Evidence-based Practice Resources for HINARI Users

1. Evidence-based Practice Resources for HINARI Users

2. Evidence-based Practice Resources for HINARI Users Instructions - This part of the: • course is a PowerPoint demonstration intended to introduce you to Evidence-based Practice and related HINARI resources. • module is off-line and is intended as an information resource for reference use.

3. Table of Contents • Evidence-based Medicine (EBM) definition, background and resources • Clinical Evidence • Cochrane Library • EBM Guidelines • HINARI EBM Journals • Searching for EBM articles in • a specific journal (Science Direct) • HINARI/PubMed’s Clinical Queries • Summary

4. What is evidence-based health care? • Using the best available evidence (research) to answer questions and support decision making Research Evidence Practitioner’s Experience Local Conditions Patient/Community Preferences & Values

5. Evidence-based Practice Definition "Evidence-Based Practice requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources." Sicily statement on evidence-based practice. BMC Medical Education, 2005 Jan 5;5(1):1

6. Evidence-based Medicine (EBM) Definition "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." Sackett, D. et al. Evidence-based Medicine - What it is and what it isn't. BMJ 1996;312(7023):71 (13 January) 1996.

7. Why use Evidence-based Resources? • Aims to locate current clinical knowledge on a topic • Can save time finding ‘the best’ information • Identifies Systematic Reviews¹ • Often contains commentary about validity • A good ‘first place’ to start your search ¹A systematic review involves the application of scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific clinical question. Cook DJ, Mulrow CD, Haynes RB. Annals of Internal Medicine March 1, 1997; 126 (5) 376.

8. Evidence-based Practice Process • Formulate answerable questions • Find the best evidence • Critically evaluate the evidence • Integrate the evidence, using patient values, in the decision-making process • Evaluate performance

9. If you are interested in learning more about EBM, go to the online tutorial Introduction to Evidence-Based Medicine from the Health Sciences Library, University of North Carolina (USA): http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm

10. From the HINARI Reference Sources drop down menu, we also can find tutorials for learning more about EBM. In this example, we will link to BMJ Learning.

11. From the BMJ Learning’s Browse our modules listing, we have clicked on Clinical Epidemiology and located four EBM-related tutorials.

12. Logging on to HINARI 1 To access the HINARI Evidence-based Medicine resources, we must Login to the HINARI website using the URL http://www.who.int/hinari/

13. Logging into HINARI 2 We will need to enter our HINARI User Name and Password in theappropriate boxes, then click on the Login button. Note: If you do not properly sign on, you will not have access to Evidence-based Medicine resources that are located in the Reference Sources drop down menu.

14. From the Reference Sources drop down menu, there are three valuable EBM- related sites. First, we will click on the Clinical Evidence link, a resource for informing treatment decisions and improving patient care. It is published by the BMJ Publishing group.

15. In the Clinical Evidence site, you can search by Sections, Full review list or (keyword) Search this site. Also note that there is a Clinical Evidence Userguide in multiple languages and links to the Latest updated reviews.

16. Using the Search this site option, we have completed a keyword search fortuberculosis andidentified 73 documents. The links include clinical evidence Guidelines, Keypoints, Interventions and Updates about this topic.

17. We have further limited this search by combining tuberculosis and HIV. This has resulted in 56 documents. We will click on the link to Tuberculosis in people with HIV.

18. The initial page of HIV: treating tuberculosis initially displays Interventions based on clinical questions. Note that also you have access to Key points, About this condition, Updates, Guidelines and References. We will click on the Guidelines hyperlink.

19. The Guidelines page contains the title, name of organization and hyperlink to 10 documents from key health agencies. The guidelines have been sourced from the National Guidelines Clearinghouse (USA).

20. We have clicked on the Full review list option and displayed the topics under the A alphabetical list. This A-Z subject access contains an extensive list of topics and clinical evidence material.

21. From the Reference Sources drop down menu, we now will click on the Cochrane Library link. The Cochrane Library contains high-quality, independent evidence including reliable evidence from Cochrane and other systematic reviews and clinical trials. It is published by John Wiley. Note the full-text reviews are available to Band 1 only while Abstracts can be accessed by all users.

22. Besides a keyword and other options Search engine, you can search by the Advanced Search option, complete a MeSH Search, look at your Search History or Saved Searches. Also from the initial page, there are links to the Cochrane Journal Club and sections for Clinicians, Researchers, Patients and Policy Makers.

23. We have opened the Advanced Search optionwhere you can specify search fields and have the ability to combine terms using AND/OR/NOT operators. In this text Advanced Search, we have combined diarrhea AND child* using the Search All Text option with the wildcard (*) used to locate the terms child and children.

24. The Advanced Search results for diarrhea AND child* has retrieved 444 records from the Cochrane Database of Systematic Reviews. You have the option to Export All Results (save). Note: if the results of your search are too many, you can narrow it by limiting the keyword search to Title instead of Search All Text.

25. The initial screen displays the Abstract of the first systematic review listed in the search - Oral zinc for treating diarrhoea in children. To access the full-text review, click on the Full PDF hypertext link in the left column. Other options are Summary and Standard. Also note the hypertext links to the entire systematic review.

