1. Novel Tools and Resources for an Evidence Based Practice Barbara Walker, Ph.D. walkerb@njhealth.org

2. The Framework Best available research evidence Patient’s situation and circumstances Clinical Expertise CD

3. EBP begins and ends with the patient Formulate Questions Find the best evidence Appraise the evidence Apply the Evidence Assess the impact

4. Types of Clinical Questions Diagnosis Therapy Harm Etiology Prognosis Cost-effectiveness Background Foreground By Content By Format THIS SLIDE COURTESY OF SUE LONDON RUTH LILLY LIBRARY

5. background foreground

6. Background questions Foreground questions Amount of experience

7. Background Questions What are the criteria for diagnosing …? What are the known risks associated with… What is the cost-effectiveness of … What is the prognosis for… What treatments have been found to be most effective for…?

8. P = Patient Population or Problem I =Intervention C =Comparison O =Outcome Foreground Questions

9. Formulating a Foreground Question ( PICO ) P atient or Population I ntervention C ompared to… O utcome you would like to measure or achieve In middle aged women with migraine headache Is there any evidence that acupuncture Compared to sham treatment, Relaxation training, Biofeedback training, and/or Cognitive Behavioral Therapy Decrease frequency, intensity, and/or severity of migraines

10. Why formulate questions so carefully?

12. High Sensitivity THIS SERIES COURTESY OF SUE LONDON IUPUI LIBRARY

13. High Specificity WHAT: WHERE: HOW: Synthesized literature Specialized databases Specialized search strategies/filters

14. SECONDARY LITERATURE: papers that synthesize original studies PRIMARY LITERATURE SYSTEMATIC REVIEWS EB Meta-analyses EB Guidelines Traditional reviews

15. Systematic vs. Traditional Reviews Focus on a clear clinically relevant question. End with a clinical bottom-line. Specific, pre-determined method and format. Research on research. Search for all relevant studies. Avoid bias Goal is replication

16. PRIMARY LITERATURE SECONDARY LITERATURE Systematic reviews EVIDENCE-BASED Traditional reviews Guidelines

17. What are we looking for? Evidence that has already been scientifically synthesized for us A new type of literature Systematic reviews Evidence-based guidelines Others

18. Where and how ?

19. Start at the top You can search specifically for one thing or… SUMMARIES (CLINICAL EVIDENCE,, GUIDELINES, ESTS ) SYNTHESES Systematic Reviews (Cochrane) Individual articles (Medline and PsycINFO)

20. SUMMARIES (CLINICAL EVIDENCE,, GUIDELINES, ESTS ) SYNTHESES Systematic Reviews (Cochrane) Individual articles (Medline and PsycINFO)

21. www.tripdatabase.com high-quality open-access material to support EBP

22. USE ADVANCED SEARCH and read the search tips

26. SUMMARIES (C LINICAL E VIDENCE,, GUIDELINES, EST S ) SYNTHESES Systematic Reviews (Cochrane) Individual articles (Medline and PsycINFO)

27. TRIP Advantages: –It’s free public access –It contains ONLY evidence-based material Disadvantages –Searches are broad –May not contain exactly what you need –Everything in TRIP is evidence-based but there is evidence-based literature NOT in TRIP.

28. SUMMARIES CLINICAL EVIDENCE ESTs SYNTHESES COCHRANE SYSTEMATIC REVIEWS Individual articles Medline and PsycINFO

29. http://clinicalevidence.bmj.com/c eweb/index.jsp

30. UPTODATE DYNAMED

31. http://www.psychology.sunysb.edu/eklonsky-/division12/ ESTs from Div 12

32. www.therapyadvisor.org

33. SUMMARIES CLINICAL EVIDENCE ESTs SYNTHESES COCHRANE SYSTEMATIC REVIEWS Individual articles Medline and PsycINFO

34. With a subscription you can obtain detailed reviews or you can access summaries free on www.cochrane.org.www.cochrane.org

35. SUMMARIES CLINICAL EVIDENCE ESTs SYNTHESES COCHRANE SYSTEMATIC REVIEWS Individual articles Medline and PsycINFO

36. EBP techniques

37. MEDLINE PSYCINFO Adapted from Shahram Yazdani, 2002 Cochrane / others IT IS IMPORTANT TO SEARCH BOTH You may miss some of the best EB resources by searching only PsycINFO

38. MEDLINE PSYCINFO DATABASES contain the articles

39. MEDLINE PSYCINFO DATABASES VENDORS Create interfaces to bring the articles to you

40. VENDORS PUBMED free CSA ILLUMINA PsycINFO OVID$$$$ MEDLINE EBSCO

41. PubMed Clinical Queries Keywords vs. Controlled vocabulary

42. CLINICAL QUERIES http://www.ncbi.nlm.nih.gov/pubmed/

44. Interested in finding articles about acupuncture as a treatment?

45. Why not just type keywords? Keywords look for that exact word in the article. AcupunctureAcupressure Behavior Behaviour Tension headacheMuscle contraction headache DepressionMajor depressive disorder

46. Controlled Vocabulary Librarians “tag” each article with labels based on the concepts in the article. These labels are standardized. This allows the user to retrieve information that uses different terminology for the same concept. Medline: MeSH terms

47. Why : We need to find the relevant scientific evidence quickly and efficiently to inform our practice What: –A newer literature (pre-appraised) Where and How: (work your way down the pyramid) SUMMARIES (GUIDELINES, ESTS ) SYNTHESES Systematic Reviews (Cochrane) Individual articles (Medline and PsycINFO) Uptodate / Dynamed / emedicine Clinical Evidence Evidence-based guidelines EB journals (EBMH) ESTs

48. The evidence can come to you: Alerts?

49. Alerts Individual journals and databases Medline and PsycINFO: save your search automatic email Ask within your own field… Librarians are your friends…

50. EBP begins and ends with the patient Formulate Questions Find the best evidence Appraise the evidence Apply the Evidence Assess the impact

51. Questions and Discussion….