SEARCHING FOR EVIDENCE BASED PRACTICE

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SEARCHING FOR EVIDENCE BASED PRACTICE
Health Sciences Library
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Description

• This module introduces the concept of Evidence
  Based Practice (EBP) and demonstrates how to
  effectively search for EBP information
• Note This module has 40 slides and should take
  20-25 minutes to complete. It is followed by an
  10 question post-test.
• Last reviewed 5/09

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Objectives

• Upon completion of this module, the participant
  will
• Understand what Evidence Based Practice (EBP) is
  and why it is important.
• Understand the steps involved in the EBP process.
  
• Understand importance of critically appraising
  the evidence.

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Introduction

• What is Evidence Based Practice (EBP)?
• Evidence-based practice is a framework for
  clinical practice that incorporates the best
  available scientific evidence with the expertise
  of the clinical staff and the patients
  preferences and values to make decisions about
  health care.
• Levin, R. Teaching Evidence-based practice in
  nursing. NY Springer, 2006. Pg. 6.

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EBP Process

• Five steps in the EBP Process
• 1. Create focused questions
• 2. Find evidence that answers the question
• Critically appraise the evidence for validity and
  
• usefulness
• 4. Apply the results in clinical practice
• Evaluate the clinical application of the evidence

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EBP Process

• Step 1 Create focused questions
• Construct a well-built question derived from a
  case. Do you need information on nursing
  intervention, treatment, diagnosis, prognosis or
  etiology?
• The clinical question should consider
• Patient population age, sex, disease symptoms
• Is the concern treating, preventing, or
  diagnosing disease, defining prognosis or
  determining disease etiology?
• Comparison of treatment, prevention or diagnostic
  method
• Expected outcome

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EBP Process

• Step 2 Find evidence that answers the question
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• EBM information can be found in
• Cinahl
• Nursing _at_ Ovid
• MEDLINE
• PubMed
• Other specialized databases
• ACP Journal Club
• Clinical Evidence
• Cochrane Database of Systematic Reviews
• Database of Abstracts of Reviews of
  Effectiveness (DARE)
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• All of these databases can be accessed from the
  Health Sciences Library Home Page at
  http//library.luhs.org.

 
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EBP Process

• Step 3 Critically appraise the evidence for
  validity and usefulness
• Determine validity of each article
• Primary Guides
• Was the assignment of patients to treatment
  randomized?
• Were all patients who entered the trial accounted
  for and attributed at its conclusion?
• Was follow-up complete?
• Were patients analyzed in the groups to which
  they were randomized?

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EBP Process

• Step 3 Critically appraise the evidence for
  validity and usefulness
• Determine validity of each article
• Secondary Guides
• Were patients, their clinicians and study
  personnel kept 'blind' to treatment received?
• Were the groups similar at the start of the
  trial?
• Aside from the experimental intervention, were
  the groups treated equally?

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EBP Process

• Step 3 Critically appraise the evidence for
  validity and usefulness
• What are the results?
• How large is the treatment effect?
• How precise is the estimate of the treatment
  effect?
• Will the results help me in my patient care?
• Can the results be applied to my patients?
• Were all clinically relevant outcomes
  considered?
• Are the benefits worth the harms and costs?
• From Guyatt GH. Users guides to the medical
  literature II. How to use an article about
  therapy or prevention. JAMA 270(21) 2598-601,
  1993.

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EBP Databases

• Nursing_at_Ovid
• A Comprehensive, Integrated Nursing Allied
  Health Portal
• Supplemented by Ovid with over 1,000 new records
  added each week
• Focuses on core specialties for the nurse in
  practice, education, research, and administration
• Note for tips on searching Nursing _at_ Ovid,
  please refer to the module Searching
  Nursing_at_Ovid.

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EBP Databases

• Cinahl
• Cinahl is the Cumulative Index to Nursing and
  Allied Health Literature
• Covers 1982-present
• Searches can be restricted to Research Articles
• A tag assigned to articles in Cinahl that
  indicates a research study containing data
  collection, methodology, discussion of results,
  etc.
• Has a subject heading Professional Practice,
  Evidence Based
• Cinahl subject heading which is used to in
  articles about clinical practice that bases
  clinical decisions on research, clinical
  expertise, patient choices, and critical
  evaluation of the literature.

