Searching for the Best Evidence

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Searching for the Best Evidence
Evidence Informed Decision Making Workshop May 3,
2011

• Liz Bayley
• Health Sciences Library

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What we are hoping you will get out of this
session

• An overview of the resources available to you to
  find the research evidence
• An understanding of the different levels of
  pre-appraised sources of evidence
• An introduction to some new tools
• A feeling of excitement to explore them

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Clinical Decisions
Clinical state, setting, and circumstances
Patient values, preferences and actions
Clinical Expertise
Clinical Expertise
Research evidence
Research evidence
Health care resources 
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Steps of EIDM
1. Formulate an answerable question 2. Conduct an
efficient literature search 3. Critically
appraise the evidence 4. Apply the results in
health care decisions 5. Evaluate the outcome
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Framing the QUANTITATIVE Question

• P opulation / Situation
• I ntervention / Exposure
• C omparison
• O utcome
• T ype of study

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Framing the QUALITATIVE Question

• P opulation
• S ituation
• T ype of study

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

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Pre-Appraised Evidence

• Previously finding high quality evidence
  required
• sophisticated searching know-how
• the application of critical appraisal skills

• Pre-appraised resources
• filtered to include only those studies that are
  of higher quality
• regularly updated so that the evidence is current

FULL DISCLOSURE! DiCenso, Bayley and Haynes
(2009). Accessing pre-appraised evidence
Fine-tuning the 5S model into a 6S model. Annals
of Internal Medicine, 151(6)JC3-2, JC3-3 OR
Evidence-Based Nursing, 12,99-101
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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Studies

• to keep up with the literature
• to update higher levels in the hierarchy
• to contribute to decisions if no higher level of
  pre-appraised evidence is available

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FROM CANADIAN PRESS (APRIL 18, 2010)
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• Searching for studies can be challenging
• Often get large results
• Difficult to separate out the research articles
• Solution
• Using filters to limit to studies with
  particular research methodologies

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http//pubmed.gov
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PubMed Clinical Queries
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Clinical Queries Filter Table
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http//pubmed.gov
Topic-Specific Queries
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PubMed Topic-Specific Queries
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PubMed Health Services Research (HSR) Queries
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CINAHL Clinical Queries
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Congratulations, you have found some studies, but

• No guarantee of quality
• Still need to be critically appraised

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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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Synopses

• Succinct descriptions of an individual study or
  a systematic review.  
• (Haynes, 2001)
• - may include a commentary by an expert
• EXAMPLES
• Evidence-based abstract journals (including
  Evidence-Based Nursing before 2010)
• Database of Abstracts of Reviews of Effects
• health-evidence.ca

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Synopsis of a Single Study ACP Journal Club
http//www.acpjc.org/
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Synopsis of a Single Study ACP Journal Club
http//www.acpjc.org/
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You have found a synopsis of a study

• But should you change practice based on a single
  study? Especially if it is a small study?

Or even better, you have found several synopses
But the different studies give different results
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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Syntheses Systematic Reviews
Meta-analyses / Metasyntheses

• Systematic consolidation of the 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

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Sources of Systematic Reviews

• The Cochrane Library
• Agency for Healthcare Research and Quality (AHRQ)
• Health care journals
• Can use the Systematic Review filter in PubMed
  Clinical queries

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http//www2.cochrane.org/reviews/
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Cochrane Review Plain Language Summary
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http//www.campbellcollaboration.org/
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As with single studies, with Systematic Reviews

• Still no guarantee of quality, although Cochrane
  reviews are considered high quality
• Still need to be critically appraised

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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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DARE Database of Abstracts of Reviews of Effects
http//www.crd.york.ac.uk/crdweb/
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http//health-evidence.ca
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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Summaries

• "These include clinical pathways or textbook
  summaries that integrate evidence-based
  information about specific clinical problems and
  provide regular updating.
• Points to look for
• How the search for evidence was carried out
• Currency
• Explicit levels of evidence
• Explicit connection of recommendations to the
  evidence

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Clinical Practice Guidelines

• systematically developed statements to assist in
  making decisions about appropriate health care
  for specific circumstances
• an attempt to distill a large body of knowledge
  into a convenient readily usable format

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Clinical Practice Guidelines

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

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RNAO Best Practice Guidelines

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RNAO Best Practice Guidelines
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National Guideline Clearinghouse
http//www.guideline.gov/
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http//www.guideline.gov/
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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 other type of well-designed
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
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http//www.clinicalevidence.com

• From BMJ
• Interventions (therapy) only
• Summarizes all interventions, and rates them as
  
• beneficial? harmful
• Background information in About this condition
• Limited coverage of conditions, but growing

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Clinical Evidence uses GRADE - Grading of
Recommendations, Assessment, Development and
Evaluations
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• ACP PIER (Physicians Information and
  Education Resource)
• American College of Physicians
• Through STAT!Ref
• Adult only no pediatrics or Obs/Gyn
• Includes diagnosis, therapy and patient
  education with evidence supporting all
  recommendations
• Includes Complementary and Alternative Medicine

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ACP PIER
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PIER
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PIER
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PIER
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PIER
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
69
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
patients circumstances to the relevant
information."
 
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Hierarchy of Pre-appraised Evidence

• Types of Resources
• Computerized decision
• support systems
• Evidence-based textbooks
• Clinical practice guidelines
• DARE, healthevidence.ca
• Evidence-based journal abstracts
• Systematic reviews
• Evidence-based journal abstracts
• Original published articles in journals

Systems
Summaries
Synopses of Syntheses
Syntheses
Synopses of Studies
Studies
Adapted from DiCenso, Bayley and Haynes (2009).
Accessing pre-appraised evidence Fine-tuning the
5S model into a 6S model. Annals of Internal
Medicine, 151(6)JC3-2, JC3-3 OR Evidence-Based
Nursing, 12,99-101
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TRIP (Turning Research into Practice)
http//www.tripdatabase.com
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TRIP Searching across the hierarchy
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Staying Current

• Nursing best evidence for nursing care
• OBESITY
• Public Health

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http//www.nccmt.ca/tools/public_health_plus-eng.h
tml
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Does 6s work for Public Health?
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http//hsl.mcmaster.ca
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http//hsl.mcmaster.ca/resources/topic/eb/nurse.ht
ml
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LibAccess Username eidm2011 Password
eidm Valid until May 31, 2011
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Liz Bayley HSC-2B28 905-525-9140, ext.
22545 bayleyl_at_mcmaster.ca Laura
Banfield HSC-2B33 905-525-9140, ext.
20239 banfie_at_mcmaster.ca