1. Transforming Research into Results
Evidence Based Practice Resources on OvidSP 
Name:
Welcome to this short presentation on EBP resources on OvidSP.
Transforming Research into Results

2. What is evidence-based medicine?
Evidence-Based Medicine (EBP): The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research.
Sackett, David L.. Evidence based medicine: what it is and what it isn’t: It’s about integrating individual clinical individual clinical expertise and the best external evidence. BMJ 321(7023)
Evidence based Medicine bases patient treatment on the results of clinical trials, other parts of the patient pathway can be explored, but treatment is the most common . The term was first coined in Oxford, but it‘s now a global movement. It‘s often expressed as a heirachy of information, with some types of documents being more supported by evidence (the results of clinical trials) than others, or as a cycle of information and its‘ implementation, research creates evidence which is appied in treatment and the effect is monitored and fed back into research.
In 2001, Brian Haynes MD, PhD, McMaster University described an approach to finding the current best evidence pertaining to clinical questions. The approach described a multi-layer “evidence pyramid” with original "studies" at the base, "syntheses" (systematic reviews) of evidence just above the base, "synopses" of studies and syntheses next up, and the most evolved evidence-based information "systems" at the top. Haynes advised searchers that they should begin their search at the top of the pyramid, because there are fewer documents and that these would be be more useful because they are pre-appraised and filtered.
Over the years the model has been refined and now includes 6 levels (as the S6 model mentioned below).
The so-called 6S model is represented on the next slides. As the model depicts, each higher level builds on the content below it. Starting with single studies at the bottom and ending with patient-specific, contextually aware content at the top. The articles are short, and worth a read
Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the "4S" evolution of services for finding current best evidence. ACP J Club 134(2): A11-3.
Haynes, R. B. (2006). Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP J Club 145(3): A8.
DiCenso, Alba, Liz Bayley and R. Brian Haynes. “Accessing preappraised evidence: fine-tuning the 5S model into a 6S model,” [Editorial]. ACP Journal Club, Sept. 15, (3): JC 3-2 – JC 3-3. 2

3. What is the best available clinical research ?
Levels of Evidence pyramids: There are so many different models about what evidence based content is – the various models impose different hierarchies on types of documents, but there are common themes and purposes.
One recurring theme is, what is the material for ? Are you look for material to help with our own research, or are you looking for pre-filtered synthesised materials that you can use for decision making or treatment straight away ?
Let look at an example…
There are many different models about what evidence based content is – the various models impose different hierarchies on types of documents, but there are common themes and purposes. Lets look at some examples… 3

4. What is the best available clinical research ?
We can consider what EBP is, in many different ways, here it is represented as a hierarchy of documents - these types of documents, or materials which are based on them, are evidence based. This approach is useful for selecting primary documents for research. Researchers may also apply filters to the documents they find – the PICOT test for example – to decide whether to include a source if it meets certain criteria.
Levels of Evidence pyramid: the types of documents at the top are more firmly based on evidence – clinical trial data or summaries of trial data - than those at the bottom. 4

5. According to these document based models, what does Ovid offer?
Level
Content S1
Systematic Reviews – via database limits then links to and Full Text S2
Randomized Controlled Trials – via database limits and links to and Full Text S3
Cohort Studies – via database limits and links to and Full Text S4
Case Controlled Studies – via database limits and links to and Full Text S5
Case Reports – via database limits and links to and Full Text S6
Other Studies – via database limits and links to and Full Text
How do we locate evidence based sources ? We find all of these publication types most reliably in databases, these first models are about research literature. But because very little publication type information is available directly in or any other direct sources of full text, or via metasearching tools, we depend on databases to define where a journal article fits into this heirarchy. These models help us locate and grade research literature, but not other publication types and they don‘t help with implementing our findings. 5

6. Publication Descriptions
Here are some publication types and types of studies and documents (and other limits) from 3 databases, where they sit within the database and how they are defined may differ, so how can we reliably create our hierarchy ? Perhaps we use them all and combine the results, but this is a challenge.

7. Using a database for EBP
Using a database is a quality filter – all our premier databases contain only quality peer-reviewed references*
They are a reliable way to find specific types of publications and link to them – You can’t search or limit by publication type (or probably any other FT product, unless it’s based on a database)
But in some cases database references may be difficult to fit into an evidence hierarchy because database descriptions (publication types etc.) differ
Multifile searching is easier on OvidSP than in many other systems
* For example Medline is all peer reviewed content, PsycInfo is all peer reviewed except for the historic segments, all the journal content in Embase is peer reviewed.

8. Evidence Summaries, Systematic Reviews, Meta-analyses
Hierarchy of evidence for decision making (Adapted from McMaster’s) (Melnyk & Fineout- Overholt, 2011)
Clinical
Decision Support
Evidence Summaries, Systematic Reviews, Meta-analyses
Original Research
We have used this model a lot when discussing EBP on Ovid, this is a model about using material in practice, not as research.

