2. • As a member of the CME
Committee I recuse myself
from voting on this activity.
• I have no relevant or
financial conflict of interest to
disclose concerning this
presentation and have
received no honorarium or
payment in kind, above and
beyond my normal salary.
DISCLOSURE STATEMENT

3. At the conclusion of this activity participant’s
performance should be enhanced regarding:
● effectively accessing the e-library
resources;
● navigating the research databases
to ‘search smarter, not harder’
for clinical information;
● appreciating the “What’s in
it for me” moment.

4. “Knowledge is of two kinds. We
know a subject ourselves, or we
know where we can find
information upon it.”
-Samuel Johnson, 1775

5. The 9th standard of the Medical Library Association’s
Standards for Hospital Libraries 2002 with 2004
Revisions states that:
“Knowledge-Based Information
resources containing evidence
based clinical information
resources be available to
clinical staff 24 hours a day,
7 days a week.”

6. Ideal 21st Century E-Library Resource:
• Evidence-Based
• Point-of-Care / Bedside Access
• Easy to use
• Fast /efficient
• Comprehensive
• Current
• If possible, provide full-text

7. E-Library Selection Criteria
Must Evaluate/trial multiple KB databases
No one database offers access to all available electronic journals
and books (very little overlap between vendors)
• Provide best evidence to support clinical decision making
• Excellence/reputation of resource
• Multi-discipline resources
• Added value clinical tools/features/CME-CE hours
• Validate expected end-user experience
• Contract negotiations
– Cost (actual + hidden = $ + employee productivity)
– Concurrency of users
– 24/7 access portals
– E-access license for all

8. Return on Investment
The literature has shown that physician’s and
hospital staff who utilize EBM enhance the
quality of patient care and value of service
through:
• Improved Outcomes
• Cost Savings
• Improved Patient Safety
(Fischer 2005;93(4):347-352. King 1987; 75(4):291-301. Marshall 1992;80(2):169-178)

9. Added Value of E-Library
• Align with changing education structure of NEPA
• Sharpen competitive edge
– Recruitment/retention tool
– Enhance IM & Podiatry programs
– Attract student programs as clinical training site
• Sustain reputation of providing clinical excellence
• Support Magnet Recognition Requirements
• Research best practice information
• Retrieve benchmark data/support
– QI decision-making
– Management decision-making
• Maintain accreditation standards

11. – ACCESS MEDICINE
– DYNAMED
– EBSCO RESOURCE DATABASES
– MDCONSULT
– NURSING REFERENCE CENTER
– PERC
– STAT!REF

18. EBSCO Basic Search Screen lets you create
a search with
•Limiters
•Expanders
•Boolean operators

19. Boolean Search Operators
• And (results contain all search terms)
• Or(results contains at least one search term)
• Not (results do not contain the specified
terms)
You can use these operators to
create a very broad or very
narrow search.

20. EBSCO Advanced Search Options
• Search modes
• “Find all of my search terms,”
• “SmartText Searching,”
• “Apply related words.”
• Limit your results
• Full Text
• Publication type
• Time Frame
• Special Limiters
• Apply limiters specific to a database. If you select
a special limiter, it is applied only to the database
under which it appears
• Click the Search button
• The Result List displays

21. (Searching…)
• SmartText Searching
– You can copy and paste chunks of text (up
to 5000 characters including spaces) to
search for results.
– SmartText Searching leverages a technology
that summarizes text entered to the most
relevant search terms then conducts search.
(This search mode is not available for all databases).
• Quotations
– Typically, when a phrase is enclosed by
double quotations marks, the exact phrase is
searched.
– Stop words are always ignored, even if they
are enclosed in quotation marks.
• Parenthesis
– Use parentheses to nest query terms within
other query terms using Boolean operators.

22. Stop Words
Are always ignored, even if they are enclosed in quotation
marks.
This allows the search engine to retrieve a more precise
Result List, especially for a natural language (relevancy
ranked) search.
Stop words vary by database. A sample list of common
stop words appears below.
a
an
are
as
at
be
because
been
but
by
for
however
if
in
is
of
on
so
the
there
to
was
were
whatever
whether
would

23. Wildcard
The wildcard is represented by a question
mark ? or a pound sign #.
• To use the ? wildcard, enter your search
terms and replace each unknown character
with a ?.
(For example, type ne?t to find all citations containing
neat, nest or next.)
• To use the # wildcard, enter your search
terms, adding the # in places where an
alternate spelling may contain an extra
character.
(For example, type colo#r to find all citations
containing color or colour.)

24. Truncation
Truncation is represented by an asterisk (*).
To use truncation,
• enter the root of a search term and replace
the ending with an *.
(For example, type comput* to find the words
computer or computing.)
• may be used between words to match any
word.
(For example, a midsummer * dream will return
results that contain the exact phrase, a midsummer
night’s dream.)

25. click the Search Options link to use Limiters or Expanders.
A result list will be displayed that matches the information you
provided.

