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

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

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

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.

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.

From the BMJ Learning’s Browse our modules listing, we have clicked on Clinical Epidemiology and located four EBM-related tutorials. Four learning resources are available.

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.

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. Take a minute to look at the various features of this resource. Note that there are 3 ways to search, by general section (e.g., Infectious Diseases), Full review (browse titles of individual reviews, e.g., AIDS: Tuberculosis in people with HIV), and Search (use keywords here). Note also, the availability of a Userguide.

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. Searching the term tuberculosis results in 73 matches. Perhaps we should limit our search to be more specific.

We have further limited this search by combining tuberculosis and HIV 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. Adding HIV to the Search box results in 56 matches. You can keep adding terms, with , of course, the possibility of missing some useful articles.

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.

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).

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.

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.

The Cochrane Library COCHRANE LIBRARY : The Cochrane Collaboration. Oxford: Update Software; 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 Specific topics, explicit evaluation criteria to minimize bias

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. Take a minute to review the main page of the Cochrane Library. Note in the upper right you can browse Cochrane Reviews and there are other sources as well, such as individual clinical trials. There is a search box and field options for searching. One can also click on Advanced Search to construct a search by filling in boxes and making selections.

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. Here we see the Advanced Search box and search for items that discuss both diarrhea AND children. Note the ability to put a wildcard * at the end of child to search for child, children.

The Advanced Search results for diarrhea child 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. Note that we retrieved more than 400 Systematic Reviews and it might be smart to further restrict the search with more terms, realizing that you might miss some good articles. For our purposes, though, let’s look at the record about oral zinc (note that variations of the spelling of diarrhoea are accounted for).

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. This is the information about who did the systematic review and when it was last updated. If we click on Summary, we’ll see the following .

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. Summary gives a good overview of purpose, methodology, results, conclusions and a plane language summary (next slide).

The final section of the Abstract is titled Plain language summary 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 author’s conclusions (the ‘bottom line’) as these sections discuss the review’s results and how they should be used.

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.

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.

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.

Cochrane Library Access to the Abstracts is free from a link at: www.cochrane.org/cochrane-reviews

After accessing the Cochrane Collaboration (http://www. cochrane After accessing the Cochrane Collaboration (http://www.cochrane.org/), click on the Cochrane Library link. This will give you access to the Library’s search options and the abstracts but not the full-text articles. On this site, click on The Cochrane Library. Click here

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

This is the initial page of EBM Guidelines Evidence-Based Medicine This is 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 completed a keyword search for Influenza 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.

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

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

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

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.

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.