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Chapter 3: Finding Relevant Evidence to Answer Clinical Questions

Chapter 3: Finding Relevant Evidence to Answer Clinical Questions. Answering Clinical Questions. Finding the right information to answer a given question often depends on the source of the information

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Chapter 3: Finding Relevant Evidence to Answer Clinical Questions

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  1. Chapter 3: Finding Relevant Evidence to Answer Clinical Questions

  2. Answering Clinical Questions • Finding the right information to answer a given question often depends on the source of the information • Searching for evidence that has already been appraised for the quality of the study methodology and the reliability of its findings is desirable • Pre-appraised literature

  3. Tools for Answering Clinical Questions • Begin with a PICOT question • Determine the source from which the best evidence is available • Clinicians need peer-reviewed research

  4. External Sources of Evidence • Textbooks and journals • Consolidated resources

  5. Hierarchy of Evidence

  6. Question • Which of the following sources of evidence is best able to inform a nurse’s clinical practice? • A well-designed randomized controlled trial (RCT) • A systematic review that encompasses multiple studies • Expert opinion of experienced and educated nurses • A case study that addresses an unique clinical scenario

  7. Answer • b. A systematic review that encompasses multiple studies • Rationale: Systematic reviews are considered to be higher on the hierarchy of evidence than expert opinion or individual RCTs and case studies.

  8. Which Resource or Database is a Good Match? • Online databases • Grey literature • Bibliographic versus full-text databases

  9. Collaboration with Healthcare Librarians • Librarians are a rich source of assistance • They are especially valuable when time is of the essence

  10. Keyword and Controlled Vocabulary Searching • Keyword searching is searching using simple, everyday language • Controlled vocabulary systems, e.g., MeSH • Normally have a hierarchical structure that helps the searcher retrieve the more specific terms that fall under a general term • Most large bibliographic databases (MEDLINE, CINAHL, and PsycINFO) use a controlled vocabulary to describe the content of references

  11. Question • Tell whether the following statement is true or false. • A controlled-vocabulary system may yield fewer hits than a keyword search, but these hits are more likely to be relevant to the clinical question.

  12. Answer • True • Controlled vocabulary systems exist to increase the relevance of search results while limiting the number of less-relevant hits.

  13. Combining and Limiting Searches • Combining search terms from within a PICOT question focuses the search results • Consider that different search engines process terms in the search box in different ways • Using the “limit” function is designed to help the searcher pare down the large results list • Manage inclusion and exclusion criteria carefully

  14. Online Searches • Managing citations • Saving searches • Organizing searches

  15. Selecting Databases: Cochrane Databases • A collection of 6 different databases • “Gold standard” database is the CochraneDatabase of Systematic Reviews (CDSR) • Systematic reviews are based on critical appraisal

  16. Selecting Databases: National Guideline Clearinghouse • A comprehensive database of evidence-based clinical practice guidelines • Guidelines are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a particular population

  17. Selecting Databases • MEDLINE - covers medicine, health, and the biomedical sciences • CINAHL – covers 13 nursing and allied health disciplines • EMBASE - major European biomedical and pharmaceutical database • PsycInfo – covers psychology, behavioral sciences, and mental health

  18. Question • Which of the following online evidence sources is most likely to provide pre-appraised evidence? • CINAHL • MEDLINE • PubMed • Cochrane Library

  19. Answer • d. Cochrane Library • Rationale: The Cochrane Databases consist of systematic reviews that synthesize evidence from multiple peer-reviewed sources. CINAHL, MEDLINE, and PubMed may contain evidence at a synthesis level, but are more often sources of individual articles that a nurse must appraise.

  20. Specialized Search Functions • PubMed • Ovid • EBSCO Any search for evidence must be followed by critical appraisal

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