Evidence-Based Practice for Pharmacy Y2 Pamela Corley, MLS, AHIP Joe Pozdol, MLIS Norris Medical Library 2003 Zonal Ave. Los Angeles, CA

Today’s Agenda Handouts and clickers Evidence-based practice (EBP) Experimental and observational studies Reviews Evidence pyramid and PICO EBP resources EBP databases Evaluations

Personal Librarians and Student Portal If Last Name Starts With: Personal Librarian Address A to D Emily Brennan E to K Pam Corley L to N Eileen Eandi O to T Joe Pozdol U to Z Evans Whitaker 2

Learning Objectives Students Will Be Able To: Define evidence-based practice Express key differences between study types Utilize the evidence pyramid and PICO Identify major concepts in a clinical question Search EBP resources for relevant information

What is Evidence-Based Practice? Relies on research evidence (a more scientific approach than hearsay) Uses most current information Attempts to find best information available (relevant and dependable) Applies scientific research to patient care (“bench to bedside”)

Asking a colleague’s opinion is a form of evidence-based practice. 1.True 2.False

Which of the following is another way of expressing evidence-based practice? 1.“Bedside to bench” 2.“Bedside to table” 3.“Bench to bedside” 4.“Bench to table”

Experimental Studies Randomized controlled trial (RCT) o Golden standard o Participants are assigned to experimental and control groups o Exposure to some agent is known and outcome is measured o A drug is compared with a placebo (and possibly other drugs) o Group assignment occurs randomly (i.e., by chance) o Good for treatment or prevention questions o E.g., drug A group v. placebo group o E.g., drug A group v. drug B group v. placebo group

Observational Studies Cohort study o Groups are followed over time o Exposure to some agent is known and outcome is measured o A drug is compared with no treatment (and possibly other drugs) o Good for etiology questions or when RCT would be unethical o Good when exposures can’t be controlled or when outcomes occur infrequently o E.g., drug A takers v. no treatment over 10 year period o E.g., drug A takers v. drug B takers v. no treatment over a 10 year period

Observational Studies Case-control study o Individuals with condition are compared to those without o Disease outcome is known and exposure is determined o Those with a disease are compared to those without o Good for etiology questions and rare conditions o Good for rare conditions or when it may take a long time for the disease to develop o E.g., men with prostate cancer v. those without

In a randomized controlled trial (RCT), the exposure is known. 1.True 2.False

A study where a group of smokers is compared to a group of non-smokers to determine lung cancer incidence is most likely a… 1.RCT 2.Cohort study 3.Case-control study 4.None of the above

A study where Drug A, Drug B, and Placebo groups are compared is most likely a… 1.RCT 2.Cohort study 3.Case-control study 4.None of the above

In case-control studies, individuals are divided into groups based on a known outcome. 1.True 2.False

Reviews Narrative review o Descriptive summary of previous studies o An expert handpicks studies that are deemed relevant to include o Author bias is a concern o E.g., summary of studies that an expert has deemed important to determining the effectiveness of Drug X Systematic review o Descriptive summary of previous studies o An expert has used a specific, replicable method of inclusion o E.g., all RCTs involving treatment of schizophrenic adults with Drug X that were conducted in psychiatric units

Reviews Meta-analysis o Statistical summary of results from multiple studies o Data are combined to increase statistical power and increase clinicians’ confidence in the conclusions o E.g., combination of data from 6 case-control studies about smoke exposure and cancer incidence

Unlike systematic reviews, the methods used in narrative reviews are easily replicated. 1.True 2.False

The Evidence Pyramid Source: There is less of the better evidence The best evidence is at the top

Which of these levels of evidence is LOWEST on the pyramid? 1.Case-control studies 2.Cohort studies 3.Meta-analyses 4.RCTs

Which of the following is NOT a type of primary literature? 1.Case-control studies 2.Cohort studies 3.Meta-analyses 4.RCTs

The PICO Model Helps formulate a clinical question Comes from evidence-based medicine in last 15 years P Problem (Patient or Population) I Intervention (or Exposure) C Comparison O Outcome

A Clinical Scenario

Applying PICO Bacterial meningitis Dexamethasone No dexamethasone Reduced mortality and/or neurologic complications Does dexamethasone improve the outcome in adult patients with bacterial meningitis (who are already receiving antibiotics)? Problem? Intervention? Comparison? Outcome?

Identifying Major Search Concepts Does dexamethasone improve the outcome in adult patients with bacterial meningitis (who are already receiving antibiotics)?

First Set of Resources Small EB Database from British Medical Journal –Clinical Evidence Free EB Databases –National Guidelines Clearinghouse –TRIP Database “Clinical Information Tools” – not strictly EB –UpToDate –Essential Evidence Plus –ACP Pier

Second Set of Resources Ovid SP –MEDLINE Randomized Control Trials Meta Analysis –Cochrane Database of Systematic Reviews Systematic Reviews (looks at many articles at once) –ACP Journal Club (looks at one article at a time) –Database of Abstracts of Reviews of Effects (DARE) (looks at one article at a time)