Searching for the Best Evidence

Searching for the Best Evidence Evidence Informed Decision Making Workshop May 3, 2011 Liz Bayley Health Sciences Library

What we are hoping you will get out of this session • An overview of the resources available to you to find the research evidence • An understanding of the different levels of “pre-appraised” sources of evidence • An introduction to some new tools • A feeling of excitement to explore them

Clinical Decisions Clinical state, setting, and circumstances Patient values, preferences and actions Clinical Expertise Clinical Expertise Research evidence Research evidence Health care resources

Steps of EIDM 1. Formulate an answerable question 2. Conduct an efficient literature search 3. Critically appraise the evidence 4. Apply the results in health care decisions 5. Evaluate the outcome

P opulation / Situation Intervention / Exposure C omparison Outcome T ype of study Framing the QUANTITATIVE Question

Framing the QUALITATIVE Question Population S ituation Type of study

PICO(T) and PS(T) can be used to: • Structure your search • Evaluate your results for relevancy

“Pre-Appraised Evidence” • Previously finding high quality evidence required: • sophisticated searching know-how • the application of critical appraisal skills • Pre-appraised resources: • filtered to include only those studies that are of higher quality • regularly updated so that the evidence is current FULL DISCLOSURE! DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Summaries Synopses of Syntheses Syntheses Synopses of Studies Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

to keep up with the literature to update higher levels in the hierarchy to contribute to decisions if no higher level of pre-appraised evidence is available Studies

FROM CANADIAN PRESS (APRIL 18, 2010)

Searching for studies can be challenging: • Often get large results • Difficult to separate out the research articles • Solution: • Using “filters” to limit to studies with particular research methodologies

http://pubmed.gov

PubMed Clinical Queries

Clinical Queries Filter Table

http://pubmed.gov Topic-Specific Queries

PubMed Topic-Specific Queries

PubMed Health Services Research (HSR) Queries

CINAHL – Clinical Queries

Congratulations, you have found some studies, but No guarantee of quality Still need to be critically appraised

Synopses • “Succinct descriptions of an individual study or a systematic review.” • (Haynes, 2001) • - may include a commentary by an expert • EXAMPLES: • Evidence-based abstract journals (including Evidence-Based Nursing before 2010) • Database of Abstracts of Reviews of Effects • health-evidence.ca

Synopsis of a Single Study: ACP Journal Club http://www.acpjc.org/

You have found a synopsis of a study Or even better, you have found several synopses But should you change practice based on a single study? Especially if it is a small study? But the different studies give different results

Syntheses: Systematic Reviews & Meta-analyses / Metasyntheses Systematic consolidation of the literature on a specific topic: comprehensive identification of studies review of study relevance evaluation of methodologic quality extraction of data analysis of data drawing of conclusions

Sources of Systematic Reviews The Cochrane Library Agency for Healthcare Research and Quality (AHRQ) Health care journals Can use the “Systematic Review” filter in PubMed Clinical queries

http://www2.cochrane.org/reviews/

Cochrane Review “Plain Language Summary”

http://www.campbellcollaboration.org/

As with single studies, with Systematic Reviews: Still no guarantee of quality, although Cochrane reviews are considered high quality Still need to be critically appraised

DARE: Database of Abstracts of Reviews of Effects http://www.crd.york.ac.uk/crdweb/

http://health-evidence.ca

Summaries • "These include clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating.” • Points to look for: • How the search for evidence was carried out • Currency • Explicit levels of evidence • Explicit connection of recommendations to the evidence

Clinical Practice Guidelines systematically developed statements to assist in making decisions about appropriate health care for specific circumstances an attempt to distill a large body of knowledge into a convenient readily usable format

Clinical Practice Guidelines Best Practice Guidelines Project RNAO (Registered Nurses Association of Ontario) funded by the Ontario Ministry of Health development, implementation and evaluation of best practice guidelines for nursing

RNAO Best Practice Guidelines

Searching for the Best Evidence

Searching for the Best Evidence

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