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Transcript of SEARCHING EVIDENCE THROUGH THE COCHRANE LIBRARY prepared by Literature Searching Team Library,...
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SEARCHING EVIDENCE THROUGHTHE COCHRANE LIBRARY
prepared by Literature Searching TeamLibrary, Faculty of Medicine, UGM
2012
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• Evidence-based medicine
• Evidence-based practice
• Types of clinical questions
• Formulating answerable clinical questions using PICO approach
• What to look for?
• Searching evidence through The Cochrane Library
• Other EBM resources
OUTLINE
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• Evidence-based medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. (Rosenberg W., Donald A. “Evidence-based medicine: an approach to clinical problem solving”, in BMJ 1995; 310: 1122-1126.)
Evidence-based: conclusions based on best available evidence
WHAT IS EVIDENCE BASED MEDICINE?
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Clinical Expertise
EachIndividual
Patient
BestAvailable
Resources
ELEMENTS OF EVIDENCE BASED PRACTICE
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FORMULATE CLEAR CLINICAL QUESTIONS*
SEARCH FOR THE EVIDENCE*
APPRAISE THE EVIDENCE
APPLY THE RESULTS TO CLINICAL PRACTICE
EVALUATE THE IMPACT ON PRACTICE
* Focus of the session
STEPS OF EVIDENCE BASED PRACTICE
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Therapy or Intervention – treatments to patients that - do more good than harm- are worth the efforts and costs
of using them
Prognosis – patient’s likely clinical course over a time and complications of the disorder
Etiology – causes or risk factors of disease
Diagnosis - possible causes of patient’s clinical problems
CLINICAL QUESTIONS CENTRAL ISSUES IN CLINICAL WORKS
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• Ask a question that you would like answered from the literature
Example:Is artesunate better than quinine for treating children with severe malaria?
ASKING A CLINICAL QUESTION
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• P : Patient, Population, Problem
• I : Intervention
• C : Comparison, Comparator
• O : Outcome
PICO APPROACH
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Type of question : THERAPY
Reformatted question:
In children with severe malaria is artesunate more effective than quinine in reducing malaria severity?
REFORMATTING THE QUESTION USING PICO APPROACH
P : children with severe malaria
I : artesunate
C : quinine
O : reduction of malaria severity
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FROM QUESTION TO SEARCH TERMS
Search Terms Alternatives
Patientchildrenmalaria
infants
Intervention artesunate
Comparator quinine
Outcomereduction of malaria severity
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COMBINING SEARCH TERMS
Note: Please refer to Module 1 (Introduction to Literature Search) for search tools to use in formulating a search phrase
Combined search terms or search phrase for reformatted clinical question:
“In children with severe malaria is artesunate more effective than quinine in reducing malaria severity?”
will be: (child* OR infant*) AND malaria AND artesunante AND quinine
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WHAT TO LOOK FOR?
The paper where someone trustworthy has
already answered our question!
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PRIMARY RESEARCH VS SECONDARY RESEARCH
Primary research research undertaken to address a question
Secondary research research undertaken to find the existing primary research that addresses a question
e.g. reviews (systematic, narrative) and meta-analyses
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x
v
NARRATIVE REVIEW VS SYSTEMATIC REVIEW
• Narrative review A narrative review discusses and summarises the literature on a particular topic, without generating any pooled summary figures through meta-analysis.(http://www.nhs.uk/news/Pages/Newsglossary.aspx)
• Systematic review A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue.(http://effectivehealthcare.ahrq.gov/index.cfm/glossary-of-terms/?pageaction=showterm&termid=7)
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THE COCHRANE LIBRARY (TCL) A KEY EBM RESOURCE
The Cochrane Library (named after Archie Cochrane) is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organisations. At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.
(http://en.wikipedia.org/wiki/Cochrane_Library)
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• The Cochrane Database of Systematic Reviews (Cochrane Reviews)
• The Database of Abstracts of Reviews of Effects (DARE)
• The Cochrane Central Register of Controlled Trials (CENTRAL)
• The Cochrane Methodology Register (Methodology Register)
• Health Technology Assessment Database (HTA)
• NHS Economic Evaluation Database (NHS EED)
CONTENTS OF TCL
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THE COCHRANE LIBRARY
Access is unlocked for subscribers
Simple search option
Advanced search option
www.thecochranelibrary.com
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Search boxes for search terms/phrases
DISPLAY OF ADVANCE SEARCH OPTION
Database in TCL
Search tips to guide searches
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SEARCHING THROUGH ADVANCED SEARCH OPTIONPUTTING SEARCH PHRASE IN THE SEARCH BOX
Search phrase:(child* OR infant*) AND malaria AND artesunate AND quinine
Search in all text
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SEARCH RESULT
46 records matched with the search phrase
Click to display search results
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DISPLAY OF SEARCH RESULTS
There are 22 Cochrane Reviews, 2 Other Reviews, and 22 Trials (46 records)
Click to view abstract
Search phrase
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DISPLAY OF ABSTRACT
Options for full article in HTML and PDF format
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DISPLAY OF FULLTEXT IN PDF FORMAT
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OTHER EBM RESOURCES
The following are some other EBM resources:
• BMJ Clinical Evidence – www.clinicalevidence.bmj.com/
• National Institute for Health and Clinical Excellence - www.nice.org.uk/
• NHS Evidence - www.evidence.nhs.uk/
• National Guideline Clearinghourse – public resource for evidence-based clinical practice guideline – www.guideline.gov/
• AAOS Evidence-based Clinical Practice Guideline - www.aaos.org/research/guidelines/guide.asp
• PubMed Clinical Queries - http://www.ncbi.nlm.nih.gov/pubmed/clinical/
• Centre for Evidence-Based Medicine - www.cebm.net/
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• Access to full text of reviews in TCL is available within medical campus
• When you are off campus and need the full text reviews, please contact library staff
END NOTES
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This Power Point Presentation is compiled by
Team of Literature Searching
Library Faculty of Medicine, UGM.