26. We have displayed the Abstract of the systematic review that includes the Background, Objectives, Search strategy, Selection criteria, Data collection and analysis and Main Results.

27. The final section of the Abstract is titled Plain language summary. This section is useful for disseminating the results to groups of health workers and patients. Also note the Main results and author’s conclusions (the ‘bottom line’) as these sections discuss the review’s results and how they should be used.

28. We have displayed the PDF Full version of the Oral zinc for treating diarrhoea in children systematic review. Other options include Summary and Standard files. Note: The url that contains http://hinari-gw.who.int/whalecom... shows that we have logged in to HINARI properly and will have access to the full-text version of this review.

29. From the initial page of the Cochrane Library, we have clicked on the Cochrane Reviews: By Topic hyperlink. This has displayed the Topics for Cochrane Reviews. From this extensive list,you have another option for locating subject- specific material.

30. For more training materials, we can click on The Cochrane Library Help hyperlink.We can access a list of User Guides, Quick Reference Guides plus other teaching tools. These resources are in multiple languages and downloadable as PDF files.

31. If your institution does not have access to Cochrane….Access to the Abstracts is free from a link at: http://www.cochrane.org/

32. After accessing the Cochrane Collaboration (http://www.cochrane.org/), click on the Cochrane Library link. This will give you access to the Library’s search options and the abstracts but not the full-text articles. Click here

33. We now access the third Reference Sources option for evidence-based health information - EBM Guidelines.

34. This is the initial page of EBM Guidelines Evidence-Based Medicine. Also published by John Wiley, this resource is a collection of clinical guidelines for primary care combined with evidence-based research. You can Search by keyword or Browse database contents by EBM Guidelines, Evidence summaries, Pictures, Audio samples, Videos and Programs.

35. We have completed a keyword search forInfluenza. The results page includes summaries of the keyissues including Related resources and References andlinks to important websites. Also included are links to the Evidence summaries.

36. We have displayed the first Evidence summary. Each link contains a brief review of the study and notes the reference(s).

37. HINARI Evidence-Based Journals(other journals may have EBM articles) We have browsed the ‘E’in the HINARI Find journals by title list and it notes several journals for evidence-based practice.

38. From the A-Z Find journals by title list, we have accessed the Evidence-based Healthcare and Public Health journal. In this journal, we will searchMRSA (Methicillin-resistant Staphylococcus aureus)in the All fields box.

39. The search results list 5 articles on MRSA related topics.

40. We now search for evidence-based articles using PubMed. From the main HINARI webpage, go to PubMed by clicking on Search HINARI journal articles through PubMed (Medline). Remember you must login to HINARI to have access to the full-text articles.

41. Open the Clinical Queries box. This search tool assigns filters to keyword searches - to locate articles on Clinical Studies, Systematic Reviews and Medical Genetics.

42. To use the Search by Clinical Study Category, you would type a disease or procedure in the Search box and select one Category and Scope per search. You only can use one Category or Scope bullet per search. For this search, we have entered Type 2 diabetes and developing countries and selected therapy (Category) and narrow, specific search (Scope).

43. The narrow Clinical Study search resulted in 7 articles on type 2 diabetes and developing countries. Note that the specific search is listed in the Search box and Search details display.

44. Now, we complete the same search in the Find Systematic Reviews box.

45. The type 2 diabetes and developing countries AND systematic reviews search resulted in 11 articles. Note the Free Full Text and HINARI filters that list 2 and 8 articles. You can access the full-text articles by clicking on these Filters or changing the display from Summary to Abstract.

46. Another option for locating evidence-based practice in PubMed is in the Limits option. After entering your terms in the PubMed search box, click on the Meta-Analysis and/or Randomized Controlled Trials Type of Article drop down menu. A Meta-Analysis is a statistical method that combines the results of several studies that address a set of related research hypotheses. A Randomized Controlled Trial (RCT) is a type of scientific experiment most commonly used in testing the efficacy or effectiveness of a health-care service or health technologies.

47. If you have a MY NCBI account, you can add Meta-analysis and Systematic Reviews to your Filters. Open Search for Filters, enter the terms in the Search box and then add these to My Filters.When you save a PubMed search, you will be sent an email listing new articles on the specific topic. Remember that you will need to go to HINARI to get the full-text articles. In this example, Free Full Text, HINARI, Meta-analysis and Systematic Reviews are listed in My PubMed Filters.

48. Additional Evidence-based Health Resources • National Guidelines Clearinghouse http://www.guideline.gov/ • DARE: Database of Abstracts of Reviews of Effects http://www.crd.york.ac.uk/crdweb/ • health-evidence.ca http://health-evidence.ca • The Campbell Library http://www.campbellcollaboration.org/library.php • McMaster PLUS collection http://hiru.mcmaster.ca/hiru/HIRU_McMaster_PLUS_projects.aspx

49. Review/Summary • Evidence-based practice depends on knowing the most recent, valid scientific knowledge. • This involves finding the ‘best’ studies. • Sometimes others have evaluated the quality of the studies, including methodology; many new evidence-based tools mentioned in this tutorial provide evaluation.

50. When there is no evaluation available, it is essential to evaluate the validity of the study. • Tools for evaluating studies can be found in the Evaluating the Evidence section in the EBM tutorial mentioned earlier and found at: http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm