Nutritional Sciences 4583 MNT II Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B –

Knowledge is the Enemy of Disease Sir Muir Gray Existing Knowledge Can Prevent – Waste & Errors – Poor Patient Experience – Adoption of low value interventions – Failure to adopt high value interventions 2

Sandra Martin Provides…. Instruction Research Assistance Small Group Consulting Database Searches Collection Development (Selection of print and online books, audiovisuals, journals and databases) Assistance with any health-related information need Office Hours: Tuesday 10 am to 4 pm – Tahlequah 3

4

5

From the NSU Libraries Home Page, Click on “Health Professions” 6

From the Health Professions Page, Click on Nutritional Sciences 7

Remote Access Enter NT-NSU user id and password to access the library’s electronic resources Contact your instructor if you have problems with your user id or password Contact Darren Tobey at to report technical Contact Sandra Martin at for search 8

Technical Issues Check your browser  Internet Explorer does not work with our online resources  Use Firefox or Chrome Check your Internet Carrier  Satellite Systems are frequently erratic or go down entirely during inclement weather  Wireless Hotspot You need at least 3G The library link from within Blackboard does not work well. Please access the Library Resources for Nutritional Sciences page directly from your browser 9

Interlibrary Loan/Document Delivery Services  Delivery of journal articles, books, and other items not owned by the library  Delivery of books, audiovisuals, and journal articles in the library’s print collection  Journal articles delivered electronically if possible ILL Requests  Click on Interlibrary Loan link from NS Web Page  Complete and submit the online registration form  Complete the online request form  Provide complete information about the journal article or book that you need. Indicate your status as a health professions student and include your contact information If you have questions or need assistance, contact:  or

Learning Objectives To familiarize students with the information retrieval process for evidence-based health care To enable students to use synthesized/filtered/pre- appraised resources to answer clinical questions To enable students to use the 4S hierarchy of organization of evidence to plan search strategies

“ Knowledge is the Enemy of Disease… but only if it is put into action.” Sir Muir Gray

Information Retrieval for Evidence Based Health Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid and available at point-of-care Developing search strategies that are feasible within time constraints of clinical practice

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. Patient Concerns Clinical Expertise Best research evidence EBM What is EBM?

EBM Process – 5 Steps 1. ASK: Convert need for information into answerable question 2. ACQUIRE: Find best evidence to answer the question 3. APPRAISE: Critically appraise evidence for validity, impact, and applicability 4. APPLY: Integrate evidence with clinical expertise and patient values 5. ASSESS: Evaluate own effectiveness

Integration of Clinical Research into Patient Care Process

Clinical Questions Four common types:  Therapy/prevention  Diagnosis  Etiology  Prognosis

Answerable Questions Select Questions That:  Are most important to the patient’s well being  Fill gaps in your clinical knowledge  Are feasible to answer in the time available

Information Retrieval to Answer Clinical Questions Requires New Skills Clinical question formulation Search and retrieval of best evidence Critical appraisal of study methods

Is All Evidence Created Equal? Small portion of medical literature is immediately useful to answer clinical questions Understanding “wedge or pyramid of evidence” is helpful in finding highest level of evidence High levels of evidence may not exist for all questions due to nature of medical problems and research limitations

As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting. Source: Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

Evidence Based Retrieval Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner Requires search terms plus best study design for question plus highest level of evidence

Therapy/Prevention Question 1. What is the best available evidence regarding the effectiveness of intake of fruits and vegetables to prevent cardiovascular diseases? 2. Find the answer that is supported by valid studies, appropriate to the type of question, and that is available in a timely manner.

PICO Model P -Patient or population I - Intervention C -Comparison Intervention O - Outcome

Clinical Question – Therapy/Intervention P -Patient or population In patients free of diagnosed cardiovascular disease, I - Intervention is increased intake of fruits and vegetables (2 or more servings per day) C -Comparison Intervention compared to fewer servings per day (1 or less) O - Outcome effective in preventing primary cardiovascular disease?