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EBP Databases

• ACP Journal Club contains two journals
• ACP Journal Club a publication of the American
  College of Physicians
• Evidence-Based Medicine a joint publication
  with the British Medical Group
• These journals identify studies that are both
  methodologically sound and clinically relevant.
• Editors write enhanced abstracts for articles and
  provide a commentary on the value of each
  article.

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EBP Databases

• Cochrane Database of Systematic Reviews
• Produced by the Cochrane Collaboration
• Includes two types of Systematic Reviews
• - Complete reviews prepared and maintained by
  the Collaborative Review Groups
• - Protocols provide place-markers for reviews,
  which are currently being written. They
  summarize the background and the rationale of
  the review.
• Collaborative Review Groups
• Choose topic of clinical importance
• Scan the literature for EBM articles on the topic
• Synthesize the information into a systematic
  topic review

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EBP Databases

• Cochrane Collaboration
• an international network of individuals and
  institutions committed to preparing, maintaining,
  and disseminating systematic reviews of the
  effects of health care. In pursuing its aims, the
  Cochrane Collaboration is guided by six
  principles collaboration, building on people's
  existing enthusiasm and interests, minimizing
  duplication of effort, avoidance of bias, keeping
  up to date, and ensuring access.
• Systematic Review
• Is a summary of the medical literature that uses
  explicit methods to systematically search,
  critically appraise, and synthesize the world
  literature on a specific issue.

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EBP Databases

• Database of Abstracts of Reviews of Effectiveness
  (DARE)
• Full text database containing critical
  assessments of systematic reviews from medical
  journals
• DARE is produced by expert reviewers and
  information staff of the National Health
  Services Center for Reviews Dissemination,
  University of York, England.

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Searching Cinahl
Access Cinahl or Nursing_at_Ovid from the Quick Link
section of the Health Sciences Librarys homepage
at http//library.luhs.org
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Searching Cinahl
Case Study Managing patients pain effectively
can be difficult for nurses, especially if the
patient cannot communicate verbally. In your
nursing unit there has been some discussion of
creating a pain assessment tool which could be
useful in evaluating a patients level of pain.
You need to search for evidence based practice
literature to help guide the development of such
a tool and the policy for its use.
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Searching Cinahl

• Before beginning a search, identify the key
  concepts in the case study
• Nonverbal communication
• Pain assessment
• Evidence based practice
• Search each concept separately before combining
  together.

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Searching Cinahl
Enter in search term or phrase and click on
Browse Cinahl will map your term to the
appropriate subject headings.
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Searching Cinahl
1. Select the appropriate term 2. Click Explode
to include narrower aspects of the concept 3.
Click Search Database
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Searching Cinahl

• The term is posted to the Search History page
  Click on Cinahl Headings to search the second
  concept.

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Searching Cinahl

• After searching for Pain Assessment, the Search
  History page will show

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Searching Cinahl

• Searching tips
• To combine the two concepts together, 1.Select
  terms, 2.click on Add and combine them with the
  3.Search Button.

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Searching Cinahl
Searching tips Use the Search Options link
next to your results listing to focus search
results.
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Searching Cinahl

• Searching Tips
• You can focus your search using Research Articles
  or Evidence based Practice.
• There are also other limits such Publication Type
  (Clinical Trials) or Age Groups.

