Table of Contents – Part C Other (Internet) Resources: –HINARI/PubMed’s Clinical Queries (Clinical Study Categories & Systematic Reviews citations) and ‘Type of Article’ Limits (Meta-Analysis, Randomized Control Trial & Clinical Practice) –PubMed Health – clinical effective research –Trip Database –Evidence Updates - BMJ and McMaster University –Knowledge Translation Learning Modules – Canadian Institutes of Health Research –Essential Health Links gateway – annotated links –Other useful websites Summary

We now search for evidence-based articles using PubMed. From the main HINARI webpage, go to PubMed by clicking on Search HINARI journal articles through PubMed (Medline). Remember you must login to HINARI to have access to the full-text articles.

Open the Clinical Queries box. This search tool assigns filters to keyword searches - to locate articles on Clinical Studies, Systematic Reviews and Medical Genetics. Note: for these PubMed applications, all individuals will have access to the free full text articles. The examples are from HINARI/PubMed searches and, for those properly logged in, will also include access to articles from HINARI participating publishers.

To use the Search by Clinical Study Categories, you would type a disease or procedure in the Search box and select one Category and Scope per search. We have displayed the options for Category and clicked on Therapy from the drop down menu. Note the definition of the Filters on the bottom of the page. Note: you can go directly to PubMed Clinical Queries The direct link to PubMed Clinical Queries is

For the Scope option, we will enter Narrow and also enter type 2 diabetes AND developing countries in the search box.

The Therapy (Category) and Narrow (Scope) type 2 diabetes AND developing countries search has resulted in 8 citations. We now will click on the See all option. Note that the results for Systematic Reviews and Medical Genetics also are displayed.

We have displayed all 8 articles for this search including 7 HINARI and 3 Free Full Text articles. Remember - you can access the full-text articles by clicking on these Filters or changing the display from Summary to Abstract. Note that the specific search is listed in the Search box including the AND (Therapy/Narrow[filter]) for systematic reviews.

We have clicked on the See all option for the systematic reviews results. The type 2 diabetes AND developing countries AND systematic [sb] search resulted in 13 articles.

If you have a MY NCBI account, you can add Meta-analysis and Systematic Reviews to your Filters. Go to Manage Filters, click on Properties option and put each term in the Search with terms box. When you save a PubMed search, you will be sent an listing new articles on the specific topic. Remember that you will need to go to HINARI to get the full-text articles. In this example, Free Full Text, HINARI, Meta-analysis and Systematic Reviews are listed in Filters.

Another tools from PubMed is using the Limits option. In this example, we have opened Limits. We will check the Meta-Analysis box in the Type of Article section and enter hypertension in the PubMed Search box. Note: From the initial PubMed search page, click on Limits to activate this option.

The results of this search are 1177 citations including 286 Free Full text articles. Note the Limits Activated: Meta-Analysis line. Remember that you must Remove this Limit if you want to complete another PubMed Search.

We have added AND developing countries to the previous search and now 4 citations.

Now displayed are the results of a hypertension search with two evidence-based medicine Type of Article boxes checked (Meta-Analysis and Randomized Controlled Trial). The citations for this search include 3104 Free Full text articles. Note the Limits Activated: Meta-Analysis, Randomized Controlled Trial line.

Definition Clinical Practice Guidelines "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990)

Overview of Guidelines Describe a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions Define practices that meet the needs of most patients in most circumstances Are recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature Primarily for use by clinicians--physicians, nurses, and other health professionals in clinical practice

Using the Limits option, we now will check the Practice Guideline box in the Type of Article section and enter malaria treatment in the PubMed Search box. Note you can click on more than 1 box in the Type of Article section.

The results of this search are 31 citations including 13 Free Full text articles. Note the Limits Activated: Practice Guideline line. Again… you must Remove this limit if you want to complete another PubMed Search.

Additional CPG resources National Guideline Clearinghouse (USA) Open Clinical: Clinical Practice Guidelines About Clinical Practice Guidelines

PubMed Health specializes in reviews of clinical effective research – which finds answers to ‘What Works’ in medicine and health care. It is based on systematic reviews of clinical trials. PubMed Health is a service provided by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

From the Contents drop down menu, you can access PubMed Health’s information in the following categories: For consumers, Executive summaries, Clinical guides and Full text reviews. We will open the Executive summaries option. Note also that PubMed Health contains a Medical encyclopedia.

