Janet G Schnall, MS, AHIP

1
Using HealthLinks A Source for Evidence-Based
Resources for Answering Clinical Questions
UW Nurse Preceptors

• Janet G Schnall, MS, AHIP
• Information Management Librarian
• Health Sciences Libraries
• University of Washington, Seattle, WA
• schnall_at_u.washington.edu
• September 26, 2009

2
Objectives

• Describe how to access UW restricted
• e-resources from off-campus
• Locate e-resources on HealthLinks to use for
  evidence-based nursing practice
• Identify strategies to improve searching skills
  for finding appropriate evidence on the web to
  answer patient care questions

3
What is evidence-based practice?

• Evidence based medicine is the conscientious,
  explicit, and judicious use of current best
  evidence in making decisions about the care of
  individual patients.
• The practice of evidence based medicine means
  integrating individual clinical expertise with
  the best available external clinical evidence
  from systematic research.
• Sackett DL et al. Evidence based medicine what
  it is and what it isn't. BMJ 1996 Jan 13
  312 (7023) 71-2.

4
Evidence-Based Practice
5
Why do nurses need to do EBP?

• Results in better patient outcomes
• Keeps practice current and relevant
• Increases confidence in decision making
• Fact Research gap takes 17 years for research
  result to make it into practice

6
What makes good evidence?
Shoddy
Good

• Based on scientific research
• RCT
• Systematic review
• Meta-analysis
• Clinical guidelines

• Opinion
• Consensus
• Because its been done this way for 100 years

7
EBP Implications for Nursing

• Are U.S. nurses ready for evidence-based
  practice?
• Many dont understand or value research
• Many have little of no training to help find
  evidence on which to base their practice
• Pravikoff DS, Tanner AB, Pierce ST. Readiness of
  U.S. nurses for evidence-based practice. American
  Journal of Nursing 2005 Sep105(9)
• 40-52.
• Failure to use evidence results in lower quality,
  less effective and more expensive care.
• Berwick DM. Disseminating innovations in health
  care. JAMA 2003 Apr 16289(15)1969-75.

8
Barriers to Nurses using EBP

• Lack of time
• Lack of value of research in practice
• Lack of understanding of electronic databases
• Lack of computer skills
• Difficulty understanding research articles

9
Searching for Evidence Categories
Cochrane,, etc
Metasearch Engines
TRIP, SUMSearch
Evidence Guidelines
NGC, etc
Evidence Summaries
Evidence Summaries DynaMed,, Nursing Reference
Center
UpToDate, etc.
Origiinal Research found with PubMed, CINAHL
other databses
PubMed, CINAHL other databases
10
Connect to UW Restricted Online Resources via
the Proxy Service
11
Proxy Servicehttp//healthlinks.washington.ed
u/howto/connect/

• Allows off-campus access to UW restricted online
  e-texts, e-journals, databases
• Click on the Off-Campus Access link at the top
  right of any HealthLinks page
• Enter your UW NetID name and password

12
(No Transcript)
13
(No Transcript)
14
Bookmark HealthLinks

• http//healthlinks.washington.edu/

15
Explore the Care Provider Toolkit http//healthlin
ks.washington.edu/care_provider
16
Explore e-TextbooksAccess from HealthLinks Care
Provider Toolkit

• UptoDate
• Concise comprehensive uptodate reviews of
  clinical topics in multiple specialties

17
Textbooks
18
Search for the Best Evidence to answer the
Question
19
Search Databases Efficiently for Research
Journal Articles

• PubMed/MEDLINE
• CINAHL or CINAHL Plus

20
PubMed

• Includes MEDLINE (1940s)
• Indexes 5,000 biomedical journals
• Covers all aspects of biosciences and healthcare
• 75-80 of citations have abstracts
• Updated 5x/week

21
2 PubMed Strategies for Finding Evidence-Based
Citations

• Use PubMed Type of Article limits
• Randomized Controlled Trial
• Meta-Analysis
• Practice Guideline
• Clinical Trial
• Consensus Development Conference
• Use the PubMed Clinical Queries and Systematic
  Reviews section

22
urinary tract infections/pc AND catheters
Can easily limit your search to Age
groups Human or Animal studies Language Researc
h or Review articles Subsets, such as Core
Clinical Journals or CAM or Nursing Journals
23
PubMed Limits
urinary tract infections/pc AND catheters
24
(No Transcript)
25
(No Transcript)
26
Full text article
27
NEW
28
PubMed Clinical Queries
2 Strategy Clinical Queries
zinc common cold
zinc common cold
29
Results for Clinical Study Category (RCTs)
(zinc common cold) AND (randomized controlled
30
PubMed Clinical Queries
zinc common cold
zinc common cold
31
Results for Systematic Reviews
32
healthlinks.washington.edu/howto/pubmed
Try
33
CINAHL Plus

• Cumulative Index to Nursing and Allied Health
  Literature
• Provides coverage from 1937 to date, of nursing
  and 17 allied health disciplines literature
• 3800 journals indexed including virtually all
  English-language nursing journals
• Can easily search for Research articles

34
CINAHLPlus Search Screen Search Screen
35
CINAHL Results
36
Expanded CINAHLPlus Results
37
CINAHL Publication Type Limits

• Clinical trial
• Critical path
• Practice guidelines
• Research
• Standards
• Systematic review

38
healthlinks.washington.edu/howto/cinahlplus
39
Search for Clinical Practice Guidelines
40
Clinical Practice Guidelines

