Evidence-Based Information Retrieval and Resources GEMP 2 © Dr Glenda Myers WHSL 18 th March 2008

EBM Assignment August Will Require You to: –Formulate a clinical question –Find relevant supporting documentation –Evaluate the paper you have chosen This tutorial is for self-study and will help you find a relevant EBM paper and formulate a suitable clinical question

Evidence-Based Practice (EBM) Requires the Practitioner to Formulate a Clear Clinical Question Search the Literature for Relevant Clinical Articles Appraise (Analyse) Articles Retrieved for Validity and Applicability How Will the Result Benefit my Patient/s? Apply the Evidence in Practice

Evidence-Based Medicine (EBM) Requires Incorporation of – All Previous Searching Skills –All Previous Knowledge of Resources Synthesized with –Clinical Knowledge –Clinical Skills –Diagnostic Acumen

Problem Statement Formulation of the Problem the Most Difficult Aspect How to Translate a Clinical Problem into a Search Strategy?

Concept (Facet) Analysis – Revision of Search Strategy Is Jogging Good for Pigs? Jogging Pigs Jogging Subset of Data on Both Jogging AND Pigs

Concept (Facet) Analysis Jogging Running Pig/s Hog/s OR AND

Clinical Problem Statement Can Antibiotics be Used to Treat Adult Pharyngitis? Concepts? Antibiotics √ Pharyngitis √ Adult? Treatment?

PICO Filters for EBM Searching Patient/Problem Intervention Comparative Intervention (If Any) Outcome/s

See PICO Chart for More Detail Patient/Problem –About the Patient/Problem/Population/ Condition Intervention –Form of Treatment/Diagnostic Test/ Aspect of Healthcare/Exposure Comparative Intervention (If Any) –Eg. Compared with No Intervention/ Placebo Study, etc. Outcome/s –Positive Prevention of Illness/Improvement in Health –Negative Adverse Effects/Side Effects

Clinical Problem Statement Can Antibiotics be Used to Treat Adult Pharyngitis? Concepts? Antibiotics √ Pharyngitis √ Adult? Treatment?

Concept (Facet) Analysis with PICO Filters Patient/ Problem Inter- vention Compa- rative Inter- vention (If Any) Out- come/s Pharyngitis Antibiotics Adult Treatment OR Therapy AND Concepts Limit Focus

Concept Analysis/ EBM Search Strategy Design Is Vital for Formulation of the Clinical Question Use the PICO Chart/Formula to Help you Analyse Your Topic –In Order to Formulate a Clinical Question Now You Need to Search for an Article which You will then Have to Analyse for Your EBM Assignment

There are Many Databases you can Use to Search for EBM Articles Start with PubMed – zawitlib_ffthttp:// zawitlib_fft

Remember to Use MeSH when Searching on PubMed Remember to Check Terms in MeSH Before Adding to Search Bar

PubMed (You Can Use the PubMed AND Strategy You Learnt Last Year)

Results – Too Much for the Clinician

Limits Date Published Human or Animal Language Gender Subsets for EBM - Either –Core Clinical Journal or – Systematic Reviews –Do NOT use Both Together Type of Article Ages

Type of Article for EBM

More EBM Article Types Clinical Trials, Phases I – IV Controlled Clinical Trial Evaluation Studies Twin Study Validation Studies Case Reports

Systematic Reviews

Results Same Article, Different Journals Why?

Why is the Same Article Published in Different Journals? One of the Purposes of EBM is to Disseminate New Findings Rapidly Practitioners Tend to Read ONLY in their Field of Specialty If the New Material is Important, it will Need to Reach ALL Affected Practitioners so that they can Alter their Practice Immediately

PubMed Has Many Different Ways to Find EBM Specific Material PubMed Search Itself Using Clinical Queries –Clinical Study Category –Also Systematic Reviews within Clinical Queries –Clinical Prediction Guides

Using Clinical Queries for EBM Searching in PubMed

Clinical Study Searching You Can Only Use ONE Category at a Time –If You want BOTH Diagnosis as well as Prognosis, you will have to Search Twice You Can Only Use ONE Scope at a Time –Either Narrow or Broad

You May Also Search for Clinical Prediction Guides for EBM

Using Systematic Reviews from the Clinical Queries Page

What is a Systematic Review? Used in EBM Searching NOT the Same as a Review Article (which is Background Reading) Includes 6 Steps –Precise Formulation of the Problem –Efficient Search Strategies –Appraisal of Research Designs, Implementations, Analyses –Synthesis of Information (Systematic NOT Selective) –Justified Conclusions –Identification of Gaps in Present Knowledge R egarded as the GOLD STANDARD of EBM Searching

Finding Systematic Reviews on PubMed

Cochrane Database of Systematic Reviews

Cochrane Library Maintained by Cochrane Collaboration –Prepares, Maintains and Promotes Systematic Reviews of the Effects of Healthcare Interventions Collaborative Review Groups (CRGs) –Many Different Specialties Cochrane Library Covers Several Databases –Began as a Result of Criticism that PubMed Does not Index Comprehensively, especially Foreign Language Publications –Gold Standard for EBM

You Can Also Find the Cochrane Database via the Wits Library Home Page

You Can Also Comment on Cochrane if Agree/Disagree with Review

Full Text (Systematic Review) on Cochrane Usually very Long and Detailed

A Systematic Review Will Be Long Detailed Will Include –Search Strategy Including Terms Selected from MeSH – Which Databases Searched –Also What Further Study is Required

Other EBM Resources EBMR (EBM Reviews) –ACP Journal Club A Synopsis of Relevant EBM Articles Although it is Full Text IN ACP Journal Club, it is in Fact a Summary of the Article Published Elsewhere Use PubMed to Locate Full Text Article –BMJ’s Clinical Evidence –ACP’s PIER Available via STAT!Ref –Research Resources –E-Databases –Databases by Title –S MDConsult and First Consult

Evidence Based Medicine Reviews (EBMR) ID and Password Not Required

ACP Journal Club

BMJ’s Clinical Evidence

Includes Updates EBM Ratings

ACP’s PIER from STAT!Ref

Don’t Forget MDConsult and FirstConsult

But No Limits

Notice Anything About this Article???

Searching for Evidence on the Web Netting the Evidence – SUMSearch – TRIP (Turning Research into Practice) –

Netting the Evidence

SUMSearch Searches Wikipedia PubMed –Including Systematic Reviews Practice Guidelines Cochrane –CDSR, DARE (Abstracts) –Including Systematic Reviews

TRIP (Turning Research into Practice) com

In Summary Databases for EBM Searching –PubMed; MDConsult; Cochrane Library (Not Necessarily in That Order!!) –Find the One You Feel Gives Good Results Journals – Evidence-based … Titles Textbooks –Clinical Evidence –ACP’s PIER EBM Search Engines –SUMSearch, TRIP Internet Resources –NettingtheEvidence

You Will Need to Complete the Formulation of the Clinical Question Assignment Practice EBM Searching –Try ALL the EBM Resources You Have Seen in this Tutorial