Guide To Nursing Resources

Guide to Nursing Resources EBN : Accessing the Research

Learning Objectives

Introduce student to evidencebased nursing literature and effective strategies for searching for and accessing evidencebased research in nursing.

What is EBM? “Evidence based medicine is 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 means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” 06/18/09

Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS.IUON - Library Research 3 Evidence based medicine: what it is and what it isn't.

Evidence Based Medicine EBM Decision Model: "Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values." EBM Cycle: Ask, Acquire, Appraise, Apply and Act

Primary Evidence Primary evidence includes the original reports of research studies and are included in journal citation databases: MEDLINE: randomized controlled trials  CINAHL: research  EMBASE  SCIRUS 

Secondary Evidence Secondary evidence is the analysis of research studies and is found in: 

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MEDLINE: meta-analysis, practice guidelines, consensus development conferences CINAHL: meta-analysis, practice guidelines, research based nursing practice Cochrane Database of Systematic Reviews Database of Reviews of Effectiveness (DARE) National Guidelines Clearinghouse

Information ‘Pyramid’ EBM journals Cochrane DB Systemic reviews Clinical Practice Guidelines primary research articles CINAHL, Medline Assoc. websites, textbooks Google Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514 06/18/09

IUON - Library Research

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Evolution of Literature Evidence Pyramid

Type of Study

The base of the pyramid is where information usually starts with an idea or laboratory research. As these ideas turn into drugs and diagnostic tools they are tested in laboratories models, then in animals, and finally in humans. The human testing may begin with volunteers and go through several phases of clinical trials before the drug or diagnostic tool can be authorized for use within the general population. Randomized controlled trials are then done to further test the effectiveness and efficacy of a drug or therapy. As you move up the pyramid the amount of available literature decreases, but increases in its relevance to the clinical setting.

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MetaAnalysis Systematic Review Randomized Controlled Trial Cohort studies Case Control studies Case Series/Case Reports Animal research/Laboratory studies

Medical Databases 

CINAHL 

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EBSCOhost

Medline EBSCOhost  PubMed 

http:// support.epnet.com/training/tutorials.php  Online training 

CINAHL.com  Online

training

http:// www.nlm.nih.gov/bsd

http:// www.cinahl.com/library/library.htm

Evidence in MEDLINE Searching for evidence in MEDLINE includes several steps:  formulate a clinical question  run a subject search 

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Ex. heart disease and aspirin

select a strategy to retrieve literature related to therapy, diagnosis, prognosis, harm/etiology.

Evidence in CINAHL 

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formulate a clinical question run a subject search use the Research limit on the Main Search Page. 

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This is a very effective way to limit retrieval to research studies in CINAHL.

Tutorial: http://

www.hscl.ufl.edu/help/CINAHL/index.htm

Cochrane Database of Systemic Reviews

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includes the full text of the regularly updated systematic reviews of the effects of healthcare prepared by The Cochrane Collaboration can be searched by combing keywords or phrases. The Browse Topics icon retrieves a list of Cochrane Groups who prepare and maintain the reviews in respective clinical areas, such as nursing. http:// www.cochrane.org/index.htm

Database of Reviews of Effectiveness (DARE) Database of Reviews of Effectiveness (DARE) a full text database with critical structured abstracts of studies reported in various medical journals.

What is Systemic Review? 

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Systematic reviews are known as the highest level of evidence in clinical research. Developed countries are developing their medical guidelines based on the information provided by systematic reviews of effectiveness. Therefore, it is mandatory for all professionals involved in the delivery of healthcare, to reach to a good understanding about systematic reviews. This web site offers information about what systematic reviews are, and how to conduct

The National Guidelines Clearinghouse includes evidence-based practice guidelines from various health centers and organizations. It can be searched by disease, treatment or organization. The Clearinghouse includes a feature comparing attributes of two or more guidelines.

HealthWeb The Evidence-Based Health Care section of HealthWeb includes a wealth of information about EB organizations, databases and publications. The Tools and Tutorials has many helpful links including the EBM Tool Kit and EBM Toolbox.