1. Possible Search Terms cardiovascular disease, primary, fruits and vegetables, prevention

2. Best Study Design for Type of Question Type of QuestionStudy Design Therapy/preventionRandomized controlled trials DiagnosisProspective cohort, blind comparison to a gold standard PrognosisCohort, Case Control, Case Series Etiology/HarmCohort, Case Control, Case Series

Begin Search at Highest Level of Evidence - Critically Appraised Content Evidence Based Summaries UpToDate, Joanna Briggs Institute Clinical Key for Nursing ClinicalKey for Nursing Cochrane Database of Systematic Reviews, ClinicalKey for Nursing, Joanna Briggs Institute ClinicalKey for Nursing, MEDLINE, CINAHL Complete, Science Direct SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), Retrieved from

New Tools Target High-Quality Studies Increase ease of accessing and understanding clinical information Preprocessed - practical resources that facilitate ready access to high-quality research Preappraised – tools that have undergone a filtering process to include only those studies that are regularly updated and of higher quality

Point-of-Care Resources Evidence based textbooks –Provide rapid access to concise information to clinicians at the point of care –Not a database of articles from books, journals, or guidelines –Original, current, summaries written by experts –Formal systems used to grade strength of recommendations and quality of evidence

Summaries UpToDate –Evidence based summaries of over 10,000 topics in over 22 specialties –8,500 Treatment Recommendations –GRADE System used to score recommendations and strength of evidence –Practice changing updates; Updated continuously –Drug database; Patient education materials –The Gold Standard of summaries

UTD – fast, current, peer reviewed

UTD – simple search, quick answers

Joanna Briggs Institute (JBI) an international, not-for-profit research organization at the University of Adelaide collaborates internationally with over 70 entities to promote synthesis and transfer of evidence contributes to improving health care outcomes by supporting evidence-based practice 37

JBI Database Evidence Summaries – literature reviews that summarize existing literature on common health care problems Evidence-Based Recommended Practices – procedures that recommend practice on clinical topics Best Practice Information Sheets – guidelines produced for practicing health care professionals Systematic Reviews – comprehensive reviews of international research literature Consumer Information Sheets – summaries designed for patients, clients, and care providers Updated weekly, access through Ovid 38

Databases – ClinicalKey for Nursing All in one resource provides access to e-Journals, e- Books, MEDLINE, images, videos, and more Unique features include full text “disease overviews” with links to related topics and resources Smart Search interface includes:  Autosuggest search terms to quickly display concepts, procedures, and drugs related to your topic  The most current, clinically relevant answers at the top of your search Full text monographs of all FDA approved drugs and patient education handouts 39

Databases – Clinical Key for Nursing 40

Databases – ClinicalKey for Nursing 41

Systematic Review Analyzes data from several primary studies to answer a specific clinical question Provides search strategies and resources used to locate studies Includes specific inclusion and exclusion criteria (results in less bias) Meta-Analysis (subclass) statistically summarizes results of several individual studies SOURCES: Cochrane Database of Systematic Reviews (Ovid Full Text), Clinical Key for Nursing, Joanna Briggs Institute

Cochrane Database of Systematic Reviews Part of the Cochrane Library (1996) 916 completed reviews, 1905 protocols Among the highest level of evidence upon which to base treatment decisions – the Gold Standard Includes Dx since 2008 Access through OVID 43

Appraisal Required by User

Primary (Original) Studies Articles that report results of original research investigations Conclusions supported by data and reproducible methodology Require time to acquire and appraise Good Sources: MEDLINE (Clinical Key or Ovid), CINAHL Complete, Science Direct

When to search for original studies If the other “S’s” don’t provide the answer, search for original studies “Do it yourself” appraisal territory You must appraise quality of the study or find analysis in evidence based summary Quality of the journal does not always guarantee quality of individual studies Limit to “Clinical Queries” in Ovid MEDLINE and CINAHL Complete

Take Home Points Focused clinical question (PICO) reveals your search terms Start your search at top of 4S hierarchy and work down Be aware of the filter, i.e., levels of evidence, speed of updating Look at more than one resource in the hierarchy. Findings may differ Apply in clinical settings and continually assess your progress

49

Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra ( preferred) 50

Nutritional Sciences 4583 MNT II Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B –