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Novel Tools and Resources for an Evidence Based Practice . Barbara Walker, Ph.D. walkerb@njhealth.org. Best available research evidence. Clinical Expertise. Patient’s situation and circumstances. Clinical Expertise. The Framework. CD. EBP begins and ends with the patient.

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novel tools and resources for an evidence based practice

Novel Tools and Resources for an Evidence Based Practice

Barbara Walker, Ph.D.

walkerb@njhealth.org

the framework

Best available research evidence

Clinical Expertise

Patient’s situation and circumstances

Clinical Expertise

The Framework

CD

types of clinical questions
Types of Clinical Questions

Diagnosis

Therapy

Harm

Etiology

Prognosis

Cost-effectiveness

Background

Foreground

By Content

By Format

THIS SLIDE COURTESY OF SUE LONDON RUTH LILLY LIBRARY

slide5

background

foreground

slide6
Background questions

Foreground questions

Amount of experience

background questions
Background Questions
  • What are the criteria for diagnosing …?
  • What are the known risks associated with…
  • What is the cost-effectiveness of …
  • What is the prognosis for…
  • What treatments have been found to be most effective for…?
foreground questions
P = Patient Population or Problem

I = Intervention

C = Comparison

O = Outcome

Foreground Questions
slide9

Formulating a Foreground Question(PICO)

In middle aged women with migraine headache

Is there any evidence that acupuncture

Compared to sham treatment, Relaxation training, Biofeedback training, and/or Cognitive Behavioral Therapy

Decrease frequency, intensity, and/or severity of migraines

  • Patient or Population
  • Intervention
  • Compared to…
  • Outcome you would like to measure or achieve
slide11
…QUESTIONS DRIVE THE SEARCH

WHAT to look for ?

WHERE to look?

HOW to search?

slide12

High Sensitivity

THIS SERIES COURTESY OF SUE LONDON IUPUI LIBRARY

slide13

High Specificity

WHAT:

Synthesized literature

WHERE:

Specialized databases

HOW:

Specialized search strategies/filters

slide14

SECONDARY LITERATURE: papers that synthesize original studies

SYSTEMATIC REVIEWS

EB Meta-analyses

EB Guidelines

Traditional reviews

PRIMARY LITERATURE

systematic vs traditional reviews
Systematic vs. Traditional Reviews
  • Focus on a clear clinically relevant question.
  • End with a clinical bottom-line.
  • Specific, pre-determined method and format.
  • Research on research.
  • Search for all relevant studies.
  • Avoid bias
  • Goal is replication
slide16

Traditional reviews

SECONDARY LITERATURE

Guidelines

EVIDENCE-BASED

PRIMARY LITERATURE

Systematic reviews

what are we looking for
What are we looking for?

Evidence that has already been scientifically synthesized for us

A new type of literature

Systematic reviews

Evidence-based guidelines

Others

slide19

Start at the top

You can search specifically for one thing or…

slide21

www.tripdatabase.com

high-quality open-access material to support EBP

slide27
TRIP

Advantages:

  • It’s free public access
  • It contains ONLY evidence-based material

Disadvantages

  • Searches are broad
  • May not contain exactly what you need
  • Everything in TRIP is evidence-based but there is evidence-based literature NOT in TRIP.
uptodate
UPTODATE

DYNAMED

slide31

ESTs from Div 12

http://www.psychology.sunysb.edu/eklonsky-/division12/

slide34

With a subscription

you can

obtain detailed reviews or you can access

summaries free on www.cochrane.org.

slide36

Medline and PsycINFO

  • EBP techniques
slide37

Cochrane / others

PSYCINFO

MEDLINE

IT IS IMPORTANT TO SEARCH BOTH

You may miss some of the best EB resources by searching only PsycINFO

Adapted from Shahram Yazdani, 2002

slide38

MEDLINE

PSYCINFO

DATABASES contain the articles

slide39

VENDORS

Create interfaces to bring the articles to you

MEDLINE

PSYCINFO

DATABASES

slide40

VENDORS

MEDLINE

PsycINFO

PUBMED

free

CSA ILLUMINA

OVID

$$$$$$$$

EBSCO

pubmed
PubMed
  • Clinical Queries
  • Keywords vs. Controlled vocabulary
slide42

CLINICAL QUERIES

http://www.ncbi.nlm.nih.gov/pubmed/

why not just type keywords
Why not just type keywords?

Keywords look for that exact word in the article.

Acupuncture Acupressure

Behavior Behaviour

Tension headache Muscle contraction headache

Depression Major depressive disorder

controlled vocabulary
Controlled Vocabulary

Librarians “tag” each article with labels based on the concepts in the article. These labels are standardized.

This allows the user to retrieve information that uses different terminology for the same concept.

Medline: MeSH terms

slide47
Why : We need to find the relevant scientific evidence quickly and efficiently to inform our practice

What:

A newer literature (pre-appraised)

Where and How: (work your way down the pyramid)

  • Uptodate / Dynamed / emedicine
  • Clinical Evidence
  • Evidence-based guidelines
  • EB journals (EBMH)
  • ESTs
alerts
Alerts
  • Individual journals and databases
  • Medline and PsycINFO:
  • save your search
  • automatic email
  • Ask within your own field…
  • Librarians are your friends…