9. What is the best available clinical research for decisions ?
Decision Support
Evidence Summaries, Systematic Reviews, Meta-analyses
Original Research
Here we are looking at two other models which bring in additional types of publications, but do not distinguish between types of studies at all, they are all lumped together. In the blue model on the right, Clinical Decision Support (representing Systems) is rated higher than Systematic Review and Metaanalysis, in a three level system rather than a 6 level one. All these models represent differences in emphasis, how many types of documents are considered, what they contain, and what they are for. Since the most highly rated publications in these models are not only evidence based but also actionable, this is part of this approach, not only finding evidence but doing something, is more important here.
Levels of Evidence pyramid refinements: Or we could just look at the higher levels of the pyramid, again in different ways, separating out again the top levels and compressing trials and studies of all types into one lower level. This type of model emphasizes materials which can be used directly to improve practice and outcomes (not just for research) 9

10. According to these models, what does Ovid offer?
Level
Content S1
Clinical Decision Support – non-Ovid S2
Summaries – Up To Date, ClinEguide Evidence Based Guidelines, OvidMD* S3
Synopses of Synthesis – ACP Journal Club, DARE, EBP Synthesis Journals* and Books, Natural Standard, JBI Databases S4
Synthesis – Cochrane Library, JBI databases S5
Synopses of Studies – ACP Journal Club, JBI databases, Natural Standard S6
Studies – Databases (Medline, Embase, PsycInfo) linked to and other Full Text
Ovid does not currently provide access to a clinical decision support tool. In level S2, two different types of summary document are mentioned. They are both accessible from OvidMD where summaries and more highly evidence based documents are sorted to the top of the results. The ClinEguide evidence based guidelines are available within OvidMD which also links to Up To Date.
The level 3 EBP Synthesis journals available in mentioned here could include:
American Journal of Critical Care
Critical Pathways in Cardiology
Evidence Based Child Health
eCAM - Evidence-based complementary and alternative medicine
Evidence-Based Cardiovascular Medicine
Evidence Based Dentistry
Evidence Based Eye Care
Evidence Based Gastroenterology
Evidence Based Healthcare
Evidence Based Healthcare and Public Health
Evidence Based Integrative Medicine
Evidence Based Mental Health
Evidence Based Nursing
International Journal of Evidence Based Healthcare
Worldviews on Evidence Based Nursing
and the JBI publications.
The five different documents which are contained in the JBI databases fall into two categories here, and the studies in level 6 are the pyramids we were looking at earlier. 10

11. EBP Content on OvidSP
What EBP content is available on Ovid platforms ?

12. What EBP resources are available on OvidSP?
Evidence based information from databases:
Researchers use databases to locate documents to create EBP materials, users may use databases to locate systematic reviews or EBP materials to use directly. Example searches and limits...
Embase - 1 exp dementia/dt, rt, su, th
2 limit 1 to evidence based medicine
PsycInfo - 1 exp Birth/
2 limit 1 to systematic review
Example Limits:
Embase – Evidence Based Medicine
Medline – Systematic Review
PsycInfo – Treatment Outcome/Clinical Trial
There are many journals and books on evidence based practice, including material from JBI. This list would be in the Synopsis of Synthesis part of the last model. 12

13. 7 steps of EBP
0: Cultivate a spirit of inquiry 1: Ask the burning question in the PICOT format 2: Search for and collect the most relevant and best evidence 3: Critically appraise the evidence 4: Integrate the best evidence with one’s own experience/ expertise and patient preference 5: Evaluate outcomes of the practice decision 6: Disseminate the outcomes of the EBP decision
Seven Steps in EBP from Anne Woods

14. Step I: Formulate the PICOT question
P: Patient population or disease of interest
Age
Gender
Ethnicity of the group with the specified disorder
Inpatient, Outpatient
I: Intervention or issue of interest
What is the therapy that will be tested?
Has the study group been exposed to the disease; does the group have a specific prognostic factor?
Does the study group exhibit risky behaviors (ex. smoking, alcohol intake)?
This is our topic today

15. Formulate the PICOT question
C: Comparison intervention or issue of interest
Is one of the study groups receiving alternative therapy, a placebo, or no intervention or therapy? (clinical trial)
Is there a group who is without disease or risk factors; does one group have an alternative prognostic factor?
O: Outcome
What outcome is expected from therapy
What are the risks of developing the disease
What is the rate of occurrence of adverse outcomes
T: Time frame
What is the expected duration of time from intervention to outcome
How long will the study group be observed for the outcome or quality of life change with the condition
Next part of PICO(T)

