Searching for the Best Evidence

Transcription

1 Evidence Informed Decision Making Workshop May 11, 2010 Liz Bayley, Health Sciences Library

2 Learning Objectives Explain and demonstrate use of preappraised sources of evidence Give an overview of resources to search for best external evidence

3 Evidence-Based Practice (EBP) The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making (Sackett et al, 2000)

4 There has been a backlash to EBM related to strongly held myth that only acceptable evidence is from randomized controlled trials or meta-analyses. We have begun to use term Evidence-Informed Decision Making (EIDM) to attempt to get beyond some resistance to EB practice, and to connote that or types of evidence are useful in making decisions. CIHR. Introduction to Evidence-Informed Decision Making (

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

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

7 Framing Question P opulation / Situation I ntervention / Exposure C ounter intervention O utcome

8 Framing QUALITATIVE Question P opulation S ituation T ype of study

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

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

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

12 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

13 Studies to keep up with literature to update higher levels such as systematic reviews to contribute to clinical decisions if no higher level of pre-appraised evidence is available

14 FROM HAMILTON SPECTATOR NEWS SERVICES (April 30, 2010) We are more healthy, live longer than Americans Canadians are healthier than Americans -- and live longer, too, according to a U.S. analysis of both countries. In fact, a 19-year-old in Canada can expect to enjoy nearly three more years of "perfect health" than an American of same age. U.S. health economist David Feeny did analysis and says populations north and south of border share many similarities, including standards of living. But Feeny offers re are two possible explanations for gap in life expectancy and quality of life -- universal "prenatal to grave" health care in Canada and prevalence of poverty in U.S. Feeny, who worked at McMaster University and University of Alberta, notes, however that while life expectancy in Canada is high by international standards -- it is by no means highest. The study is published online in BioMed Central's open access journal Population Health Metrics.

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17 PubMed Clinical Queries

18 Clinical Queries Filter Table

19 Special Queries

20 PubMed Special Queries

21 PubMed Health Services Research (HSR) Queries Searching for

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23 CINAHL Clinical Queries

24 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

25 Synopses Succinct descriptions of an individual study or a systematic review. (Haynes, 2001) EXAMPLES: Evidence-based abstract journals Database of Abstracts of Reviews of Effects health-evidence.ca

26 Synopsis of a Single Study: ACP Journal Club

27 Synopsis of a Single Study: ACP Journal Club /

28 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

29 Synses: Systematic Reviews &Metasynses Systematic consolidation of 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

30 Sources of Systematic Reviews The Cochrane Library Agency for Healthcare Research and Policy Health care journals

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38 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

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43 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

44 Summaries "These include clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating.

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

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

47 Best Practice Guidelines

48 Best Practice Guidelines

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50 Detailed Search Searching for National Guideline Clearinghouse

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53 National Guidelines Clearinghouse: Levels of Evidence for Recommendations Ia Evidence obtained from meta-analysis or systematic review of randomized controlled trials Ib Evidence obtained from at least one randomized controlled trial IIa Evidence obtained from at least one well-designed controlled study without randomization IIb Evidence obtained from at least one or type of welldesigned quasi-experimental study without randomization III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies IV Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities

54 From BMJ Interventions (rapy) only Summarizes all interventions, and rates m as to beneficial harmful Background information in About this condition Limited coverage of conditions, but growing

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56 ACP PIER (Physicians Information and Education Resource) American College of Physicians Through STAT!Ref Adult only no pediatrics or Obs/Gyn Includes diagnosis, rapy and patient education with evidence supporting all recommendations Includes Complementary and Alternative Medicine

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63 FirstCONSULT From MD CONSULT (Elsevier) Includes background, diagnosis, rapy and outcomes prognosis Evidence only attached to rapy

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

67 Systems An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient s circumstances to relevant information."

68 Hierarchy of Pre-appraised Evidence Types of Resources Systems Summaries Synopses of Synses Synses Synopses of Studies Studies Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healvidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Adapted from: Haynes, RB. Of studies, synses, synopses, summaries, and systems: "5S" evolution of information services for evidence-based healthcare decisions. Evidence-Based Nursing. 2007;10: 6-7.

69 TRIP (Turning Research into Practice)

70 TRIP Searching across hierarchy

71 Staying Current Nursing + : best evidence for nursing care OBESITY + Public Health +

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73 Consumer Resources MEDLINEplus ( Informed Health Online ( Bandolier Healthy Living Zone (

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79 LibAccess Username: eidm2010 Password: eidm

80 Liz Bayley HSC-2B , ext Laura Banfield HSC-2B , ext Neera Bhatnagar HSC-2B , ext