Finding the Evidence

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Finding the Evidence Cheryl Hamill Alex
Petrie
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What is Evidence?
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Where and How to Source the Evidence
The Problem of Evidence
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Volume
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Provenance
"The fact that an opinion has been widely held
is no evidence whatever that it is not utterly
absurd. Bertrand Russell
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Currency
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Comprehensiveness
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Relevance
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Acceptability
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Access
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Skills in Finding and Using Evidence
Beyond Google Closing the Evidence
Practice Gap
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Who Produces Evidence Resources?

• Commercial companies - publishers such as
  InfoPOEMS, ClinicalResource_at_Ovid, Clinical
  Evidence, DynaMed, Evidence Matters, TRIP
  Database, UpToDate, MDConsult, NursingConsult,
  journal publishers
• Professional bodies (SIGN)
• Government agencies (AHRQ, NHRMC, Prodigy, NICE)
• Institutes (Joanna Briggs Institute)
• Collaborative bodies (Cochrane Campbell
  Collaborations)

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Finding Evidence
Its All Available on the Web ? Its All Freely
Available on the Web
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Finding Evidence
Whats Freely Available

• Cochrane Library (because the Government has paid
  for a national site licence)
• Parts of the Joanna Briggs Institute site
  (including the Best Practice Information sheets)
• Database of Uncertainties about the Effects of
  Treatments (DUETS)
• Bandolier (after a 6 month delay)
• PEDro
• OTseeker
• TRIP Database (Turning Research Into Practice)

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Finding Evidence
Whats Freely Available

• SUMsearch
• A wide variety of clinical guidelines and
  guidelines finders (NHMRC, NICE, SIGN, NeLH
  Guidelines finder, National Guideline
  Clearinghouse)
• Some online journals
• PubMed index with the Clinical Queries
  functionality
• Some online books eg the National Library of
  Medicines Bookshelf and FreeBooks4Doctors
• The NICS Wheres the Evidence online
  guidehttp//wherestheevidence.nicsl.com.au/

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Finding Evidence
Whats Freely Available

• Search engines such as GoogleScholar and Scirus
• Some journals are born digital and are free from
  birth and some are free after an embargo period
• PubMed Central (Journals)
• BioMed Central original research titles free
  but review type titles generally only available
  on subscription
• FreeMedicalJournals.com
• Highwire Press has a free articles section
• Directory of Open Access Journals (DOAJ)

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Finding Evidence
Whats Available for a Fee

• Full access to the Joanna Briggs site, including
  the Clinical Information Service Online Clinical
  Practice Manuals
• Online journals, books, evidence summaries,
  metasearch tools, and packages of information
  such as UpToDate, DynaMed, InfoPOEMS, ACP PIER
  (American College of Physicians Physicians
  Information Education Resource), Scopus, G-I-N,
  Clinical Resource_at_Ovid, Evidence Matters,
  Clinical Evidence, Nursing Consult, MD Consult
  etc etc

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Finding Evidence
Whats Worth Searching for is Determined by

• the clinical question
• degree of clinical risk and other motivating
  factors in the framing of the question
• perception that an answer might be findable
• the clinical culture of the organisation
• available resources
• time available
• skill of the searcher

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Finding Evidence
Skills Development

• Designing Answerable Questions
  tutorialhttp//www.urmc.rochester.edu/hslt/miner/
  resources/evidence_based/
• PubMed online tutorialhttp//www.nlm.nih.gov/pubs
  /web_based.html
• Users Guides to Evidence Based
  Practicehttp//www.cche.net/usersguides/main.asp
• Work with your librarian

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Finding Evidence
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Finding Evidence
Hierarchies of Evidence Information Pathways
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Using Evidence
Evidence Practice Mind
the Gap !

• Obtain evidence relevant to the clinical action
• Choose evidence that has been systematically
  reviewed
• Apply summary evidence within a specific decision
  context at the point of care
• Support and measure the practice change that
  should result from applying the evidence.

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Using Evidence

• "there are five elements of a new or substitute
  clinical behaviour that will each partly
  determine whether adoption or diffusion of a new
  activity will occur
• relative advantage
• the degree to which an innovation is perceived
  as being better than the idea it supersedes
• compatibility
• the degree to which an innovation is perceived
  as being consistent with existing values, past
  experiences, and needs of potential adopters
• complexity
• the degree to which an innovation is perceived
  as difficult to understand and use
• trialability
• the degree to which an innovation may be
  experimented with on a limited basis and
• observability
• the degree to which the results of an innovation
  are visible to others."
• Everett M Rogers as cited in http//www.mja.com.a
  u/public/issues/180_06_150304/san10748_fm.html

