Evidence Informed Decision Making Workshop May 11, 2010 Liz Bayley, Health Sciences Library
Learning Objectives Explain and demonstrate use of preappraised sources of evidence Give an overview of resources to search for best external evidence
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)
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 (http://www.learning.cihr-irsc.gc.ca/course/view.php?id=10)
Clinical Decisions Clinical state, setting, and circumstances Patient values, preferences and actions Clinical Expertise Clinical Expertise Research evidence Health care resources
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
Framing Question P opulation / Situation I ntervention / Exposure C ounter intervention O utcome
Framing QUALITATIVE Question P opulation S ituation T ype of study
PICO(T) and PS(T) can be used to: Structure your search Evaluate your results for relevancy
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
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
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.
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
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.
http://pubmed.gov
PubMed Clinical Queries
Clinical Queries Filter Table
http://pubmed.gov Special Queries
PubMed Special Queries
PubMed Health Services Research (HSR) Queries Searching for
CINAHL Clinical Queries
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.
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
Synopsis of a Single Study: ACP Journal Club http://www.acpjc.org/
Synopsis of a Single Study: ACP Journal Club http://www.acpjc.org /
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.
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
Sources of Systematic Reviews The Cochrane Library Agency for Healthcare Research and Policy Health care journals
http://www.cochrane.org/reviews/
http://www.campbellcollaboration.org/
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.
http://www.crd.york.ac.uk/crdweb/
http://health-evidence.ca
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.
Summaries "These include clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating.
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
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
http://www.rnao.org/bestpractices/ Best Practice Guidelines
http://www.rnao.org/bestpractices/ Best Practice Guidelines
Detailed Search Searching for http://www.guideline.gov/ National Guideline Clearinghouse
http://www.guideline.gov/
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
http://www.clinicalevidence.com 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
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
PIER
PIER
PIER
PIER
FirstCONSULT From MD CONSULT (Elsevier) Includes background, diagnosis, rapy and outcomes prognosis Evidence only attached to rapy
FirstCONSULT
FirstCONSULT
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
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."
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.
http://www.tripdatabase.com TRIP (Turning Research into Practice)
TRIP Searching across hierarchy
Staying Current Nursing + : best evidence for nursing care OBESITY + Public Health +
http://www.nccmt.ca/tools/public_health_plus-eng.html
Consumer Resources MEDLINEplus (http://medlineplus.gov) Informed Health Online (http://www.informedhealthonline.org) Bandolier Healthy Living Zone (http://www.medicine.ox.ac.uk/bandolier/)
http://www.cochrane.org/reviews/
http://hsl.mcmaster.ca/resources/topic/eb/nurse.html
LibAccess Username: eidm2010 Password: eidm
Liz Bayley HSC-2B28 905-525-9140, ext. 22545 bayleyl@mcmaster.ca Laura Banfield HSC-2B33 905-525-9140, ext. 20239 banfie@mcmaster.ca Neera Bhatnagar HSC-2B30 905-525-9140, ext. 23775 bhatnag@mcmaster.ca