4. Evidence Based Practice
SEARCHING FOR THE EVIDENCE
Gebb, B.A., Young, Z., & Anderson, B.A. (2012). Evaluating and using the evidence. In B.A. Anderson &
S. Stone (Eds.), Best practices in midwifery: Using the evidence to implement change. New York:
Springer Publishing.
5. Evidence Based Practice
• What is EBP?
– Most commonly cited definition is “the
conscientious, explicit, and judicious use of
current best evidence in making decisions about
the care of individual patients.”
– Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., &
Richardson, W.S. (1996, January 13). Evidence-based
medicine: what it is and what it isn’t. BMJ, 312(71).
Retrieved from
http://www.bmj.com/content/312/7023/71.full
6. Evidence Based Practice
The EBP Cycle
• Identifying a clinical problem
• Formulating a focused, answerable question
• Locating relevant and appropriate resources
• Searching for information
• Critically appraising the information
• Implementation in clinical practice
7. What is Evidence?
Systematic
Hierarchy of Research Evidence
Hierarchy of Research Evidence
Reviews
Meta-Analyses
Critical Appraisal
Randomized Controlled Trials
Cohort and case-controlled studies
Consensus Statements
Anecdotal Information
8. Search Strategy
• Form a clinical question
– Must be focused and answerable
NOT
What are therapies for depression?
INSTEAD
Does exercise reduce depressive symptoms in
women?
9. Form a Clinical Question
PICO framework:
P – patient/problem
I – intervention
C – comparison
O – outcome
10. Form a Clinical Question
Does exercise reduce depressive symptoms in
women?
P – women with depression (age group?)
I – exercise (how strenuous? how often?)
C – medication
O – symptom reduction, quality of life
11. Boolean Operators
AND – both terms must be present
(will narrow a search)
OR – either term is present (will
broaden a search)
NOT – only first term is present
(will exclude terms)
12. Boolean Operators
• exercise AND depression – will retrieve articles
with both words
• zoloft OR sertraline – will retrieve articles with
either word
• exercise NOT running – will retrieve articles
with exercise and exclude those with running
14. Subject Headings
• Specific words or phrases selected from a
controlled vocabulary that describe a work
– MEDLINE = MeSH
– CINAHL = CINAHL Headings
15. Limiters
• Parameters for your search
– MEDLINE limiters include:
• Age group
• Publication type
• Language
• Dates
16. Research Filters
• Research filters are pre-designed search
strategies
• Clinical Queries
– PubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinical
– Limiter in MEDLINE (EBSCOhost)
– ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical
trials[MeSH Terms] OR clinical trial[Publication Type] OR
random*[Title/Abstract] OR random allocation[MeSH
Terms] OR therapeutic use[MeSH Subheading])
17. Where is the Evidence?
• Traditional bibliographic databases
• Meta-search engines
• Point of Care resources
23. Finally…
• Don’t forget about librarians as a resource!
• Call us before starting your literature review!
24. Library Staff
• Billie Anne Gebb, Director of Library Services
– billieanne.gebb@frontier.edu
– (859) 253-3637 x5019
• Zach Young, Information Service Librarian
– zach.young@frontiers.edu
– (859) 253-3637 x5011
• Kristy Nowak, Library Technician
– kristy.nowak@frontier.edu
– (859) 253-3637 x5026
25. Stay in Touch!
• Library Information Forum on the Banyan Tree
• Find us on Facebook
• Follow us on Twitter @FSMFNLibrary
• Read the FNU Library blog:
http://frontierlibrary.blogspot.com/
• Email
• Phone
Hinweis der Redaktion
Library is housed in Aunt Hattie’s BarnMost resources are online
The library website is your gateway to our online resourcesLibrary 101 is a tutorial on information literacy and using our libraryShould already be enrolled and will stay enrolled so you can consult at any timeExcellent review
We want to talk mainly today about searching for evidence – search strategies to use in evidence based practiceWe wrote a chapter in a forthcoming book on this topic for nurse midwives and this presentation follows that chapter outlineThis is a word cloud of the chapter
Most commonly cited definition from seminal article in BMJ
EBP cycle – we come in mostly in 3 and 4
Evidence Hierarchy – best evidence on topSystematic Reviews – an overview of all primary studies on a topic; “interrogating the literature”Meta-analyses – combine statistical data from individual studies and recalculateCritical appraisal – summaries to answer specific clinical questions – often found in point of care toolsRCTs – patients/subjects assigned to either receive treatment or serve as a control; other variables do not come into playCohort and case-controlled studies – compare two groups (one with condition or intervention, one without); cohort follows the groups over time, case control looks at historiesConsensus statements – guidelines from respected authorities (professional organizations)Anecdotal information – least reliable since it cannot be verified, but uses experience
Field – individual piece of information within a record
These are the ones we have – there are others
Zach will demo RefWorks
Most important resource…Once you pick your topic, talk to us before starting lit reviewWe can discuss subject headings and keywords, resources; brainstorm search strategies, etc.
