1. Table of Contents – Part B HINARI Resources –Clinical Evidence –Cochrane Library –EBM Guidelines –BMJ Practice –HINARI EBM Journals

2. 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

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

4. Logging into HINARI 2 We will need to enter our HINARI User Name and Password in the appropriate 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.

5. From the HINARI Reference Sources A-Z list, we also can find tutorials for learning more about EBM. In this example, we will link to BMJ Learning.

6. From the BMJ Learnings Browse our modules listing, we have clicked on Clinical Epidemiology and located four EBM-related tutorials.

7. From the Reference Sources A-Z list, there are four 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.

8. 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.

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

10. 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.

11. 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.

12. 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).

13. 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.

14. From the Reference Sources A-Z list, 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.

15. The Cochrane Library COCHRANE LIBRARY : The Cochrane Collaboration. Oxford: Update Software;Cochrane Collaboration 1996-. Updated quarterly. Cochrane Database of Systematic Reviews (CDSR) – High-quality pre-evaluated systematic reviews from all over the world – International, not-for-profit organization – Complete reviews and protocols (reviews that are still in progress) – CDSR abstracts are in Medline but there is no link to full-text of the review Note: As of April 2013, the Cochrane Libraries is available to all Group A & Group B institutions.

16. The initial page of this site has a title, abstract or keyword option Search engine. You also can Browse Cochrane Database by broad subject heading. The initial page also highlights New and Updated Cochrane Reviews. We will go to the Advanced Search. Also from the initial page, there is a link to the Cochrane Journal Club.

17. We have opened the Advanced Search option where 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 child* using the Search All Text option with the wildcard (*) used to locate the terms child and children. Note that you also can complete a MeSH Search, look at your Search History or Saved Searches.

18. The Advanced Search results for diarrhea child* has retrieved 451 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.

19. The 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 specific sections of the systematic review.

20. 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.

21. 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 authors conclusions (the bottom line) as these sections discuss the reviews results and how they should be used.

22. 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.http://hinari- gw.who.int/whalecom

23. From the Advanced Search 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. Note that there are other search lists including an A-Z list, Updated Reviews and New Reviews.

24. For more training material, you can click on The Cochrane Library Help hyperlink. We have opened the Search Manual. Another option is a listing of Web Updates.

25. For non-HINARI institutions, there is access to the Cochrane Summaries (cochrane.org, click on the Cochrane Summaries – summaries.cochrance.org

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

27. From the Reference Sources list, we have opened 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.

28. We have completed a keyword search for Influenza. The results page includes summaries of the key issues including Related resources and References and links to important websites. Also included are links to the Evidence summaries.

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

30. We now access the fourth Reference Sources option for evidence-based health information – BMJs BestPractice – a combination of research evidence, guidelines and expert opinion.

31. We have completed a keyword search for diabetes. Note the drop down menu with the broad category results of the search.

32. The results for the diabetes search are displayed in broad subject categories. Note that each category contains full-text documents on the Highlights, Basics, Prevention, Diagnosis, Treatment, Followup and Resources.

33. From the Reference Sources list, we have opened the initial page of Essential Evidence Plus. Also published by John Wiley, it includes access to Cochrane Library and also a series of databases and tools to access the EBM material. By keyword, you can Search all or some of the databases.

34. We have opened the EBMG evidence summaries database that, via broad subject categories, has access to 4312 articles.

35. We have opened the initial page of EBMG evidence summaries listing for Infectious disease. Material is listed by either a summary view or expanded view that includes a sentence describing each entry.

36. From the Reference Sources list, we have opened 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. We have opened the (Patient- Oriented Evidence that Matters listing) POEMs research summaries database that, has 4500+ articles and is organized by Date or Category.

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. Table of Contents – Part C Other (Internet) Resources: –HINARI/PubMeds Clinical Queries (Clinical Study Categories & Systematic Reviews citations) and Type of Article Limits (Meta-Analysis, Randomized Control Trial & Clinical Practice) –Clinical Practice Guidelines –BestBETS –PubMed Health – clinical effective research –Trip Database –Evidence Updates - BMJ and McMaster University –Knowledge Translation Learning Modules – Canadian Institutes of Health Research –Essential Health Links gateway – annotated links Summary

39. For Non-HINARI version PubMed – would go directly to the database and not via HINARI and some of the text would be changed. Cochrane Libraries – summaries is the access point.

40. We now search for evidence-based articles using PubMed. From the main HINARI webpage, go to PubMed by clicking on Search inside HINARI full- text using PubMed. 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. Note: for these PubMed applications, all individuals will have access to the free full text articles. The examples are from HINARI/PubMed searches and, for those properly logged in, will also include access to articles from HINARI participating publishers.

