NUTR 4352 Advanced Nutrition Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B marti004@nsuok.edu – 918-444-3263

Knowledge is the Enemy of Disease Sir Muir Gray Existing Knowledge Can Prevent Waste & Errors Poor Patient Experience Adoption of low value interventions Failure to adopt high value interventions

Sandra Martin Provides…. Instruction Research Assistance Small Group Consulting Database Searches Collection Development (Selection of print and online books, audiovisuals, journals and databases) Assistance with any health-related information need Office Hours: Tuesday 10 am to 4 pm – Tahlequah

From the NSU Libraries Home Page, Click on “Health Professions”

Remote Access Enter NT-NSU user id and password to access the library’s electronic resources Contact your instructor if you have problems with your user id or password Contact Darren Tobey at tobey@nsuok.edu to report technical problems Contact Sandra Martin at marti004@nsuok.edu for search assistance

Technical Issues Check your browser Check your Internet Carrier Internet Explorer does not work with our online resources Use Firefox or Chrome Check your Internet Carrier Satellite Systems are frequently erratic or go down entirely during inclement weather Wireless Hotspot You need at least 3G The library link from within Blackboard does not work well. Please access the Library Resources for Nutritional Sciences page directly from your browser

Interlibrary Loan/Document Delivery Services Delivery of journal articles, books, and other items not owned by the library Delivery of books, audiovisuals, and journal articles in the library’s print collection Journal articles delivered electronically if possible ILL Requests Click on Interlibrary Loan link from Nutritional Sciences Web Page (link located under “Library Info”) Complete and submit the online registration form Complete the online request form Provide complete information about the journal article or book that you need and include your contact information If you have questions or need assistance, contact: ill@nsuok.edu or 918-444-3278

Learning Objectives To familiarize students with the information retrieval process for evidence-based research To enable students to use synthesized/filtered/pre-appraised resources to answer research questions To enable students to use the 6S hierarchy of organization of evidence to plan search strategies

What is EBM? “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” Patient Concerns Clinical Expertise Best research evidence EBM Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. This definition of what EBM is and isn’t has gained wide acceptance and made it easier for us to get our points across. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.

EBM Process – 5 Steps ASK: Convert need for information into answerable question ACQUIRE: Find best evidence to answer the question APPRAISE: Critically appraise evidence for validity, impact, and applicability APPLY: Integrate evidence with clinical expertise and patient values ASSESS: Evaluate own effectiveness

“Knowledge is the Enemy of Disease… but only if it is put into action “Knowledge is the Enemy of Disease… but only if it is put into action.” Sir Muir Gray

Is All Evidence Created Equal? Small portion of medical literature is immediately useful to answer clinical questions Understanding “wedge or pyramid of evidence” is helpful in finding highest level of evidence High levels of evidence may not exist for all questions due to nature of medical problems and research limitations

As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting. Source:  Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

Evidence Based Retrieval Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner Requires search terms plus best study design for question plus highest level of evidence

2. Best Study Design for Type of Question Therapy/prevention Randomized controlled trials Diagnosis Prospective cohort, blind comparison to a gold standard Prognosis Cohort, Case Control, Case Series Etiology/Harm

Information Retrieval to conduct Research Comprehensive in scope and time All levels of resources Current and Retrospective Background and Foreground Information

Background Questions Generally ask who, what, why, where or how about a single concept

Background Questions What foods naturally contain Vitamin D? What is the tolerable upper intake level (UL) for Vitamin D in healthy adults? What are the causes of Vitamin D deficiency?

Answers to Background Questions Resources UpToDate First Consult ClinicalKey - eBooks Access Medicine - eBooks

Foreground Questions Usually compare two or more concepts – theories, drugs, treatments, tests, harms or benefits of two approaches

Foreground (Clinical) Question In post menopausal women with osteoporosis, [patient] is calcium plus vitamin D more effective than [intervention] vitamin D alone [comparison intervention] in reducing the risk of hip fracture [outcome]? PICO Model: Patient, Intervention, Comparison Intervention, Outcome

Answers to Foreground Questions Require precise information about complex issues Sources should provide current, original clinical research data Start with evidence-based summaries and systematic reviews Supplement with searches of ClinicalKey [MEDLINE], CINAHL Complete, Science Direct

New Tools Target High-Quality Studies Increase ease of accessing and understanding clinical information Preprocessed - practical resources that facilitate ready access to high-quality research Preappraised – tools that have undergone a filtering process to include only those studies that are regularly updated and of higher quality

