1. Table of Contents – Part C Other (Internet) Resources: –HINARI/PubMed’s Clinical Queries (Clinical Study Categories & Systematic Reviews citations) and ‘Type of Article’ Limits (Meta-Analysis, Randomized Control Trial & Clinical Practice) –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 –Other useful websites Summary

2. Table of Contents – Part C Other (Internet) Resources: –PubMed’s Clinical Queries and ‘Type of Article’ Limits –Systematic Reviews (BioMed Central) –Clinical Practice Guidelines – definition & examples –Cochrane Library ‘Abstracts’ –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 –Johns Hopkins POC-IT Guides –Other useful websites

3. 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.

4. 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.

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

6. 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

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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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)

17. 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

18. 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.

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

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

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

22. 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 John Hopkins POC-IT Guides: ABX, Diabetes and HIV http://www.hopkinsguides.com/hopkins/ub

23. 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.

24. We have opened the initial page to the Johns Hopkins POC-IT Guides – ABX, Diabetes and HIV Guides. These are ‘evidence-based clinical decision resources’ that are commercial products but the material is available online for free.

25. We have opened the Johns Hopkins ABX Guide for infectious diseases. Note that there is an A-Z Topics list and also a keyword search engine.

26. 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).

27. From the Contents drop down menu, you can access PubMed Health’s 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.

28. 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.

29. 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.

30. 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.

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

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

34. 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.

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

36. 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.

37. Fulltext goes to journal – The Lancet Infectious Diseases and will be asked to pay for the article. Need to copy citation and go to HINARI A-Z journals list… We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

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

39. 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.

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

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

42. We have entered chloroquine resistance in the tool’s search box.

43. 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.

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

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

46. 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.

47. 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.

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

50. We have opened the initial page to the Johns Hopkins POC-IT Guides – ABX, Diabetes and HIV Guides. These are ‘evidence-based clinical decision resources’ that are commercial products but the material is available online for free.

51. We have opened the Johns Hopkins ABX Guide for infectious diseases. Note that there is an A-Z Topics list and also a keyword search engine.

52. 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

53. 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

54. 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.

55. 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

56. 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.

57. 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

58. 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 2012 07 Research Evidence Practitioner’s Experience Local Conditions Patient/Community Preferences & Values