1. EXSS-36100 Medical Science II
Laura Kuo
March 1, 2012

2. Outline – Class 1 What is evidence-based practice?
How do you build a good clinical question?
What are the bibliographic databases to search?
MEDLINE
CINAHL
Cochrane Database of Systematic Reviews
Search strategies
Keyword vs Subject Heading
Boolean
Limits
Search History

3. Outline – Class 2 Brief Review and Continuation of Class 1
How do you build a good clinical question?
Search strategies
Developing PICO on Your Own
Practice Searching on Your Own

4. What is Evidence-based Practice?
Clinical Expertise
Patients’ Preferences
Research Evidence

5. What do we mean by “evidence”?
The evidence pyramid is used to illustrate the evolution of the literature.
As you move up the pyramid the amount of available literature decreases, but …
increases in its relevance for application in clinical settings.
Image:

6. Evidence-based Practice: The Process

7. A well-built clinical question
Patient, population, or problem
Intervention, prognostic factor, or exposure
Comparison or intervention
Outcomes to measure or be achieved

8. Types of Clinical Questions
Once the basic parameters of the clinical question are established, what type of question is it?
THERAPY/INTERVENION – RCT, Meta-Analysis, Systematic Reviews
OUTCOME – Self-Report Instruments, Patient Centered Measures, Quality of Life
DIAGNOSIS
PROGNOSIS
HARM / ETIOLOGY

9. Clinical Scenario
As an athletic trainer you’re interested in learning various treatment approaches for tennis elbow (Lateral Humeral Epicondylitides/Lateral Humeral Epicondylitis). More specifically, you’re curious to know which ones actually work, or does the pain associated with tennis elbow disappear on its own over time (aka “wait and see”). You’ve heard of everything from Leech Therapy to Surgery, so you’re going to search the literature and find the evidence.

10. Example (cont.)
P I C O Clinical Question: Type of Study:

11. Searching the Literature - Strategies
Before going online, PREPARE!
Identify the relevant database(s) to search
Formulate a clear research or clinical question
Identify the key concept(s) of the question, relevant synonym and alternate terms or spelling
Use Boolean operators to show concept relationships
Apply limits (date, language, age, human…)