Point-of-Care Resources Provide rapid access to concise information to clinicians at the point of care Not a database of articles from books, journals, or guidelines Original, current, summaries written by experts Secondary resources that “point you to” high quality primary resources Formal systems used to grade strength of recommendations and quality of evidence

Information Retrieval for Evidence Based Health Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid and available at point-of-care Developing search strategies that are feasible within time constraints of clinical practice

Summaries UpToDate Evidence based summaries of over 10,000 topics in over 22 specialties 8,500 Treatment Recommendations GRADE System used to score recommendations and strength of evidence Practice changing updates; Updated continuously Drug database; Patient education materials The Gold Standard of summaries

UTD – Smart Search Interface

UTD – fast, current, peer reviewed

UTD – simple search, quick answers

Summaries FirstConsult Search online in Clinical Key App available through NSU subscription to Clinical Key for iPhone or iPad only Create a personal account in Clinical Key Download the app from the Apple app store Login with your CK username and password Concise summaries; sections on differential diagnosis; quality of evidence graded Not updated as rapidly as UTD

ClinicalKey “Autosuggest” displays search term choices

CK First Consult Summary

Systematic Review Analyzes data from several primary studies to answer a specific clinical question Provides search strategies and resources used to locate studies Includes specific inclusion and exclusion criteria (results in less bias) Meta-Analysis (subclass) statistically summarizes results of several individual studies SOURCES: Cochrane Database of Systematic Reviews (Ovid Full Text), Clinical Key

Syntheses Cochrane Database of Systematic Reviews (DSR) Part of the Cochrane Library (1996) Over 3,000 reviews & protocols (reviews in the making) The Gold Standard of systematic reviews Full Text Available in Ovid

CK Search for Systematic Reviews

Not all topics fit the 6S Model High levels of evidence may not exist for all questions

If no synthesized research is available, find individual studies Clinical Key (Includes MEDLINE) Ovid MEDLINE (tools for “precise” search strategies) CINAHL Complete – targets nursing & allied health topics Science Direct – targets scientific and technical topics

Journal Article Databases Clinical Key, CINAHL Complete, and Science Direct are most frequently used resources to find journal articles on Nutritional Sciences topics Search these resources when you need articles on subjects, e.g., vitamin D deficiency, nutrition disorders, diet therapy, etc. Databases in this section provide links to full text journal articles and other resources You must start at the library’s NS web page to access our subscribed full text

Clinical Key “All in one” database with full text access to 1,000 books and 500 journals in every medical and surgical specialty 12 Content Types including MEDLINE, images & videos Access to information at all levels from topic overview to evidence-based data in one search Smart search engine matches first few letters of search word/words to relevant clinical content No complicated search strategies or Boolean connectors Easier than Google – but with reliable, evidence-based results

ClinicalKey “Autosuggest” displays search term choices

Easy to add additional search terms and select source types

MEDLINE Covers 1946-present U. S. National Library of Medicine’s premier database. Contains over 20 million citations to journal articles in medicine, nursing, allied health, and basic sciences as they relate to health care Covers 1946-present Ovid and Clinical Key include “user friendly” interface. Natural language processing of keywords eliminate complicated searches Use Ovid or Clinical Key MEDLINE for links to full text in our subscribed journals

Databases - CINAHL Complete CINAHL stands for Cumulative Index to Nursing and Allied Health Literature Core research tool that contains full text of 1,400 journals and citations in more than 5,300 journals Check the box next to “suggest subject terms” and search CINAHL headings for best results, e.g., search “pediatric obesity” for “childhood obesity” View the brief tutorial to get started

Databases - CINAHL Complete

Databases – Science Direct Scientific database produced by Elsevier Provides journal articles from over 2,500 journals and chapters from almost 20,000 books in all life sciences disciplines Useful to find full text articles on nutrition and dietetics topics in scientific journals across multiple disciplines Contains full text of journals published by the American Academy of Nutrition and Dietetics Choose “Advanced Search” to narrow your search results to full text in selected time periods

Science Direct Choose “Advanced Search” to retrieve only full text

Science Direct Full Text in Journals not Found in Other Databases

If full text is not available in your database search, try another NS Journal Collection Example: Article not in full text in ClinicalKey Search Return to the NS web page and click on “NSU Journals@Ovid” under “e-Journals”

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Take Home Points Focused clinical question (PICO) reveals your search terms and best type of studies Start your search at top of 6S hierarchy and work down (UpToDate, First Consult, Systematic Reviews in Cochrane & ClinicalKey) Be aware of the filters: levels of evidence, graded recommendations, speed of updating Look at more than one resource in the hierarchy. Findings may differ

Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra (email preferred)

If you need Help, contact Sandra marti004@nsuok.edu