16. PICOT questions Intervention Etiology Diagnosis or Diagnostic Test
In _____________(P), how does __________(I) compared to _____________(C) affect ______________(O) within ________________(T).
In African American female adolescents with hepatitis B, how does acetaminophen compared to ibuprofen affect liver function?
Etiology
Are ____________(P), who have ____________(I) compared with those without _____________(C) at _______________(risk for/of ____________(O) over _________________(T).
Are 30 to 50 year old women who have high blood pressure compared with those without high blood pressure at increased risk for an acute myocardial infarction during the first year after hysterectomy?
Diagnosis or Diagnostic Test
In __________(P) are /is _____________(I) compared with _________________(C) more accurate in diagnosing _______________(O)?
In middle-aged males with suspected myocardial infarction, are serial 12-lead ECGs compared to one initial 12-lead ECG more accurate in diagnosing an acute myocardial infarction?
Here are some examples of different types of PICO questions.

17. PICOT questions Prognosis Meaning
In ____________(P), how does _____________(I) compared to _______________(C) influence _______________(O) over ___________(T)?
For patients 65 years and older, how does the use of an influenza vaccine compared to not receiving the vaccine influence their risk of developing pneumonia during the flu season?
Meaning
How do _____________(P) with _______________(I) perceive _________(O) during ______________(T)?
How do 20 to 29 year old males with a diagnosis of below the waist paralysis perceive their interactions with their romantic significant others during the first year after their diagnosis?
And more…

18. Step 2: Search for the best evidence
Hierarchy of Evidence for interventions and treatment questions
Level 1: Evidence from systematic reviews or meta-analysis of all relevant Randomized controlled trials (RCTs)
Level 2: Evidence obtained from well-designed RCTs
Level 3: Evidence from well-developed controlled trials without randomization
Level 4: Evidence from well designed case-control and cohort studies
Level 5: Evidence from systematic reviews of descriptive qualitative studies
Level 6: Evidence from single descriptive or qualitative studies
Level 7: Evidence from opinion of authorities and/or reports of expert committees
This is our evidence type pyramid

19. Example of a PICO search on OvidSP

20. EBP on OvidSP
What EBP content is available on Ovid platforms ?

21. What EBP resources are available on OvidSP?
Books about Evidence Based Practice:
Many books and journals include or are about evidence based practice. Here are some..
Evidence Based Medicine Toolkit
Sample Size tables for clinical studies
Searching skills toolkit
Systematic Reviews to Support Evidence Based Medicine
Therapeutics, Evidence and Decision Making
These are books about doing EBP research. 21

22. What other EBP resources are available on OvidSP?
Evidence based practice Journals and Books:
These products are primary sources of synthesised evidence based materials in a particular discipline. Many books and journals include or are about evidence based practice. Here are some..
There are many journals and books on evidence based practice, including material from JBI. This list would be in the Synopsis of Synthesis part of the last model. 22

23. What EBP resources are available on OvidSP?
Evidence Based Medicine Reviews:
ACP Journal Club
Cochrane Central Register of Controlled Trials
Cochrane Database of Systematic Reviews
Cochrane Methodology Register
Database of Abstracts of Reviews of Effects
Health Technology Assessment
NHS Economic Evaluation Database
Full Text - Cochrane DSR, ACP Journal Club and DARE
Enhanced abstracts – ACP Journal Club, Heath Technology Assesment, Econonmic Evaluation Database
Bibliographic – C Central R Controlled Trials, C Methodology Register
The main part of EBPR is the Cochrane database of systematic reviews, which is linked to Ovid Medline. CDSR is in the Synopsis section of the model, it brings together results from many high quality studies. 23

24. What EBP resources are available on OvidSP?
OvidMDTM and UpToDate®:
These products either contain systematic reviews and summary data, or are based on these sources (with references and links), so they are all evidence based. One of the sorting and ranking criteria in OvidMD is based on the type of publication, giving added weight to EBP sources and publications.
See OvidMD literature for more details about which parts are evidence based. In addition one of the ranking criteria for MEDLINE references is – is itn a document type high in the EBP pyramid. 24

25. EBP Book Content on Ovid
Wiley-Blackwell Evidence-Based Medicine eBooks Collection
Or over 50 other titles including…
Acute Ischemic Stroke: An Evidence-based Approach
Addiction Medicine: An Evidence-Based Handbook
Anxiety Disorders in Adults: An Evidence-Based Approach to Psychologic ...
Atlas Of Procedures in Surgical Oncology with Critical, Evidence ...
Best Practices: Evidence-Based Nursing Procedures
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane ...
Complementary and Integrative Medicine in Cancer Care and Prevention ...
Concise Cardiology: An Evidence-Based Handbook
Concise Guide to Clinical Trials, A
Evidence Base of Clinical Diagnosis, The: Theory and Methods ...
Evidence-Based Cardiology (LWW)
Evidence-Based Cardiology Practice: A 21st Century Approach
Evidence-Based Emergency Care: Diagnostic Testing and Clinical ...
Evidence-Based Endocrinology (LWW)
Evidence-Based Eye Care
Evidence-Based Medical Monitoring: From Principles to Practice
Evidence-Based Medicine Toolkit
Evidence-Based Neurology: Management of Neurological Disorders
Evidence-Based Obstetric Anesthesia
Evidence-Based Otitis Media
EBP Book content, there are also JBI Books on OvidSP.