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Skills in Finding and Using Evidence
Should you need skills in finding and using
evidence?
Appraising and applying evidence needs clinical
skills. Finding evidence should be easier for
clinicians.
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Links
AHRQ Agency for Healthcare Research Quality (US)
http//www.ahrq.gov free American College of
Physicians ACP PIER Physicians Information
Education Resource http//pier.acponline.org/index
.html subscription required and can be bought as
part of StatRef http//www.statref.com Bandolier
http//www.jr2.ox.ac.uk/bandolier/ some parts
free, some on subscription BioMedCentral Journals
http//www.biomedcentral.com/ free Bookshelf
(US National Library of Medicine)
http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbB
ooks free Campbell Collaboration The
international Campbell Collaboration (C2) is a
non-profit organization that aims to help people
make well-informed decisions about the effects of
interventions in the social, behavioral and
educational arenas. http//www.campbellcollaborat
ion.org/ Clinical Evidence http//www.clinicalev
idence.com subscription Clinical Resource_at_Ovid
http//www.ovid.com/site/products/tools/ovid/Clini
calResource.jsp subscription required Cochrane
Library http//www.thecochranelibrary.com
free Database of Uncertainties About the Effects
of Treatments (DUETS) http//www.duets.nhs.uk/
free Directory of Open Access Journals
http//www.doaj.org Free
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Links
DynaMed http//www.dynamicmedical.com/
subscription required Evidence Matters
http//www.il.proquest.com/products_pq/description
s/evidence_matters.shtml subscription
required FreeBooks4Doctors http//freebooks4doct
ors.com/ free FreeMedicalJouranls.com
http//highwire.stanford.edu/lists/freeart.dtl
free Google http//www.google.com
free GoogleScholar http//scholar.google.com
free to search items found will include
resources that need to be paid in order to gain
access Guidelines Finder (NHS)
http//libraries.nelh.nhs.uk/guidelinesFinder/
free Guidelines International Network G-I-N
seeks to improve the quality of health care by
promoting systematic development of clinical
practice guidelines and their application into
practice, through supporting international
collaboration. G-I-N's Guideline Library
contains regularly-updated information about
guidelines of the G-I-N membership. In March 2006
more than 3,300 documents are available.
http//www.g-i-n.net/ membership required
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Links
Highwire Press http//highwire.stanford.edu/lis
ts/freeart.dtl this is the free section of
Highwire Press InfoPOEMS http//www.infopoems.co
m Patient Oriented Evidence that Matters
subscription required Joanna Briggs Institute
http//www.joannabriggs.edu.au/about/home.php
some parts free, some parts require a
subscription MD Consult http//www.mdconsult.com
subscription required National Health and
Medical Research Council Links to Clinical
Practice Guidelines (Aust)http//www.nhmrc.gov.au
/publications/subjects/clinical.htm
free National Guideline Clearinghouse (US)
http//www.guideline.gov/ free New Zealand
Guidelines Group http//www/nzgg.org.nz
free NICE National Institute for Health and
Clinical Excellence (UK) http//www.nice.org.uk/
free Nursing Consult http//www.nursingconsult.c
om subscriptions required NICS National
Institute for Clinical Studies
http//www.nicsl.com.au OT Seeker OTseeker is
a database that contains abstracts of systematic
reviews and randomised controlled trials relevant
to occupational therapy. http//www.otseeker.com
free
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Links
PEDro Physiotherapy Effectiveness Database
http//www.pedro.fhs.usyd.edu.au/index.html
free Prodigy PRODIGY Knowledge is an
up-to-date source of clinical knowledge that can
help healthcare professionals and patients in
managing the common conditions generally seen in
primary and first-contact care. PRODIGY Knowledge
is practical and reliable, supporting safe and
effective clinical practice. http//www.prodigy.n
hs.uk free Protocols Care Pathways Knowledge
Service (NHS) http//libraries.nelh.nhs.uk/pathway
s/ free PubMed http//pubmed.gov
free PubMedCentral http//pubmedcentral.gov
free Scirus http//www.scirus.com/srsapp/
free to search items found will include
resources that need to be paid in order to gain
access Scopus http//www.scopus.com/scopus/home.u
rl search engine subscription required SIGN
Scottish Intercollegiate Guidelines Network
http//www.sign.ac.uk/ free SUMsearch
SUMSearch is a unique method of searching for
medical evidence by using the Internet. SUMSearch
combines meta-searching and contingency searching
in order to automate searching for medical
evidence. http//sumsearch.uthscsa.edu/
free TRIP Database Turning Research into Practice
TRIP - the most reliable evidence in healthcare
searched quickly and intelligently with one
interface. http//www.tripdatabase.com UpToDate
http//www.uptodate.com/ subscription
required