1. NSUOCO Faculty Retreat Fall 2012 Sandra A. Martin, M.L.I.S. Health Sciences Resource Coordinator Instructor of Library Services John Vaughan Library Room 305B marti004@nsuok.edu – 918-444-3263

2. Sandra Provides…. Instruction Research Assistance Consulting for individuals and small groups Database Searches Help in Locating Full Text Articles Customized Information Services Collection Development (Selection of print and online books, audiovisuals, journals and databases) Help with RUSH delivery of ILL requests Assistance with any health-related information need 2

3. Information Retrieval for Evidence Based Patient Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid, and available at point of care Developing search strategies that are feasible within time constraints of clinical practice

4. EBM Process – 5 Steps 1. ASSESS: Recognize and prioritize important patient problems 2. ASK: Construct clinical questions that facilitate an efficient search 3. ACQUIRE: Track down the best evidence to answer the questions 4. APPRAISE: Systematically evaluate best available evidence for validity, importance, and usefulness 5. APPLY: Interpret the applicability of evidence to specific problems, given patient preferences and values

5. Step 3 ACQUIRE: Track down the evidence to answer the question Use the 4S approach to select the most likely resource Start with the highest level resource available

6. 4S Hierarchy

7. Information Pyramid Point of Care Tools: DynaMed, UptoDate, ACP PIER, FIRSTConsult ACP Journal Club Evidence Based Ophthalmology Cochrane and other Systematic Reviews MEDLINE Searches using Ovid Clinical Queries Tools SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36 http://ebm.bmj.com/cgi/reprint/6/2/36

8. Critically Appraised Content

9. Therapy/Prevention Question 1. In patients with open angle glaucoma, does lowering intraocular pressure versus no treatment delay visual field loss? 2. Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner.

10. Best Study Design for Type of Question Type of QuestionStudy Design Therapy/preventionRandomized controlled trials DiagnosisProspective cohort, blind comparison to a gold standard PrognosisCohort, Case Control, Case Series Etiology/HarmCohort, Case Control, Case Series

11. As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting. Source: Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

12. Find critically appraised content under “Evidence Based Medicine”

13. Systems DynaMed –Summaries for more than 3,000 topics –Monitors >500 medical journals and systematic review databases –Updated daily –Each article evaluated for clinical relevance and scientific validity

14. Glaucoma Summary Evidence-based answer found in 1 minute, 39 seconds

15. DynaMed 1:39

16. Systems ACP PIER –Over 400 evidence-based summaries for primary care published by the American College of Physicians –Recommendations based on citations from medical literature and ranked by experts at McMaster University –Updated monthly –Reference citations rated by type and quality of study

17. Systems UptoDate –Evidence based summaries of over 9,500 topics in over 20 specialties –Ophthalmology not one of the specialties –Good for information on systemic conditions –Available through individual subscription. Online access plus Mobile app for iPhone and iPad. Cost: $199 per year in training; $499 per year in practice

18.  Available in the Optometry Clinic at Hastings Hospital. Use Resource tab and scroll down to the UptoDate link  Sample summary at http://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2- diabetes-mellitus http://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2- diabetes-mellitus

19. Systems FirstConsult –Available through NSU subscription to MD Consult for iPhone or iPad only –Create a personal account in MD Consult –Download the app from the Apple app store –Login with your username and password –Summaries are detailed and include sections on Differential Diagnosis –Eyes and Vision topics well covered

20. Systems http://www.firstconsult.com/php/349337404280/home.html?q=pdxmd/about-first-consult/overview.html

21. Syntheses Cochrane Database of Systematic Reviews (DSR) –Part of the Cochrane Library (1996) –916 completed reviews, 1905 protocols –Among the highest level of evidence upon which to base treatment decisions –Includes Dx since 2008 –Eyes & Vision Research Group Contains over 165 reviews

22. Systematic Review Analyzes data from several primary studies to answer a specific clinical question Provides search strategies and resources used to locate studies Includes specific inclusion and exclusion criteria (results in less bias) Meta-Analysis (subclass) statistically summarizes results of several individual studies Access full text of Cochrane reviews in OVID

23. Review found in 15 seconds Cochrane DSR

24. Copyright: The Cochrane Library, Copyright 2009, The Cochrane Collaboration

25. Levels of Evidence Grade the quality of evidence based on the design of the clinical study Variety of hierarchies in use

26. DynaMed

27. Appraisal Required by User

28. MEDLINE Premier biomedical database from the National Library of Medicine (NLM) Covers 1946-present Full text available from subscribed NSU journals plus Ovid Deposit Account journals available only for NSUOCO Ovid interface includes tools to quickly filter search results to specific study types and levels of evidence Access from http://library.nsuok.edu/collegeop/index.html

29. To Use Clinical Queries Tool, enter search terms and then click on “Additional Limits”.

30. Ovid MEDLINE Clinical Queries Tool

32. Levels of Evidence in Ovid based on AAFP Criteria  Level A = “Specificity” in Ovid Clinical Queries Systematic reviews of randomized controlled trials including meta- analyses Good-quality randomized controlled trials  Level B = “Sensitivity” in Ovid Clinical Queries Good-quality nonrandomized clinical trials Systematic reviews not in Level A Lower-quality randomized controlled trials not in Level A Other types of study: case control studies, clinical cohort studies, cross sectional studies, retrospective studies, and uncontrolled studies  Level C Evidence-based consensus statements and expert guidelines

33. Ovid MEDLINE Pay-Per-View Deposit Account Temporary (24 hour) access to full text of hundreds of medical and pharmacology journals not included in the library’s subscription No charge to Optometry faculty, residents, and students Follow “pay-per-view” instructions at http://library.nsuok.edu/collegeop/index.html Contact Sandra if you have questions or need help 33

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35. How you can help me… Contact me if I can help you select resources to integrate into your assignments Let me know if I can provide instruction for your classes Email me lists of books and/or journals you need for your curriculum or research Let me know the databases, e-Books, e-Journals, and apps most useful to you in the clinic 35