42. On the PubMed Clinical Queries page, we have entered the type 2 diabetes AND developing countries search.

43. The default search results for the Clinical Study Categories are Category: Therapy and Scope: Broad. Other options in the Category drop down menu are Etiology, Diagnosis, Prognosis and Clinical Prediction Guides. There are 142 articles for Therapy: Broad and 20 articles for Systematic Reviews. Note: you can go directly to PubMed Clinical Queries. The direct link to PubMed Clinical Queries is http://www.ncbi.nlm.nih.gov/pubmed/clinical http://www.ncbi.nlm.nih.gov/pubmed/clinical

44. For the Scope option, we will enter Narrow and for the same type 2 diabetes AND developing countries search.

45. The Therapy (Category) and Narrow (Scope) type 2 diabetes AND developing countries search has resulted in 11 citations. We now will click on the See all option (bottom of the page). Note that the results for Systematic Reviews and Medical Genetics also are displayed.

46. We have displayed all 11 articles for this search including 7 HINARI and 8 Free Full Text articles. Remember - you can access the full-text articles by clicking on these Filters or changing the display from Summary to Abstract. Note that the specific search is listed in the Search box including the AND (Therapy/Narrow[filter]) for clinical studies categories and systematic reviews.

47. After returning to the search results on the Clinical Queries page, we have clicked on the See all option for the systematic reviews results. The type 2 diabetes AND developing countries AND systematic [sb] search resulted in 20 articles.

48. If you have a MY NCBI account, you can add Meta-analysis, Randomized Control Trials and Systematic Reviews to your Filters. Go to Manage Filters, click on Properties option and put each term in the Search with terms box. When you save a PubMed search, you will be sent an email listing new articles on the specific topic with these filters. 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 Filters.

49. Another tools from PubMed is using the Filters option – see left-column. We have checked the Meta-Analysis box in the Article Types section and entered hypertension in the PubMed Search box. The search Results number is 1239. Note the Filters activated: Meta-Analysis line below the Results number. Filters can be activated from any search results page. Remember to clear them before beginning other searches.

50. Now displayed are the results of a hypertension search with the Systematic Reviews Article Type filter activated. The citations for this search include 1158 Free Full text and 2368 HINARI articles.

51. Now displayed are the results of a hypertension search with the Randomized Controlled Trial Article Type filter activated. The citations for this search include 2862 Free Full text and 6667 HINARI articles.

52. The final displayed search are the results of a hypertension and developing countries search with the Meta-Analysis, Systematic Reviews and Randomized Controlled Trial Article Type filters activated. The citations for this search total 64.

53. Definition Clinical Practice Guidelines "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990)

54. Overview of Guidelines Describe a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions Define practices that meet the needs of most patients in most circumstances Are recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature Primarily for use by clinicians--physicians, nurses, and other health professionals in clinical practice

55. Using the Filters option, we now will activate the Practice Guideline Article types filter and enter malaria treatment in the PubMed Search box. You can click on more than 1 box in the Article types section. The results of this search are 31 citations. Note the Limits Activated: Practice Guidelines text below the results line. Remember that you must remove this before beginning another PubMed search.

56. apps.who.int/medicinedocs/documents/s16427e/s16427e.pdf Examples of Clinical Practice Guidelines documents from the Kenya, South Africa and Uganda.

57. www.health.go.ug/docs/ucg_2010.pdf

58. www.kznhealth.gov.za/research/guideline2.pdf

59. Additional CPG resources National Guideline Clearinghouse (USA) http://www.guideline.gov/ Open Clinical: Clinical Practice Guidelines http://www.openclinical.org/guidelines.html About Clinical Practice Guidelines http://www.nhlbi.nih.gov/guidelines/about.htm#what

60. We have opened the initial issue – April 2012 - of Systematic Reviews, an open access journal published by BioMed Central. This and subsequent issues can be access from the above url.

61. We have opened the BestBETS site which contains numerous Best Evidence Topics. Originally having a emergency medicine focus, BETs for cardiology, nursing and pediatrics now are included.

62. This slide discusses Best Evidence Topic (BET) Format. Each BET is analyzed with a 3 part question and answered with a standardized Report Format.

63. We have opened the SEARCH BETs option and completed a search for cardiac arrest. Note the color coded Status list for all the BETs.

64. This is an example of how each BETs record is displayed including the Three Part Question, Clinical Scenario, Search Strategy Search Outcome Relevant Paper(s) plus Comments.

65. A second option for accessing the material is to Browse BET Categories by Topic or Specialty.

66. A third option is to Search Critical Appraisals which are one page summaries of the evidence related to a particular clinical question.

67. PubMed Health specializes in reviews of clinical effective research – which finds answers to What Works in medicine and health care. It is based on systematic reviews of clinical trials. PubMed Health is a service provided by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

68. From the Contents drop down menu, you can access PubMed Healths information in the following categories: For consumers, Executive summaries, Clinical guides and Full text reviews. We will open the Executive summaries option. Note also that PubMed Health contains a Medical encyclopedia.

69. The Executive Summaries Results is organized via an A-Z alphabetical listing. This format also is used for the other options in the Contents drop down menu. We have entered HIV AND pregnancy in the keyword search box.