26. EBP Book Content on Ovid
Evidence-Based Pediatric Infectious Diseases
Evidence-based Cardiology (Wiley-Blackwell)
Evidence-based Chronic Pain Management
Evidence-based Economics: Health Care, Social Welfare, Education ...
Evidence-based Emergency Medicine
Evidence-based Gastroenterology and Hepatology
Evidence-based Hematology
Evidence-based Infectious Diseases
Evidence-based Nephrology
Evidence-based Oncology
Evidence-based Ophthalmology
Evidence-based Paediatric and Adolescent Diabetes
Evidence-based Pediatric Oncology
Evidence-based Pediatrics and Child Health
Evidence-based Respiratory Medicine
Evidence-based Rheumatology
Evidence-based Sports Medicine
Hospitalist Manual, The
Information Mastery: Evidence-Based Family Medicine
Management of Complex Cardiovascular Problems: The Evidence-Based ...
Medical Management of Kidney Transplantation
Nutrition in Clinical Practice: A Comprehensive, Evidence-Based ...
Oxford Handbook of Clinical Medicine
EBP Book content, there are also JBI Books on OvidSP.

27. EBP Book Content on Ovid
PDQ Evidence-Based Principles and Practice
Pocket Orthopaedics: Evidence-Based Survival Guide
Preventing Childhood Obesity: Evidence Policy and Practice
Prove It! Evidence-Based Analysis of Common Spine Practice
Psychiatry: An Evidence Based Text
Pulmonary Arterial Hypertension: Diagnosis and Evidence-Based ...
Sample Size Tables for Clinical Studies
Searching Skills Toolkit: Finding the Evidence
Stroke Units: An Evidence Based Approach
Wellness and Physical Therapy
EBP Book content, there are also JBI Books on OvidSP.

28. More EB Book Content on Ovid
American Nurses Association
Largest, most influential nursing professional organization in US
40 premium, professional reference covering:
The Magnet® journey
Nursing informatics
Quality nursing care
Healthcare ethics
Professional development
Additional Nursing Book Recommendations from:
Wiley-Blackwell
Hodder-Arnold
Lippincott Williams & Wilkins
Jones & Bartlett
Springer Publishing
And more…
Lippincott/JBI Synthesis Science in Healthcare Online Book Series
Book 1: Translation Science and The JBI Model of Evidence-Based Healthcare
Book 2: Synthesizing Qualitative Evidence
Book 3: Synthesizing Evidence from Narrative, Text and Opinion
Book 4: Synthesizing Quantitative Evidence
Book 5: Synthesizing Evidence of Risk
Book 6: Synthesizing Evidence of Diagnostic Accuracy
Book 7: Synthesizing Economic Evidence
EBP Book content, there are also JBI Books on OvidSP.

29. EBP Journal Content on Ovid
American Journal of Critical Care
Critical Pathways in Cardiology: A Journal of Evidence-Based ...
Evidence Based Women’s Health Journal
Evidence-Based Child Health: A Cochrane Review Journal
Evidence-Based Integrative Medicine
Evidence-Based Medicine
Evidence-Based Mental Health
Evidence-Based Nursing
Evidence-Based Ophthalmology: Critical Appraisals and Healthcare
Future Prescriber
International Journal of Evidence Based Healthcare
Journal of Evidence Based Dental Practice, The
Journal of Evidence-Based Complementary & Alternative Medicine
Worldviews on Evidence-Based Nursing
EBP Journal content but also medical content too

30. More EBP Journal Content on Ovid
American Association of Critical-Care Nurses
AACN Advanced Critical Care (LWW)
AACN Bold Voices (AACN)
American Journal of Critical Care (AACN)
Critical Care Nurse (AACN)
Nursing Journal Highlights
PACEsetterS
Official journal of the Joanna Briggs Institute (JBI)
Globally renowned leader in evidence-based health care
Collections
Ovid Nursing Community College Collection
Ovid Nursing Vocational Collection
And more…
LWW Journals – top sellers
AJN (14.8%)
Cancer Nursing (13.3%)
CIN (12.5%)
JONA (13.3%)
Nursing2011 (37.9%)
EBP Journal content not just nursing content

31. And of course The JBI EBP Database and EBMR !
EBP Journal content not just nursing content