• Systematically developed statements of
  appropriate care designed to assist the
  practitioner and patient make decisions about
  appropriate health care for specific clinical
  circumstances
• Usually based on the most current available
  research if from reputable, authoritative
  organizations
• Developed using widely varying standards
• Cost may be considered as well as health outcomes
  or politics

41
Practice Guidelines Resources

• National Guideline Clearinghouse guideline.gov
• Nursing Reference Center ebscohost.com
• PubMed/MEDLINE pubmed.go
• CINAHL/CINAHL Plus cinahl.com
• Google or Advanced Google or Google Scholar
• google.com
• google.com/advanced_search?hlen
• scholar.google.com

42
guideline.gov
43
Guideline Summary
44
(No Transcript)
45
Searching for Practice Guidelinesin PubMed

• Limit to Practice Guideline under
• Type of Article
• CINAHL
• Use Practice guideline as Publication Type

acute kidney failure management
46
Searching for Practice Guidelinesin CINAHL PLUS

• Limit to Practice Guidelines as a
• Publication Type

47
Search for Evidence Summaries and Structured
Abstracts
48
Evidence Summaries and Structured Abstract
Resources

• DynaMed
• Nursing Reference Center

49
DynaMed

• Provides summaries of the best evidence for over
  3,000 clinical topics
• Can quickly browse and find key recommendations
• Updated daily
• Download available for PDA and iPhones

50
(No Transcript)
51
DynaMed
Level 1 evidence
Full-text
52
(No Transcript)
53
Point of Care Evidence-Based Resources have
some level of evidence-based information

• DynaMed
• Essential Evidence Plus
• Evidence Matters
• PEPID
• UptoDate

54
UpToDate

• UpToDate
• Concise comprehensive up-to-date reviews of
  clinical topics in multiple specialties
• Most heavily used clinical e-resource at the UW
  Health Sciences Libraries

55
UpToDate
56
Point of Care EBP Nursing ResourceNursing
Reference Center

• Includes Evidence-Based Care Sheets
  (Evidence-based summaries on key topics
  incorporating the best available evidence through
  rigorous systematic surveillance)
• Also includes full-text journals and texts
  practice guidelines skills and procedures
  patient education materials and more

57
(No Transcript)
58
Nursing Reference Center
Evidence-Based Care Sheet
59
Nursing Reference Center
60
(No Transcript)
61
(No Transcript)
62
Use Meta-Search Engines
Allow you to search multiple other search
engines simultaneously and combines the results
63
Special Meta -Search Enginesthat find evidence
sites
TRIP
SUMSearch
SUMSearch
64
TRIP Databasewww.tripdatabase.com

• Meta-search engine
• Performs a simple search of more than
• 75 databases
• Finds evidence-based resources
• Searches Cochrane, National Guideline
  Clearinghouse, Bandolier, etc.

65
TRIP search prevention of pressure ulcers
66
Search for Systematic Review and Meta-Analyses
Resources

• Cochrane Database of Systematic Reviews
• PubMed Systematic Reviews
• CINAHL/CINAHL Plus

67
Systematic review vs Meta-analysis

• Systematic review a literature review focused on
  a single question which tries to identify,
  appraise, select and synthesize all high quality
  research evidence relevant to that question.
• Meta-analyses systematic reviews that combine
  the results of several studies using quantitative
  statistics.

68
(No Transcript)
69
Finding Systematic Reviews and Meta-Analyses in
PubMed

• Use Clinical Queries Section Systematic Reviews
• Limit to Type of Article Meta-Analysis

70
Finding Systematic Reviews and Meta-Analyses in
CINAHL Plus

• Refine search to Publication Type
• Systematic Reviews
• Search for Meta Analysis as a Subject Heading

71
Searching for Evidence Categories
Cochrane,, etc
Metasearch Engines
TRIP, SUMSearch
Evidence Guidelines
NGC, etc
Evidence Summaries
Evidence Summaries DynaMed,, Nursing Reference
Center
quality of evidence
UpToDate, etc.
Origiinal Research found with PubMed, CINAHL
other databses
PubMed, CINAHL other databases
72
MedlinePlus medlineplus.gov

• 1 SOURCE for basic quality consumer/patient
  information
• Includes drug information
• Medical Encyclopedia full-text with
  illustrations
• Spanish version
• Preformulated PubMed searches
• Interactive tutorials
• Current health news

73
MedlinePlus Content
Interactive tutorials 165 total
Health topics (today) 800 English 700 Spanish
ClinicalTrials links on display 640 (today)
3 drug and herbal databases approx 1700
monographs
NIH-Seniorhealth 43 topics
ADAM.com encyclopedia approx 4000 monographs
Health news Approx 15-20 new stories added per
day
OR-Live surgery videos 73
Announcement listservs 11 daily weekly
Directories Over 100 directories covering
doctors, hospitals, clinics and libraries.
74
MedlinePlus medlineplus.gov
75
MedlinePlus Medical Encyclopedia Small
bowel resection
1
3
2
76
Final Thoughts

• Contact Your Ultimate Search Engine a
  librarian!
• Remember key resources
• PubMed/MEDLINE and CINAHL
• Evidence-based practice resources

77
For more informationcontactthe UW library
liaisons to the SoN

• Janet G Schnall, MS,AHIP
• 206.543.7474
• schnall_at_uw.edu
• Joanne Rich, MLIS
• 206.616.6601
• jrich_at_uw.edu