Searching: Steps for Success

1
Searching Steps for Success

• September 6th 2007
• Island Health

2
Meet the trainers

• Abigail Barker Healthcare Library, Queen
  Elizabeth Hospital
• Mary Last Bloomsbury Healthcare Library
  UCLH
• Louise Wann Patricia Bowen Library, West
  Middlesex UHT
• Jane Willson Knowledge and Library
  Services,Newham University Hospital

3
Learning Objectives

• At the end of this course, all participants will
  be able to
• Carry out a search using the evidence based
  process
• Identify search terms
• Apply the key elements of a search question to a
  PICO model
• Use the Boolean operators AND, OR and NOT to
  combine search terms

4
What do you think makes a good search?
5
An Introduction to Evidence Based Practice

• Aims and objectives
• To complete a search using the evidence based
  process.

6
What is Evidence Based Practice ?

• the conscientious, explicit and judicious use
  of current best evidence in making decisions
  about the care of the individual patient.
  Sackett D. et al., 1996
• is an approach to decision making in which the
  clinician uses the best evidence available, in
  consultation with the patient, to decide upon the
  option which suits that patient best Muir Gray
  JA., 1997

7
Why is Evidence Based Practice important?

• Best for patient care
• When Clinicians have access to information, it
  changes their patient care management decisions.
  (Sackett D, 1998 Crowley S, 2003)
• Without current best evidence, practice risks
  becoming rapidly out of date, to the detriment of
  patients. (BMJ 1996 312 71-2)
• http//www.cebm.net/?o1014

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The Hierarchy of Research Evidence
Systematic Review
A review in which all available evidence on a
particular subject is systematically identified,
appraised and summarised.
A group of patients are randomly allocated to
receive different interventions. Outcomes are
then compared.
Randomised Controlled Trials
Groups of people are selected on the basis of
their exposure to a particular agent and followed
up.
Cohort Study
Survey or interview of a sample of the population
of interest at one point in time.
Cross Sectional Survey
A report based on a single subject or patient.
Case Report
A consensus of experience amongst professionals.
Expert opinion
Anecdotal
Something a bloke told you after a meeting or in
the bar.
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The Evidence Based cycle

• Identify and define the problem
• Formulate a focused clinical question
• Identify the appropriate resources
• Search for valid and relevant information
• Critical appraisal
• Implement in practice

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Identify and define the problem

• Starts with the patient, a clinical question
  arising out of the care of the patient.
• A GP comes to your library with this scenario
  During a regular check up, an elderly patient who
  is feeling unsteady on her feet is nervous about
  falling and asks you what she can do to prevent
  any falls? It is affecting her daily life as she
  enjoys walking but feels less confident at the
  moment and so has cut down her exercise.

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Formulate a focused clinical question

• Well built
• Answerable
• Clearly framed
• Specifies the problem
• Structured
• PICO model, more of which later

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Identify the appropriate resource

• Select the appropriate resource and conduct a
  search
• Databases Cochrane Library, Clinical Evidence,
  TRIP, Medline, Embase etc
• Journals print and electronic
• Web based resources reports, statistics,
  guidelines
• Books

13
Critical appraisal

• Appraise the evidence for its validity and
  applicability
• Are the results of the study valid?
• What are the results?
• Was their any bias?
• CASP guidelines will help work through the
  article
• www.phru.nhs.uk/Pages/PHD/resources.htm

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Implement in practice

• Return to the patient, integrate the evidence
  with clinical expertise, patient preferences and
  apply it to practice.
• After searching The Cochrane Library you find a
  review, which you pass on to the GP.
• The next time they see the patient, they tell her
  that she will be having a home visit to assess
  her environment for potential hazards, and
  suggest that she might like to take up Tai Chi.
• http//tinyurl.com/353ha8