Human and Family Sciences 2111 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

From the NSU Libraries Home Page, Click on “Health Professions” 4

From the Health Professions Page, Click on Dietetics and Nutrition 5

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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 Sandra to report other technical problems or for search assistance 7

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 Dietetics and Nutrition 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:  Donna Graham – x3243 –

Learning Objectives To provide a mechanism for students to access the most current dietetics and nutrition and health care information To familiarize students with specific information resources and services to support the dietetics and nutrition curriculum To familiarize dietetics and nutrition students with evidence-based health care and lifelong learning skills 9

Overview of Online Resources Research and Clinical Databases e-Journals e-Books Consumer Health Evidence-Based Information Retrieval 10

Journal Article Databases CINAHL Plus w/Full Text, MEDLINE, and Science Direct are most frequently used resources to find journal articles on Dietetics and Nutrition topics. Search this section when you need articles on subjects, e.g., child nutrition disorders, diet therapy, etc. Databases in this section provide links to full text journal articles and other resources You must start at the library’s Dietetics and Nutrition web page to access our subscribed full text

Databases - CINAHL Plus w/Full Text CINAHL stands for Cumulative Index to Nursing and Allied Health Literature Core research tool that contains full text of hundreds of nursing and allied health journals Use “CINAHL Headings” to search topics for best results, e.g., search “pediatric obesity” to find articles on “childhood obesity” Follow links on Dietetics and Nutrition Web Page for Basic and Advanced Tutorials to get started 12

Databases - MEDLINE Premier biomedical database from the National Library of Medicine Provides journal articles from 1946 to present in medicine, nursing, health care system, and allied health care practice, education, and research Useful to find articles on the relation of nutrition disorders to medical problems, e.g. “intake of fruits and vegetables to prevent cardiovascular diseases” Link to Tutorial from Dietetics and Nutrition Library Web Page 13

Databases – Science Direct Scientific database produced by Elsevier Provides journal articles from over 2,500 journals and chapters from almost 20,000 books in all life sciences disciplines Useful to find full text articles on nutrition and dietetics topics in scientific journals across multiple disciplines Contains full text of journals published by the American Academy of Nutrition and Dietetics 14

Databases – Mosby’s Nursing Consult All in one resource provides full text of e-Journals, e- Books, images, and other documents Unique features include full text from pre-searches of popular health topics, e. g., “cancer”, “heart disease”, “stroke” under the “top picks” option. Also includes full text monographs of all FDA approved drugs, and peer- reviewed patient education materials Widely used in major hospitals and medical centers Link to Tutorial from Dietetics and Nutrition Web Page 15

Databases – Academic Search Premier Multi-disciplinary database that provides full text of over 4,600 journals Useful as a starting point to find a variety of viewpoints on a general topic, e.g., nutrition across the life cycle Limit search results to “full text”, “scholarly peer- reviewed” and “academic journals” 16

Databases – Education Full Text Full text of over 350 journals Includes coverage of special education and educational tests Useful for nutrition topics related to children and young adults K-12 Includes full text back to

Databases – Social Sciences Full Text Full text of over 600 journals Useful for targeting “socioeconomic” aspects of nutrition topics, e.g., childhood obesity Limit search results to “scholarly-peer reviewed”, “academic journals” 18

Additional Research Databases National Library of Medicine – provides access to hundreds of databases covering a wide range of biomedical information resources Native Health Databases – contains citations and abstracts of documents pertaining to the health care of North American indigenous peoples 19

Tracking Down the Full Text If your database search does not provide a link to full text of a relevant article:  Print a list of the citations  Click on the Library e-Journals link on the Library’s Dietetics and Nutrition web page  Enter full title of the journal  Click on link to database that contains the full text 20

e-Books R2 Digital Library – Nutrition and Dietetics books from the current Doody’s Core Titles in the Health Sciences - full text of health sciences books published by Lippincott Williams & Wilkins and other leading publishers Access Medicine - text of leading medical and health sciences books from the McGraw-Hill clinical library Mosby’s Drug Monographs - full text monographs for the health care professional and the patient of all FDA approved drugs 21

Consumer Health Resources Current, authoritative, peer-reviewed, and evidence- based resources written specifically for the layperson MEDLINEPlus – the National Institutes of Health’s web site for patients and families Joanna Briggs Database - provides full text consumer information sheets Mosby’s Nursing Consult - includes patient education handouts produced by Elsevier 22

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Human and Family Sciences 2111 Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B –

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.

1. Possible Search Terms cardiovascular diseases, 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

3. Begin Search at Top Level of Evidence

Evidence Based Databases – Critically Appraised Decision Support Tools DynaMed – Expert summaries for over 3,000 topics to answer clinical questions at point of care. Based on studies evaluated for clinical relevance and validity. Updated daily Cochrane Systematic Reviews – Over 900 full text reviews of research studies based on specific quality criteria and produced by the Cochrane Collaboration, an international network of researchers Joanna Briggs Institute – International research organization provides full text of expert summaries, best practice information sheets, systematic reviews, and consumer information sheets 39

Hierarchy of Evidence-Based Resources Dynamed, Joanna Briggs Joanna Briggs, Mosby’s Nursing Consult Cochrane and Joanna Briggs Systematic Reviews CINAHL Plus with Full Text, MEDLINE 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

Critically Appraised Content

Appraisal Required by User

Dynamed Summaries for more than 3,000 topics Monitors >500 medical journals and systematic review databases Updated daily Each article evaluated for clinical relevance and scientific validity Recommendations labeled with Levels of Evidence 43

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 44

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 45

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 46

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 Access Joanna Briggs and Cochrane Systematic Reviews through Ovid 47

Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra ( preferred) 48