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EXSS-36100 Medical Science II

EXSS-36100 Medical Science II. Laura Kuo lkuo@ithaca.edu March 1, 2012. Outline – Class 1. What is evidence-based practice? How do you build a good clinical question? What are the bibliographic databases to search? MEDLINE CINAHL Cochrane Database of Systematic Reviews

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EXSS-36100 Medical Science II

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  1. EXSS-36100 Medical Science II Laura Kuo lkuo@ithaca.edu March 1, 2012

  2. Outline – Class 1 • What is evidence-based practice? • How do you build a good clinical question? • What are the bibliographic databases to search? • MEDLINE • CINAHL • Cochrane Database of Systematic Reviews • Search strategies • Keyword vs Subject Heading • Boolean • Limits • Search History

  3. Outline – Class 2 • Brief Review and Continuation of Class 1 • How do you build a good clinical question? • Search strategies • Developing PICO on Your Own • Practice Searching on Your Own

  4. Clinical Expertise Research Evidence Patients’ Preferences What is Evidence-based Practice?

  5. What do we mean by “evidence”? The evidence pyramid is used to illustrate the evolution of the literature. As you move up the pyramid the amount of available literature decreases, but … increases in its relevance for application in clinical settings. Image: http://library.downstate.edu/EBM2/2100.htm

  6. Evidence-based Practice: The Process

  7. A well-built clinical question • Patient, population, or problem • Intervention, prognostic factor, or exposure • Comparison or intervention • Outcomes to measure or be achieved

  8. Types of Clinical Questions Once the basic parameters of the clinical question are established, what type of question is it? • THERAPY/INTERVENION – RCT, Meta-Analysis, Systematic Reviews • OUTCOME– Self-Report Instruments, Patient Centered Measures, Quality of Life • DIAGNOSIS • PROGNOSIS • HARM / ETIOLOGY

  9. Clinical Scenario • As an athletic trainer you’re interested in learning various treatment approaches for tennis elbow (Lateral Humeral Epicondylitides/Lateral Humeral Epicondylitis). More specifically, you’re curious to know which ones actually work, or does the pain associated with tennis elbow disappear on its own over time (aka “wait and see”). You’ve heard of everything from Leech Therapy to Surgery, so you’re going to search the literature and find the evidence.

  10. Example (cont.) P I C O Clinical Question: Type of Study:

  11. Searching the Literature - Strategies Before going online, PREPARE! • Identify the relevant database(s) to search • Formulate a clear research or clinical question • Identify the key concept(s) of the question, relevant synonym and alternate terms or spelling • Use Boolean operators to show concept relationships • Apply limits (date, language, age, human…)

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