Note for additional tips on searching Cinahl,
please refer to the module Searching Cinahl.
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Searching Ovid
Access Ovid from the Quick Link section of the
Health Sciences Librarys homepage at
http//library.luhs.org After clicking on Ovid
databases, select the EBM databases from the
database list.
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Searching ACP Journal Club, Cochrane DARE
Clinical question Can nursing intervention ease
the level of pain for a patient? Enter your
search strategy that reflects your clinical
question.
Click on display to see your results
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Searching ACP Journal Club, Cochrane DARE
Viewing EBP Results Click on Topic Review
(Cochrane) or Article Review (ACP Journal Club or
DARE) to view full text.
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Searching ACP Journal Club, Cochrane DARE

• Topic Review
• is the review found in the Cochrane Database of
  Systematic Reviews. Topic Review provides
  information to help readers find the results of
  research quickly and to assess the validity,
  applicability and implications of those results.
• Article Review
• The editors of ACP Journal Club screen the top
  clinical journals on a regular basis and identify
  studies that are both methodologically sound and
  clinically relevant. They write an enhanced
  abstract of the chosen articles and provide a
  commentary on the value of the article for
  clinical practice.

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Searching for EBP in Ovid Medline
Access Medline (Ovid) from the Quick Link
section of the Health Sciences Librarys homepage
at http//library.luhs.org
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Searching Medline Ovid

• The Gold Standard of EBP is the double-blind
  randomized controlled trial.
• To find additional EBP articles that are not part
  of ACP Journal Club, Cochrane, or DARE
• Perform a subject search in MEDLINE
• Click on the Icon at the top of the page
• Scroll down to Publication Types and choose
  randomized controlled trial

   
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Searching Medline Ovid

• If you do not find articles using the above
  methods consider combining your topic with the
  following subject headings
• Clinical trial
• Pre-planned clinical study of the safety,
  efficacy or optimum dosage schedule of one or
  more drugs, devices, or techniques in humans
  according to predetermined criteria of
  eligibility and observed for evidence of
  favorable or unfavorable effects.
• Meta-analysis
• A quantitative method of combining the results of
  independent studies (usually drawn from the
  published literature) and synthesizing summaries
  and conclusions which may be used to evaluate
  clinical effectiveness. It is often an overview
  of clinical trials.
• Double-Blind method
• A method of studying a drug or procedure in which
  both the subjects and investigators are kept
  unaware of who is actually getting which specific
  treatment.

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Searching PubMed for EBP articles

• PubMed is the National Library of Medicines
  search engine for searching Medline. It is
  freely available worldwide on the Internet.
• PubMed should be accessed through the Librarys
  homepage (QuickLinks) to benefit from the
  librarys direct links to electronic full text
  articles and the library catalog.

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Searching PubMed for EBP articles

• Clinical Queries (found on the side bar) can be
  searched to find EBP literature in PubMed.
• Uses built-in filters
• Four categories therapy, diagnosis,
  etiology, prognosis
• Broad, sensitive includes most relevant
  articles some less relevant ones
• Narrow, specific includes mostly relevant
  articles

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Searching PubMed for EBP articles
Clinical question Can nursing intervention ease
the level of pain for a patient? Enter your
search strategy that reflects your clinical
question.
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Evidence Based Practice Additional Resources

• For more information about Evidence Based
  Practice go to the library home page at
  http//library.luhs.org, click on Resources for
  Nursing then click on Evidence Based Nursing
  Practice.

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Evidence Based Practice Additional Resources

• Resources on the Evidence Based Practice page
  include
• Searching filters and tips
• Original Resources for practice guidelines
• Links to EBP journals
• Tutorials and other tools
• For more information, or for help searching for
  Evidence Based Practice information, please
  contact a Research Services Librarian at (708)
  216-9192

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AMA Category 2 Credit for Physicians

• Time spent studying this educational content can
  be self-reported for category 2 credit towards
  the AMA Physician's Recognition Award.
• Each physician should claim only those credit
  hours that he/she actually spent in the
  educational activity.
• LUMC physicians may transcribe these credit hours
  to their personal Category 2 credit log by
  copying and pasting the following address into
  your web browser http//www.meddean.luc.edu/depts/
  cme/credit_reports.htm

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Conclusion
We hope this Computer Based Learning course has
been both informative and helpful. Feel free to
review the screens of this course until you are
confident about your knowledge of the material
presented. By clicking Next on the slide,
you will begin the test.
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Evidence Based Practice in Nursing
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Thank You

• Thank you for your participation