4. SEARCHING FOR THE EVIDENCE
Evidence Based Practice
Gebb, B.A., Young, Z., & Anderson, B.A. (2012). Evaluating and using the evidence. In B.A. Anderson &
S. Stone (Eds.), Best practices in midwifery: Using the evidence to implement change. New York:
Springer Publishing.
5. Evidence Based Practice
• What is EBP?
– Most commonly cited definition is “the
conscientious, explicit, and judicious use of
current best evidence in making decisions about
the care of individual patients.”
– Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., &
Richardson, W.S. (1996, January 13). Evidence-based
medicine: what it is and what it isn’t. BMJ, 312(71).
Retrieved from
http://www.bmj.com/content/312/7023/71.full
7. Evidence Based Practice
The EBP Cycle
• Identifying a clinical problem
• Formulating a focused, answerable question
• Locating relevant and appropriate resources
• Searching for information
• Critically appraising the information
• Implementation in clinical practice
8. Form a Clinical Question
• Must be focused and answerable
NOT
What are therapies for depression?
INSTEAD
Does exercise reduce depressive symptoms in
women?
9. Form a Clinical Question
PICO framework:
P – patient/problem
I – intervention
C – comparison
O – outcome
10. Form a Clinical Question
Does exercise reduce depressive symptoms in
women?
P – women with depression (age group?)
I – exercise (how strenuous? how often?)
C – medication
O – symptom reduction, quality of life
11. Locate Resources
• Where is the Evidence?
– Traditional bibliographic databases
– Meta-search engines
– Point of Care resources
14. Point of Care Tools
• DynaMed
• Essential Evidence Plus
• Natural Standard
• Lexicomp
15. Search for Information
• Advanced Search Strategies
– Boolean Operators
– Field Searching
– Subject Headings
– Limiters
– Research Filters
16. Boolean Operators
AND – both terms must be present
(will narrow a search)
OR – either term is present (will
broaden a search)
NOT – only first term is present
(will exclude terms)
17. Boolean Operators
• exercise AND depression – will retrieve articles
with both words
• zoloft OR sertraline – will retrieve articles with
either word
• exercise NOT running – will retrieve articles
with exercise and exclude those with running
19. Subject Headings
• Specific words or phrases selected from a
controlled vocabulary that describe a work
– MEDLINE = MeSH
– CINAHL = CINAHL Headings
20. Limiters
• Parameters for your search
– MEDLINE limiters include:
• Age group
• Publication type
• Language
• Dates
21. Research Filters
• Research filters are pre-designed search
strategies
• Clinical Queries
– PubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinical
– Limiter in MEDLINE (EBSCOhost)
– ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical
trials[MeSH Terms] OR clinical trial[Publication Type] OR
random*[Title/Abstract] OR random allocation[MeSH
Terms] OR therapeutic use[MeSH Subheading])
24. Finally…
• Don’t forget about librarians as a resource!
• Call us before starting your literature review!
25. Library Staff
• Billie Anne Gebb, Director of Library Services
– billieanne.gebb@frontier.edu
– (859) 899-2519
• Zach Young, Assistant Director of Library Services
– zach.young@frontier.edu
– (859) 899-2511
• Aimee Niles, Library Technician
– aimee.niles@frontier.edu
– (859) 899-2526
26. Stay in Touch!
• Find us on Facebook
• Follow us on Twitter @FSMFNLibrary
• Read the FNU Library blog:
http://frontierlibrary.blogspot.com/
• Email
• Phone
Notas del editor
Library is housed in Aunt Hattie’s Barn
Most resources are online
The library website is your gateway to our online resources – brief tour of website
Library 101 is a tutorial on information literacy and using our library – find on the Get Help page
We want to talk mainly today about searching for evidence – search strategies to use in evidence based practice
We wrote a chapter in Best Practices in Midwifery about using evidence and this presentation follows that chapter outline
This is a word cloud of the chapter
Most commonly cited definition from seminal article in BMJ
Evidence Hierarchy – best evidence on top
Systematic Reviews – an overview of all primary studies on a topic; “interrogating the literature”
Meta-analyses – combine statistical data from individual studies and recalculate
Critical appraisal – summaries to answer specific clinical questions – often found in point of care tools
RCTs – patients/subjects assigned to either receive treatment or serve as a control; other variables do not come into play
Cohort and case-controlled studies – compare two groups (one with condition or intervention, one without); cohort follows the groups over time, case control looks at histories
Consensus statements – guidelines from respected authorities (professional organizations)
Anecdotal information – least reliable since it cannot be verified, but uses experience
EBP cycle – we come in mostly in 3 and 4
Some add a T for time frame
These are the ones we have – there are others
Field – individual piece of information within a record
Sensitivity (broad) vs. Specificity (precise)
Zach will demo RefWorks
Most important resource…
Once you pick your topic, talk to us before starting lit review
We can discuss subject headings and keywords, resources; brainstorm search strategies, etc.