient make decisions about appropriate health care for specific clinical circumstances Usually based on the most current available research if from reputable organizations Developed using widely varying standards Cost may be considered as well as health outcomes or politics

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54. Searching for Practice Guidelines in CINAHL and MEDLINE/PubMed In CINAHL: Limit to Practice Guidelines as a Publication Type In MEDLINE/PubMed: Limit to Practice Guideline under Type of Article 54

55. Special Meta-Search Enginesthat find evidence sites 55

56. TRIP Databasetripdatabase.com Meta-search engine Performs a simple search of more than 75 databases Finds evidence-based resources Searches Cochrane, National Guideline Clearinghouse, Bandolier, etc. 56

57. TRIP search: prevention of pressure ulcers 57

58. SUMSearchsumsearch.uthscsa.edu 58

59. Systematic Review/Meta-Analyses Resources Cochrane Database of Systematic Reviews (CDSR) PubMed/MEDLINE Systematic Reviews CINAHL/CINAHL Plus 59

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61. Cochrane Database of Systematic Reviews Widely regarded as the �gold standard� of evidence-based information Extensive systematic reviews and complex synthesis Very focused, specific questions 61

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63. Finding Systematic Reviews and Meta-Analyses in PubMed/MEDLINE and CINAHL In CINAHL: Refine search to Publication Type: Systematic Reviews Search for Meta Analysis as a Subject Heading In PubMed/MEDLINE: Select Systematic Reviews in Clinical Queries section Limit to Meta-analysis as Publication/Type of Article 63

64. Searching for Evidence Categories 64

65. Search for Evidence in Drug and Natural Medicines Databases AHFS Drug Information [on HEAL-WA] Davis�s Drug Guide for Nurses [on HEAL-WA] Natural Standard [on HEAL-WA] --Evidence-based information on CAM, including supplements, herbs, acupuncture, massage, etc. -Also available partially through MedlinePlus www.nlm.nih.gov/medlineplus/druginformation.html Natural Medicines Comprehensive Database www.naturaldatabase.com 65

66. AHFS Drug Information [on HEAL-WA] 66 American Society of Health System Pharmacists. The 2009 AHFS Drug Information is the premier source of comprehensive, unbiased, evaluative drug data available for healthcare professionals today. AHFS DI is a tested and proven source of comparative, unbiased, and evidence-based drug information. Drug monographs, and final determinations specifically published for medically acceptable off-label uses, are prepared by a professional editorial and analytical staff, who critically evaluate published evidence on the drug. American Society of Health System Pharmacists. The 2009 AHFS Drug Information is the premier source of comprehensive, unbiased, evaluative drug data available for healthcare professionals today. AHFS DI is a tested and proven source of comparative, unbiased, and evidence-based drug information. Drug monographs, and final determinations specifically published for medically acceptable off-label uses, are prepared by a professional editorial and analytical staff, who critically evaluate published evidence on the drug.

67. Natural Medicines Comprehensive Database 67

68. Natural Standard [on HEAL-WA]  68

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71. Drugs, Supplements & Herbal Information pagewww.nlm.nih.gov/medlineplus/druginformation.html 71 USP Advice for the Patient. New feature: Natural Standard herbal supplement database released � late Fall 2005 This is the 105 monographs in English and Spanish - written for the layperson. It is the same as on Harvard's site and Mayo clinic ( http://www.mayoclinic.com/findinformation/druginformation/index.cfm )�it�s the only appropriate one that is evidence based.�  USP Advice for the Patient. New feature: Natural Standard herbal supplement database released � late Fall 2005

72. 105 Herbs and Supplements Monographs in English & Spanish 72 English and Spanish with pictures Includes evidence-based information on effectiveness, side effects, interactions, dosing, and pregnancy, breastfeeding. English and Spanish with pictures Includes evidence-based information on effectiveness, side effects, interactions, dosing, and pregnancy, breastfeeding.

73. MedlinePlus medlineplus.gov #1 SOURCE for basic quality consumer/patient information Includes drug information Medical Encyclopedia � full-text with illustrations Spanish version Preformulated PubMed searches Interactive tutorials Current health news 73 There are so many places to go on the Internet for quality information. We are going to describe the very best websites here. These websites are all consumer-oriented, up to date and contain accurate information. MedlinePlus is one of the best places of many to go for basic, quality consumer health information on the Web. In most cases you can start here. Why is it one of the best? The National Library of Medicine produces it The information is reviewed and reliable. It links to governmental and non-profit organizations� Web sites. Continually updated No advertising or links to commercial sites Minimum redundancy American Customer Satisfaction Index Scores, Q1 2004 Government Web Sites: Health #1: MedlinePlus #2: MedlinePlus en espa�ol MedlinePlus is available in Spanish by clicking on the �espa�ol� link This is not a �mirror� site, all the materials here are responsive to the language, dietary, and cultural needs of the Hispanic population There are so many places to go on the Internet for quality information. We are going to describe the very best websites here. These websites are all consumer-oriented, up to date and contain accurate information. MedlinePlus is one of the best places of many to go for basic, quality consumer health information on the Web. In most cases you can start here. Why is it one of the best? The National Library of Medicine produces it The information is reviewed and reliable. It links to governmental and non-profit organizations� Web sites. Continually updated No advertising or links to commercial sites Minimum redundancy American Customer Satisfaction Index Scores, Q1 2004 Government Web Sites: Health #1: MedlinePlus #2: MedlinePlus en espa�ol MedlinePlus is available in Spanish by clicking on the �espa�ol� link This is not a �mirror� site, all the materials here are responsive to the language, dietary, and cultural needs of the Hispanic population

