Tracking Down the Evidence

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Tracking Down the Evidence
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Critically appraising the evidence

• What are the best studies on a topic?
• Are the sources credible?
• Do you have the time or expertise to answer these
  questions?

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3 pronged approach to EBP
Patients characteristics values
Clinically relevant research, the literature
Practitioners knowledge experience
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http//ebling.library.wisc.edu/
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Tracking Down the Evidence Involves

• Understanding your information need
• Formulating a searchable question
• Defining levels of evidence
• Identifying the appropriate information resources
  
• Evaluating search results
• Understanding the organic nature of the process

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Converting need for information into questions

• Background info
• General knowledge about disease or condition
• What, when, how type questions
• Obtain info from books, texts, review sources
• Foreground info
• Specific knowledge about managing a patient or
  disorder
• Is this therapy better than no therapy for this
  specific patient?
• Obtain from journal databases (CINAHL/PubMed) or
  EBP resources

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Hierarchy of Evidence

• Meta Analyses
• Systematic reviews
• Evidence-based guidelines
• Randomized control trials (RCTs)
• Control trails w/o randomization
• Case-control and cohort studies
• Case studies/Qualitative studies
• Opinion of authorities

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Sample Scenario

• A parent of an obese son asks about weight loss
  medication for her son

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Converting need for information into questions

• Patient population/disease/condition
• Intervention
• Comparison
• Outcome

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Scenario again

• In a 14 year old obese male,how effective is the
  drug Meridia for long term weight loss?

P
I
O
C no comparison/placebo
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Search terms

• P 14 yo obese male
• I Meridia
• C
• O long term weight loss?

P obese obesity overweight
I Meridia sibutramine
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Scenario again

• Background
• Weight loss options for obesity
• Foreground
• In a 14 year old obese male,how effective is the
  drug Meridia for long term weight loss?

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Background Information

• MedlinePlus
• Nursing Consult
• NCBI Bookshelf
• Others

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Foreground Information

• PubMed
• Covers 4600 health and biomedical journals in
  medicine, nursing, pharmacy, dentistry, and
  allied health.
• Search tips
• Use the limits feature to limit results to
• Meta Analysis ? Publication Type limit
• Systematic Reviews ? Subject Subset limit
• Guidelines ? Publication Type limit

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Foreground Information

• CINAHL
• Covers 1800 health journals and other
  publications (society guidelines, conference
  proceedings, book chapters, newsletters, etc.) in
  nursing and allied health.
• Search tips
• Use the Evidence Based Practice Special Interest
  Category to limit results to
• Meta Analysis
• Systematic Reviews
• Guidelines

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Foreground Information

• A guideline is a guideline.
• Utilize guidelines created by experts as one
  resource for best evidence.
• Evidence-based practice requires the practitioner
  to apply their knowledge experience and the
  patients values characteristics to the best
  evidence (guideline)

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Foreground Information

• Agency for Healthcare Research and Quality
• National Guidelines Clearinghouse
• Includes both evidence-based and opinion-based
  guidelines.
• 1300 guidelines on diseases and 120 on mental
  disorders(over 600 are intended for nurses)
• Search tips
• Use OR to search synonyms, abbreviations, brand
  and generic names
• Use truncation character () to find variation of
  a word stem
• Try using the Detailed Search

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A little hands-on
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Scenario in yellow Wound care

• Various solutions have been recommended for
  cleansing wounds, however normal saline is
  favored as it is an isotonic solution and does
  not interfere with the normal healing process.
  Tap water is commonly used in the community for
  cleansing wounds because it is easily accessible,
  efficient and cost effective however, there is
  an unresolved debate about its use. Find evidence
  on this topic

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Clinical Question

• In patients with a wound that needs cleansing,
  will tap water compared with saline solution
  improve or equal the rates of healing?

P
I
C
O
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Take a few minutes to

• Using the case, construct a clinical question
• Identify the search terms
• Select appropriate resources
• Execute your search
• Evaluate your results

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Short Break!