Evidence-Based Information Retrieval and Resources GEMP 2 Dr Glenda Myers WHSL 18 th March 2008 EBM Assignment August Will Require You to: Formulate a clinical question Find relevant supporting documentation Evaluate the paper you have chosen This tutorial is for self-study and will help you find a relevant EBM paper and formulate a suitable clinical question Evidence-Based Practice (EBM) Requires the Practitioner to Formulate a Clear Clinical Question Search the Literature for Relevant Clinical Articles Appraise (Analyse) Articles Retrieved for Validity and Applicability How Will the Result Benefit my Patient/s? Apply the Evidence in Practice Evidence-Based Medicine (EBM) Requires Incorporation of All Previous Searching Skills All Previous Knowledge of Resources Synthesized with Clinical Knowledge Clinical Skills Diagnostic Acumen Problem Statement Formulation of the Problem the Most Difficult Aspect How to Translate a Clinical Problem into a Search Strategy? Concept (Facet) Analysis Revision of Search Strategy Is Jogging Good for Pigs? Jogging Pigs Jogging Subset of Data on Both Jogging AND Pigs Concept (Facet) Analysis Jogging Running Pig/s Hog/s OR AND Clinical Problem Statement Can Antibiotics be Used to Treat Adult Pharyngitis? Concepts? Antibiotics Pharyngitis Adult? Treatment? PICO Filters for EBM Searching Patient/Problem Intervention Comparative Intervention (If Any) Outcome/s See PICO Chart for More Detail Patient/Problem About the Patient/Problem/Population/ Condition Intervention Form of Treatment/Diagnostic Test/ Aspect of Healthcare/Exposure Comparative Intervention (If Any) Eg. Compared with No Intervention/ Placebo Study, etc. Outcome/s Positive Prevention of Illness/Improvement in Health Negative Adverse Effects/Side Effects Clinical Problem Statement Can Antibiotics be Used to Treat Adult Pharyngitis? Concepts? Antibiotics Pharyngitis Adult? Treatment? Concept (Facet) Analysis with PICO Filters Patient/ Problem Inter- vention Compa- rative Inter- vention (If Any) Out- come/s Pharyngitis Antibiotics Adult Treatment OR Therapy AND Concepts Limit Focus Concept Analysis/ EBM Search Strategy Design Is Vital for Formulation of the Clinical Question Use the PICO Chart/Formula to Help you Analyse Your Topic In Order to Formulate a Clinical Question Now You Need to Search for an Article which You will then Have to Analyse for Your EBM Assignment There are Many Databases you can Use to Search for EBM Articles Start with PubMed http://www.pubmed.gov?holding=i zawitlib_ffthttp://www.pubmed.gov?holding=i zawitlib_fft Remember to Use MeSH when Searching on PubMed Remember to Check Terms in MeSH Before Adding to Search Bar PubMed (You Can Use the PubMed AND Strategy You Learnt Last Year) Results Too Much for the Clinician Limits Date Published Human or Animal Language Gender Subsets for EBM - Either Core Clinical Journal or Systematic Reviews Do NOT use Both Together Type of Article Ages Type of Article for EBM More EBM Article Types Clinical Trials, Phases I IV Controlled Clinical Trial Evaluation Studies Twin Study Validation Studies Case Reports Systematic Reviews Results Same Article, Different Journals Why? Why is the Same Article Published in Different Journals? One of the Purposes of EBM is to Disseminate New Findings Rapidly Practitioners Tend to Read ONLY in their Field of Specialty If the New Material is Important, it will Need to Reach ALL Affected Practitioners so that they can Alter their Practice Immediately PubMed Has Many Different Ways to Find EBM Specific Material PubMed Search Itself Using Clinical Queries Clinical Study Category Also Systematic Reviews within Clinical Queries Clinical Prediction Guides Using Clinical Queries for EBM Searching in PubMed Clinical Study Searching You Can Only Use ONE Category at a Time If You want BOTH Diagnosis as well as Prognosis, you will have to Search Twice You Can Only Use ONE Scope at a Time Either Narrow or Broad You May Also Search for Clinical Prediction Guides for EBM Using Systematic Reviews from the Clinical Queries Page What is a Systematic Review? Used in EBM Searching NOT the Same as a Review Article (which is Background Reading) Includes 6 Steps Precise Formulation of the Problem Efficient Search Strategies Appraisal of Research Designs, Implementations, Analyses Synthesis of Information (Systematic NOT Selective) Justified Conclusions Identification of Gaps in Present Knowledge R egarded as the GOLD STANDARD of EBM Searching Finding Systematic Reviews on PubMed Cochrane Database of Systematic Reviews Cochrane Library Maintained by Cochrane Collaboration Prepares, Maintains and Promotes Systematic Reviews of the Effects of Healthcare Interventions Collaborative Review Groups (CRGs) Many Different Specialties Cochrane Library Covers Several Databases Began as a Result of Criticism that PubMed Does not Index Comprehensively, especially Foreign Language Publications Gold Standard for EBM You Can Also Find the Cochrane Database via the Wits Library Home Page You Can Also Comment on Cochrane if Agree/Disagree with Review Full Text (Systematic Review) on Cochrane Usually very Long and Detailed A Systematic Review Will Be Long Detailed Will Include Search Strategy Including Terms Selected from MeSH Which Databases Searched Also What Further Study is Required Other EBM Resources EBMR (EBM Reviews) ACP Journal Club A Synopsis of Relevant EBM Articles Although it is Full Text IN ACP Journal Club, it is in Fact a Summary of the Article Published Elsewhere Use PubMed to Locate Full Text Article BMJs Clinical Evidence ACPs PIER Available via STAT!Ref Research Resources E-Databases Databases by Title S MDConsult and First Consult Evidence Based Medicine Reviews (EBMR) ID and Password Not Required ACP Journal Club BMJs Clinical Evidence Includes Updates EBM Ratings ACPs PIER from STAT!Ref Dont Forget MDConsult and FirstConsult But No Limits Notice Anything About this Article??? Searching for Evidence on the Web Netting the Evidence http://www.shef.ac.uk/scharr/ir/netting SUMSearch http://sumsearch.uthscsa.eduhttp://sumsearch.uthscsa.edu TRIP (Turning Research into Practice) http://www.tripdatabase.com/index.htmlhttp://www.tripdatabase.com/index.html Netting the Evidence SUMSearch Searches Wikipedia PubMed Including Systematic Reviews Practice Guidelines Cochrane CDSR, DARE (Abstracts) Including Systematic Reviews TRIP (Turning Research into Practice)com In Summary Databases for EBM Searching PubMed; MDConsult; Cochrane Library (Not Necessarily in That Order!!) Find the One You Feel Gives Good Results Journals http://web.wits.ac.za/Libraryhttp://web.wits.ac.za/Library Evidence-based Titles Textbooks Clinical Evidence ACPs PIER EBM Search Engines SUMSearch, TRIP Internet Resources NettingtheEvidence You Will Need to Complete the Formulation of the Clinical Question Assignment Practice EBM Searching Try ALL the EBM Resources You Have Seen in this Tutorial