Other Search Engines  Medstory  Google Scholar  MammaHealth  MedlinePlus  Kosmix  ReleMed

Databases  DynaMed  Up-to-Date  MDConsult  NursingConsult  InfoPOEMS

Steps to answering Clinical Questions using the Medical Literature The Anatomy of the Clinical Question: 1. Formulate a clinical question ("PICO" approach): Patient characteristics Intervention being considered Comparison intervention (if any) Outcome of clinical interest

Clinical Question cont. 2. Run your subject search. 3. Select the MEDLINE strategy to answer the question: Therapy, Diagnosis, Prognosis, Harm/Etiology. (including study design/article type)

For Quick Searches A question of... Therapy Limit search to Publication Type - Randomized Controlled Trial pt

In-depth EBM Searches: Therapy exp research design/ or exp clinical trials/ or comparative study/ or placebos/ or multicenter study.pt. or clinical trial$1.pt. Or random$.ti,ab. or (single blind$ or double blind$ or triple blind$3).ti,ab. or placebo$1.ti,ab. or (clinical adjtrial$1).ti,ab. or exp epidemiologic research design/ or (controlled clinical trial or randomized controlled trial).pt. or practice guideline.pt. Or feasibility studies/ or clinical protocols/ or exp treatment outcome/ or double blind

For Quick Searches A question of... Diagnosis Combine subject search with search for exp "sensitivity and specificity"

In-depth EBM Searches: Diagnosis exp "sensitivity and specificity"/ or false negative reactions/ or false positive reactions/ or (sensitivity or specificity).ti,ab. or (predictive adj value$1).ti,ab. or (likelihood adj ratio$1).ti,ab. or (false adj (negative$1 or positive$1)).ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or double blind method/ or single blind method/ or practice guideline.pt. Or consensus development conference$.pt. or random$.ti,ab. or random allocation/ or (single blind$3 or double blind$3 or triple blind$3).ti,ab.

For Quick Searches A question of... Prognosis Combine subject search with search for exp cohort studies or exp risk

In-depth EBM Searches: Prognosis exp cohort studies/ or prognosis/ or exp mortality/ or exp morbidity/ or (natural adj history).ti,ab. or prognos$.ti,ab. or course.ti,AB or predict$.ti,ab. or exp "outcome assessment (health care)"/ or outcome$1.ti,ab. or (inception adj cohort$1).ti,ab. or disease progression/ or exp survival analysis/

For Quick Searches A question of... Harm/Etiology Combine subject search with search for exp cohort studies OR exp risk

In-depth EBM Searches: Harm/Etiology random$.ti,ab. or exp epidemiological studies/ or odds ratio/ or cohort$.ti,ab. or (case$1 adj control$).ti,ab. or risk$.ti,ab. or (odds adj ratio$1).ti,ab. or causa$.ti,ab. or (relative$1 adj risk$).ti,ab. or predispos$.ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or exp risk/ or practice guideline.pt. or exp case-control studies/ or exp cohort studies/

For Quick Searches 4. Locate other sources of evidence as necessary. 5. Examine the evidence, critically appraise/evaluate the literature. 6. Apply the evidence + clinical experience + the patient's preferences. 7. Evaluate patient outcomes.

In-depth EBM Searches 4. Once copied, paste it into the search box in MEDLINE. 5. Click "Perform Search." 6. Combine this set with your original search using AND (i.e. 1 AND 2). (EBM filters developed by the Miner Library at the University of Rochester Medical Center

Note You can save each of these EBM filters as a separate search in MEDLINE so that they can be run as needed when searching MEDLINE To do this:  Authenticate to a new MEDLINE session with a blank search history.  Copy and paste one EBM filter.  Click "Perform Search."  After retrieving search results, click "Save Search History."  Select "Permanent," and name the search (ex. EBM Therapy or Therapy Filter).

To use save searches: Run your subject search.  Click "Run Saved Search."  Select the EBM filter to run based on the type of question being asked (Therapy, Diagnosis, Prognosis, or Harm/Etiology).  Combine the two searches using AND. 

For further clarification and practice check out more online training ‘EBM Toolkit’ based on the series in JAMA: http://www.med.ualberta.ca/ebm/ebm.htm OR From Duke University Medical Center: http:// www.hsl.unc.edu/services/tutorials/EBM/welcome.htm

EVIDENCE BASED MEDICINE TOOLKITS & TUTORIALS

EBM Jeopardy

Thank you

Ann Celestine, BA MLS AHIP Library Director