26. The Result List Screen has three columns ● Narrow your results
● All Results
● Limit your results
You can hide or show the different areas by clicking the control arrows
near the top of your results

27. Citation View
Print
E-mail
Save
Cite
Export
Folder

28. (EBSCOhost User Guide - Searching April 2010 support.ebsco.com)
On the Citation Matcher search screen, enter as much information as you
have into the fields provided (Publication, Volume, Author, Title, etc.) and
click Search.

29. • SmartLinks
– A hyperlink within the citation when the article is
available as full text or a page image (PDF)
within another EBSCOhost database.
• Create a new Account
• My Folder
• Sharing a Folder
• Un-sharing a Folder
• HELP Link
• CME/CE
Additional Features

30. My Folder

31. There are three folder areas for use:
– My Folder – this area holds the items that you have
collected during your current session. This folder
cannot be shared.
– My Custom – custom folders you create, and then
move result items into. You can share custom folders
with other EBSCOhost users, if desired.
– Shared by – custom folders that another user
creates and then shares with you.
You must be signed into My EBSCOhost to access custom
or shared folders.
In order to share a folder, it must be at the “top level” of the
folders.
If you have multiple levels of folders, the sub-folders cannot
be shared.
Sharing a Folder

32. Sharing Options

33. EBSCO Help Link

35. DynaMed

36. Nursing Reference Center

37. Patient Education Reference Center

38. MDConsult

39. Access Medicine

40. STAT!Ref

42. Additional Open Access Links

43. PubMed

44. PubMed Central

45. Centre for Evidence-Based Medicine

46. Founder of the
Oxford Centre for Evidence-Based Medicine
• pioneered and considered to
be the “Father of Evidence-
Based Medicine”
• is a Canadian medical
doctor
• founded the first department
of clinical epidemiology at
McMaster University,
Canada
• well known for his textbooks
Clinical Epidemiology and
Evidence-Based Medicine
David Lawrence Sackett

47. What is EBM?
Evidence-based medicine (EBM) is the integration of best
research evidence with clinical expertise and patient values.
•BEST RESEARCH evidence we mean clinically relevant research, often
from the basic sciences of medicine, but especially from patient centered
clinical research into the accuracy and precision of diagnostic tests (including
the clinical examination), the power of prognostic markers, and the efficacy
and safety of therapeutic, rehabilitative, and preventive regimens. New
evidence from clinical research both invalidates previously accepted
diagnostic tests and treatments and replaces them with new ones that are
more powerful, more accurate, more efficacious, and safer.
•CLINICAL EXPERTISE we mean the ability to use our clinical skills and past
experience to rapidly identify each patient's unique health state and diagnosis,
their individual risks and benefits of potential interventions, and their personal
values and expectations.
•PATIENT VALUES we mean the unique preferences, concerns and
expectations each patient brings to a clinical encounter and which must be
integrated into clinical decisions if they are to serve the patient.

49. Level of Evidence
Level A
– Cochrane Reviews of randomized controlled trials (RCTs) where adequate
data are found for analysis
– Other good quality systematic reviews or meta-analyses of RCTs where
adequate data are found for analysis
– Good-quality RCTs
Level B
– Other RCTs not included in Level A
– Other systematic reviews or meta-analyses not included in Level A
– Rarely, good-quality nonrandomized clinical trials, and very occasionally
other types of study such as case-control studies, clinical cohort studies,
cross-sectional studies, retrospective studies, or uncontrolled studies
Level C
– Evidence-based consensus statements and expert guidelines

50. The U.S. Preventive Services Task Force (USPSTF)
Another grading system for EBM
Quality of Evidence
The USPSTF grades its recommendations according to one of five classifications
(A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit
(benefits minus harms).
The overall evidence for a service is graded on a 3-point scale (good, fair, poor):
• Good: Evidence includes consistent results from well-designed, well-
conducted studies in representative populations that directly assess effects on
health outcomes.
• Fair: Evidence is sufficient to determine effects on health outcomes, but the
strength of the evidence is limited by the number, quality, or consistency of the
individual studies, generalizability to routine practice, or indirect nature of the
evidence on health outcomes.
• Poor: Evidence is insufficient to assess the effects on health outcomes
because of limited number or power of studies, important flaws in their design
or conduct, gaps in the chain of evidence, or lack of information on important
health outcomes.
(U.S. Preventive Services Task Force Ratings: Grade Definitions. Guide to Clinical Preventive Services, Third Edition:
Periodic Updates, 2000-2003. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/clinic/3rduspstf/ratings.htm )

51. Evidence-Based Process
The evidence-based practice process involves the following steps:
1. Problem Identification: Converting information needs into
an answerable question
2. Finding the Evidence: Finding, with maximum efficiency,
the best evidence with which to answer the question
3. Critique: Determining the merit, feasibility and utility of
evidence
4. Summarize the Evidence: Combining findings from all
evidence to make a practice recommendation
5. Application to Practice: Incorporating the recommendation
into a clinical setting or organization
6. Evaluation: Determining the effectiveness of the practice
change over time
EBM is patient centric, beginning & ending with the patient.

52. Thank you for supporting today’s CME Program
& utilizing the E-Library Databases at CMC!
“The Desk Set” (1957) Emmerac is introduced to assist the
researchers…(Emmerac can make a mistake, but only if the human
element made the mistake first upon entering the data)