This document discusses strategies for searching secondary sources of evidence to answer clinical questions. It begins by distinguishing between primary sources like original studies and secondary sources like syntheses, synopses, textbooks, and guidelines. It then provides an overview of popular secondary sources within each category, including systematic reviews, critically appraised abstracts, textbooks like UpToDate, clinical practice guidelines, and decision support systems. It emphasizes the importance of appraising the quality of secondary sources. Finally, it discusses paid evidence services and meta search tools that can help clinicians efficiently find relevant evidence to inform decisions.
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Searching Secondary Sources: A 6-Step Model for Evidence-Based Practice
1. SearchingSecondary Sources SohailBajammal, MBChB, MSc, FRCS(C), PhD(c) ssbajammal@uqu.edu.sa Assistant Professor of Orthopaedics, Faculty of Medicine Vice Dean, Academic Development, Faculty of Dentistry
2. How many questions do you ask yourself at the end of a busy clinical day? What % you look up? What % you answer?
5. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 Computerized decision support system Evidence-Based Guidelines & Textbooks Secondary Critically-Appraised Journal Articles & Abstracts Systematic Reviews RCTs, Cohort, Case control, Case series Primary Expert Opinion: Classical Textbooks
7. Primary Sources Original articles Through databases: MEDLINE, EMBASE Using: PubMed, OVID You have to retrieve and appraise the articles Strength (pyramid) of evidence
11. It is a “strategy” Low Back Pain Treatment OR OR Low Back Ache Management Acute OR OR Low Backache Therapy AND AND OR OR "Low Back Pain"[Mesh] Surgery
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15. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13
16. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13
22. Satisficing ‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience” Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.
23. Usefulness of information Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.
28. Syntheses The authors have done the work for you Hopefully: They asked a good question They searched the literature systematically (keywords & MeSH) They identified the studies and assessed their quality This is called Systematic Review If they did statistical combination of results, this is called Meta-analysis
29. How to search for “Syntheses”? Same databases: MEDLINE, EMBASE Cochrane Library
40. Synopses Physicians with training in research methodology: Read the articles Assess their quality Summarize them for you Many sources: Database of Abstracts of Reviews of Effects (DARE) ACP Journal Club Evidence-based sections in many journals Others: DynaMed, EvidenceMatters, EssentialEvidence
61. Guidelines Types of guidelines: Consensus Evidence-based Use the limiting features in the website
62. Guidelines NICE: National Institute for Health & Clinical Excellence SIGN: Scottish Intercollegiate Guidelines Network NGC: National Guideline Clearinghouse
146. Searching for evidence DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009