70. For the HIV AND pregnancy search, there are 368 Results displayed in PubMed Health. The initial display is in the Summary format. By clicking on the title, the Abstract will be displayed. The Refine your search option organizes the results by the categories in Contents drop down menu. Also note the Medical Encyclopedia links to key concepts in the search results.

71. When available, PubMed Health contains links to full-text documents. Displayed in this slide are the titles from the H listing for the Full Text Reviews. We will open the HIV in Pregnant Women document.

72. The Full Text Review contains a Structured Abstract and then links to the various sections of the Review (next slide).

74. We have displayed the AIDS (Acquired immune deficiency syndrome) definition from the A.D.A.M. Medical Encyclopedia.

75. Question for next two resources Both Trip Database and Evidence Updates are aggregators that search various EBM tools for results to keyword searches. The problem is that the results are often resources that are fee-based and users are asked for their username and password or requested to pay a fee. Do you think these should be included or excluded? Or should they just be mentioned in the bibliography at the end?

76. Trip Database is a clinical search tool for health professionals to identify quality clinical evidence for clinical practice. It allows simultaneous searching of multiple sites which speeds up the question answering process. Registration is required but free and gives the users additional resources.

77. We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

78. Preview goes to source – in this case PubMed… We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

79. We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text. Access to the full-text article will be if it is a free full text one or your institution has access via HINARI or a subscription.

80. For this search, we checked 4 boxes and now will Export selected links as a CVS file.

81. The report is displayed as an Excel spreadsheet with the title, url, publication and date of each checked citation. Access to full-text journal articles will depend on whether they are free full text articles or if your institution is eligible for HINARI or has a subscription.

82. We have displayed the Advanced Search for the trip database.

83. EvidenceUPDATES contain a searchable database, an email alerting system and links to selected evidence-based resources. Registration is required but free.

84. We have entered chloroquine resistance in the tools search box.

85. For this search there are 14 matches that note the citation information plus type of article (e.g. Review, Original). Access to the full-text article again will be if it is a free full text one or your institution has access via HINARI or a subscription.

86. EvidenceUPDATES contain options to Download Citations including to several commercial reference manager softwares. We will download to the Text File option.

87. In the Text File option, the abstracts for the checked results are listed in a Notepad file.

88. EvidenceUPDATES also contains an Advanced Search option that initially is based on disciplines, categories and populations. From the drop down menu, subcategories for each broad discipline will be displayed.

89. The Canadian Institutes of Health Research web site contains four Knowledge Translation Learning Modules. Several of these online courses are relevant for evidence based practice and use of knowledge to make informed health decisions.

90. The Essential Health Links gateway contains annotated links to numerous Evidence-Based Medicine resources available on the Internet.

92. Additional Evidence-based Health Resources Bandolier Knowledge: Oxford University http://www.medicine.ox.ac.uk/bandolier/knowledge.html The Campbell Library http://www.campbellcollaboration.org/library.php http://www.campbellcollaboration.org/library.php DARE: Database of Abstracts of Reviews of Effects http://www.crd.york.ac.uk/crdweb/ http://www.crd.york.ac.uk/crdweb/ Duke University Medical Center Library: EBM http://www.mclibrary.duke.edu/subject/ebm?tab=contents http://www.mclibrary.duke.edu/subject/ebm?tab=contents

93. EBM Librarian https://sites.google.com/site/ebmlibrarian/ McMaster PLUS collection http://hiru.mcmaster.ca/hiru/HIRU_McMaster_PLUS _projects.aspx http://hiru.mcmaster.ca/hiru/HIRU_McMaster_PLUS _projects.aspx National Guidelines Clearinghouse http://www.guideline.gov/ Nesbit Guide Evidence-Based Resources http://www.urmc.rochester.edu/hslt/miner/digital_libr ary/evidence_based_resources.cfm

94. 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.

95. 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

96. It is always important to consider studies in terms of applicability to and values of the local patient/situation. Evidence-based practice is a developing field and new, useful resources are continuously being developed.

97. Appendix 1 Appendix 1 – Contains four case studies for developing Evidence-Based Practice curriculum: experimental cancer research, EBP curriculum for pharmacy students, health literacy for pharmacy students and outreach activity for early intervention providers Developed by: Irena Bond, Library Manager Associate Professor of Library and Learning Resources Massachusetts College of Pharmacy and Health Sciences

98. This is the end of the Evidence-based Medicine for HINARI Users module. The material initially was developed by: Gale G. Hannigan, PhD, MLS, MPH; Professor & Medical Informatics Education Librarian, Texas A&M University. Material revised and enhanced by Irena Bond, Library Manager, Associate Professor of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences. There is a workbook that accompanies this module. The workbook will take you through a live session covering the topics included in this demonstration with working examples. Updated 2013 03 Research Evidence Practitioners Experience Local Conditions Patient/Community Preferences & Values