Sources of Clinical Effectiveness Information & Finding the Evidence Presenter Contact details

EBP/Clinical Effectiveness Process Define problem Define problem Find evidence Find evidence Appraise evidence Appraise evidence Apply results of appraisal (disseminate & implement) Apply results of appraisal (disseminate & implement) Evaluate change Evaluate change Redefine problem Redefine problem

Comprehensive  Individual Guidelines Systematic Reviews Systematic Reviews Individual studies

Hierarchy of Evidence Systematic review Systematic review RCTs RCTs Cohort studies Cohort studies Case control studies Case control studies Case series Case series Case studies Case studies Opinion Opinion

Traditional vs Evidence Based Medline Medline Cinahl Cinahl BNI BNI Embase Embase Amed Amed PsycInfo PsycInfo Contain all types of information from letters to systematic reviews and articles reporting guidelines Contain all types of information from letters to systematic reviews and articles reporting guidelines Cochrane Library NHS CRD databases DARE NHS EED Clinical Knowledge Summaries Contain only high quality research evidence which in some cases is also appraised

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Using CINAHL, Medline etc. You have to be systematic in searching these databases

Preparation Develop your question Develop your question Divide the question into its “concepts” using the Divide the question into its “concepts” using the P I C O formula Think of alternative words/terms/synonyms/abbreviations Think of alternative words/terms/synonyms/abbreviations If the words are written, you have to find them If the words are written, you have to find them Investigate the available resources Investigate the available resources

Process Access an appropriate resource Access an appropriate resource Search each “concept” separately Search each “concept” separately Search for keywords AND MeSH (Medical Subject Headings) Search for keywords AND MeSH (Medical Subject Headings) Combine your separate searches Combine your separate searches

Formulating a Question Think about what you are looking for

The problem Pick a topic area to demonstrate – briefly describe the problem

The answerable question Convert the problem into an answerable question

P I C O – The anatomy of a good question P – Patient/Population/Problem P – Patient/Population/Problem Who or what is the question about Who or what is the question about I – Intervention/Exposure I – Intervention/Exposure What is being done to or happening to the above What is being done to or happening to the above C – Comparison (if appropriate) C – Comparison (if appropriate) What else can be done instead of the above What else can be done instead of the above O – Clinical Outcome O – Clinical Outcome How does the intervention affect the patient: How does the intervention affect the patient: (diagnosis/screening, prognosis, therapy, event, harm, prevention)

P I C O Briefly fill in the PICO as an example P P I I C C O O

Free text searching Use words and phrases from titles, abstracts and keyword fields to retrieve records Use words and phrases from titles, abstracts and keyword fields to retrieve records Consider the problems Consider the problems Plurals Plurals Different spellings Different spellings Different terminology Different terminology

TIPS

Truncation A helpful little symbol used when a root of a word has multiple endings – even just multiples! A helpful little symbol used when a root of a word has multiple endings – even just multiples! * Prophyl* gives prophylaxis or prophylactic etc. BUT Tonsil* gives tonsils, tonsillitis, tonsillectomy – this is one to be careful with because tonsillitis is a problem and tonsillectomy is an intervention Tonsil* gives tonsils, tonsillitis, tonsillectomy – this is one to be careful with because tonsillitis is a problem and tonsillectomy is an intervention In this case us a number if all are not require e.g. tonsil*5 will preclude tonsillectomy. In this case us a number if all are not require e.g. tonsil*5 will preclude tonsillectomy.

Proximity = ADJ3 E.g ADJ3 placed between two words finds phrases with the words in any order within 3 words of one another E.g ADJ3 placed between two words finds phrases with the words in any order within 3 words of one another E.g. Tonsil$ adj6 surg$ will produce tonsil surgery OR surgery of the tonsils OR surgical removal of the tonsils, surgery for tonsillitis E.g. Tonsil$ adj6 surg$ will produce tonsil surgery OR surgery of the tonsils OR surgical removal of the tonsils, surgery for tonsillitis

Words and terms Give examples of words and terms that you have found; asking for others from your audience etc. etc. etc…………… etc. etc. etc……………

You have to think like this for each area of your question!

Using a thesaurus Using a thesaurus A controlled vocabulary used to index information A controlled vocabulary used to index information Every review, article etc. will have been assigned Subject Headings or Descriptors Every review, article etc. will have been assigned Subject Headings or Descriptors Cochrane Library and Medline etc. use MeSH Cochrane Library and Medline etc. use MeSH EMBASE uses Emtree Classification EMBASE uses Emtree Classification

Thesaurus v Free text (1) Thesaurus headings are standard and consistent terms used to describe a subject Thesaurus headings are standard and consistent terms used to describe a subject e.g. heart attack is indexed to myocardial infarction: e.g. heart attack is indexed to myocardial infarction: hip replacement = arthroplasty, replacement, hip hip replacement = arthroplasty, replacement, hip Indexers are always instructed to use the most specific term available Indexers are always instructed to use the most specific term available

Thesaurus v Free text (2) What if there is no abstract and your term is not in the title? What if there is no abstract and your term is not in the title? You have to rely on the Subject Headings assigned to the article You have to rely on the Subject Headings assigned to the article What if there is no Subject Heading? relatively new terms What if there is no Subject Heading? relatively new terms MeSH is stronger for searches on conditions and interventions MeSH is stronger for searches on conditions and interventions You have to rely on keywords as well as subject headings You have to rely on keywords as well as subject headings Free text is used to broaden your search Free text is used to broaden your search

Combining searches Combine concepts with: OR / AND

OR Fill in a few keywords/MeSH terms in the boxes below (MeSH) Subject broadened to include all terms (Keywords)

AND Fill in P & I in the boxes below or any combination e.g. Tonsillitis and Prophylactic antibiotics etc. in the SAME article etc.

Putting it all together Fill in the PICO with some of the terms used to demonstrate out systematic it is. This seems to pull it all together – delete if not required. OR PI C O OR ANDAND ANDAND OR

Summary The better formulated your search question, the better your search will be The better formulated your search question, the better your search will be Think carefully about which source(s) will be appropriate Think carefully about which source(s) will be appropriate Get to know the database(s) you use most often Get to know the database(s) you use most often Save your search strategy ( you never know when you might need it again) Save your search strategy ( you never know when you might need it again) Allow plenty of time ( always double what you think) Allow plenty of time ( always double what you think)

In a spin In a spin

When all else fails