74. MedlinePlus Content 74 Slide provided by Angela B. Ruffin, Head NN/LM National Network Office National Library of Medicine National Institutes of Health, HHS October 18, 2005 Senior Health: can enlarge text and view in high contrast Clinical Trials: provides easy information on clinical trials for a wide range of conditions Pre-recorded webcasts of surgical procedures Actual operations performed at medical centers in U.S. One-hour programs with printable transcripts Slide provided by Angela B. Ruffin, Head NN/LM National Network Office National Library of Medicine National Institutes of Health, HHS October 18, 2005 Senior Health: can enlarge text and view in high contrast Clinical Trials: provides easy information on clinical trials for a wide range of conditions Pre-recorded webcasts of surgical procedures Actual operations performed at medical centers in U.S. One-hour programs with printable transcripts

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76. 76 Encyclopedia includes: 4,000+ entries on diseases, tests, symptoms, injuries and surgeries an extensive library of photographs and illustrations.Encyclopedia includes: 4,000+ entries on diseases, tests, symptoms, injuries and surgeries an extensive library of photographs and illustrations.

77. Search eBooks UpToDate Concise comprehensive uptodate reviews of clinical topics in multiple specialties www.uptodate.com HEAL-WA e-Books HealthLinks eBooks page 1400+ e-Texts healthlinks.washington.edu/textbooks 77 Summarize current standards of care, based on experiences of expert clinicians and results of research studies. Concise and easy to scan for relevant information, but ... Expensive and take years to publish, so information in them may be incomplete or inaccurate Summarize current standards of care, based on experiences of expert clinicians and results of research studies. Concise and easy to scan for relevant information, but ... Expensive and take years to publish, so information in them may be incomplete or inaccurate

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80. Navigate the Web Beyond Basic Google To Find Evidence? Size of the Web Lack of control or review Lack of quality standards 80 Google google.com Largest search engine: over 11.5 billion pages Relevance ranking based on link analysis Advanced Search features: File Format, i.e. pdf Date, i.e. pages updated in last 3 months Occurrences, i.e. terms appear in title Domain, i.e. .gov, .edu Links, i.e. pages that link to the page Google google.com Largest search engine: over 11.5 billion pages Relevance ranking based on link analysis Advanced Search features: File Format, i.e. pdf Date, i.e. pages updated in last 3 months Occurrences, i.e. terms appear in title Domain, i.e. .gov, .edu Links, i.e. pages that link to the page

81. Google Scholarscholar.google.com Searches for scholarly literature, including peer-reviewed papers, theses, books, abstracts and technical reports From academic publishers, professional societies, universities, etc. as well as scholarly articles on the web "Cited by" link identifies # that have cited the original Access to full-text only available with subscription Links to full-text articles the UW or others subscribes to Caution: Not a reliable sole source for searching scholarly literature 81

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83. Must Evaluate Web Resources: Evaluation Strategies Evaluate using Criteria for Evaluating Web Resources Determine the type of site by analyzing Web Site Addresses A User's Guide to Finding and Evaluating Health Information on the Webwww.mlanet.org/resources/userguide.html 83

84. Criteria for Evaluating Web Siteshealthlinks.washington.edu/howto/navigating/criteria.pdf Authority Accuracy Objectivity Currency Coverage Design 84

85. Analyze the Website Address:URL (Uniform Resource Locator) edu org com gov net 85

86. Final Thoughts Contact Your Ultimate Search Engine� a librarian! Remember key resources: PubMed/MEDLINE and CINAHL DynaMed, Cochrane, Natural Standard Google Scholar and Nursing Reference Center And HEAL-WA! 86 Tips and strategies: Select one or two tools and get to know them well Read the Help Try Advanced Search options Know when NOT to search: 10 minute rule Is it worth your time? Would a phone call to a colleague or librarian be more productive? Is the information you seek likely to be on the web? Tips and strategies: Select one or two tools and get to know them well Read the Help Try Advanced Search options Know when NOT to search: 10 minute rule Is it worth your time? Would a phone call to a colleague or librarian be more productive? Is the information you seek likely to be on the web?

87. For more information� Affiliated with the UW: contact the nursing library liaison: Janet G Schnall, MS,AHIP 206.543.7474 schnall@u.washington.edu At HMC, contact the HMC librarian: Amy Harper, MLIS 206.604.9876 alharper@u.washington.edu Or, contact your institution�s librarian 87

88. Finding Evidence on the Web Through HEAL-WA: Only a Click Away PowerPoint presentation located: healthlinks.washington.edu/hsl/liaisons/schnall/hmc2010.ppt