The Executive Summaries Results is organized via an A-Z alphabetical listing. This format also is used for the other options in the Contents drop down menu. We have entered HIV AND pregnancy in the keyword search box.

For the HIV AND pregnancy search, there are 368 Results displayed in PubMed Health. The initial display is in the Summary format. By clicking on the title, the Abstract will be displayed. The Refine your search option organizes the results by the categories in Contents drop down menu. Also note the Medical Encyclopedia links to key concepts in the search results.

When available, PubMed Health contains links to full-text documents. Displayed in this slide are the titles from the H listing for the Full Text Reviews. We will open the HIV in Pregnant Women document.

The Full Text Review contains a Structured Abstract and then links to the various sections of the Review (next slide).

We have displayed the AIDS (Acquired immune deficiency syndrome) definition from the A.D.A.M. Medical Encyclopedia.

Trip Database is a clinical search tool for health professionals to identify quality clinical evidence for clinical practice. It allows simultaneous searching of multiple sites which speeds up the question answering process. Registration is required but free and gives the users additional resources.

We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

Preview goes to source – in this case PubMed… We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

Fulltext goes to journal – The Lancet Infectious Diseases and will be asked to pay for the article. Need to copy citation and go to HINARI A-Z journals list… We have completed a search for malaria AND bednets. The results are displayed with, in some cases, links to Full Text.

For this search, we checked 4 boxes and now will Export selected links as a CVS file.

The report is displayed as an Excel spreadsheet with the title, url, publication and date of each checked citation. Access to full-text journal articles will depend on whether they are free full text articles or if your institution is eligible for HINARI or has a subscription.

We have displayed the Advanced Search for the trip database.

EvidenceUPDATES contain a searchable database, an alerting system and links to selected evidence-based resources. Registration is required but free.

We have entered chloroquine resistance in the tool’s search box.

For this search there are 14 matches that note the citation information plus type of article (e.g. Review, Original). Access to the full-text article again will be if it is a free full text one or your institution has access via HINARI or a subscription.

EvidenceUPDATES contain options to Download Citations including to several commercial reference manager softwares. We will download to the Text File option.

In the Text File option, the abstracts for the checked results are listed in a Notepad file.

EvidenceUPDATES also contains an Advanced Search option that initially is based on disciplines, categories and populations. From the drop down menu, subcategories for each broad discipline will be displayed.

The Canadian Institutes of Health Research web site contains four Knowledge Translation Learning Modules. Several of these online courses are relevant for evidence based practice and use of knowledge to make informed health decisions.

The Essential Health Links gateway contains annotated links to numerous Evidence-Based Medicine resources available on the Internet.

Additional Evidence-based Health Resources Bandolier Knowledge: Oxford University The Campbell Library DARE: Database of Abstracts of Reviews of Effects Duke University Medical Center Library: EBM

EBM Librarian McMaster PLUS collection _projects.aspx _projects.aspx National Guidelines Clearinghouse Nesbit Guide Evidence-Based Resources ary/evidence_based_resources.cfm

Review/Summary Evidence-based practice depends on knowing the most recent, valid scientific knowledge. This involves finding the ‘best’ studies. Sometimes others have evaluated the quality of the studies, including methodology; many new evidence-based tools mentioned in this tutorial provide evaluation.

When there is no evaluation available, it is essential to evaluate the validity of the study. Tools for evaluating studies can be found in the Evaluating the Evidence section in the EBM tutorial mentioned earlier and found at:

It is always important to consider studies in terms of applicability to and values of the local patient/situation. Evidence-based practice is a developing field and new, useful resources are continuously being developed.

Appendix 1 Appendix 1 – Contains four case studies for developing Evidence-Based Practice curriculum: experimental cancer research, EBP curriculum for pharmacy students, health literacy for pharmacy students and outreach activity for early intervention providers Developed by: Irena Bond, Library Manager Associate Professor of Library and Learning Resources Massachusetts College of Pharmacy and Health Sciences

This is the end of the Evidence-based Medicine for HINARI Users module. The material initially was developed by: Gale G. Hannigan, PhD, MLS, MPH; Professor & Medical Informatics Education Librarian, Texas A&M University. Material revised and enhanced by Irena Bond, Library Manager, Associate Professor of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences. There is a workbook that accompanies this module. The workbook will take you through a live session covering the topics included in this demonstration with working examples. Updated Research Evidence Practitioner’s Experience Local Conditions Patient/Community Preferences & Values