Evidence Based Information Retrieval for Nursing 2017 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

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 and by appointment

http://library.nsuok.edu/collegesh/healthpr/nursing/index.html

From the NSU Libraries Home Page

From the Health Professions page, click on Nursing

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 Google Chrome works best with our resources Check your Internet Carrier Satellite Systems are frequently erratic or go down entirely during inclement weather Wireless Hotspot You need at least 3G Please access the Library Resources for Nursing page directly from Chrome. Access via Blackboard can be slow.

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 Nursing 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 & patient care To enable students to use synthesized/filtered/pre-appraised resources to answer clinical questions To enable students to use the 6S hierarchy of organization of evidence to plan search strategies

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

Harmful practices once supported by expert opinion Time period Accepted practice Shown to be harmful Impact on clinical practice From 500 bc Blood Letting 1820 Ceased in 1910 1957 Thalidomide for morning sickness in early pregnancy 1960 Withdrawn when first case report of severe malformations appeared From 1900 Bed rest for acute low back pain 1986 Still advised by some doctors 1960s Benzodiazepines for mild anxiety 1975 “Diazepam” prescribing fell in 1990s due to severe dependence and withdrawal symptoms Late 1990s Cox-2 inhibitors to treat arthritis 2004 Withdrawn following legal cases in the US Source: Adapted from How to read a paper: the basics of evidence-based medicine. 4th edition. By Trisha Greenhalgh. 2010 Blackwell Publishing

What is EBM? “Evidence-based medicine is the integration of research evidence with clinical expertise and patient values.”best Patient Concerns Clinical Expertise Best research evidence EBM Sackett, DL, Richardson, WS, Rosenberg, WMC, & Haynes, RB (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone. .

Evolution of EBM in the Literature Term “evidence based medicine” coined by Dr. Gordon Guyatt at McMaster University Term first appeared in the literature in a 1991 editorial in ACP Journal Club Volume 114, Mar-April 1991, pp A-16 Seminal article by the Evidence-Based Medicine Working Group published in JAMA Volume 268, No. 17, 1992, pp 2420-2425 Importance of evidence as integral aspect of practice and education now included in educational standards for medicine and allied health professions

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

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

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.

Definitions Randomized Controlled Clinical Trial (RCT) Participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest Systematic Reviews and Meta Analyses. A summary of the clinical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies that address a focused clinical question. If the studies report comparable quantitative data and have a low degree of variation in their findings, a meta-analysis can be performed to derive a summary estimate of effect. Point of Care Evidence Summaries Comprehensive, predigested, rapidly accessible, frequently updated, searchable summaries that synthesize the current evidence with links to relevant literature that support clinical decisions for diagnosis, tests, and interventions. Most include a formal system for grading the quality of the evidence and recommendations for practice.

New Approach Requires New Skills Clinical question formulation Search and retrieval of best evidence Critical appraisal of study methods to determine validity of results

Well Built Questions include Elements of PICO Model P - Patient or population I - Intervention C - Comparison Intervention O - Outcome

Therapy/Prevention Questions In patients with urinary catheters [patient], are antibiotic coated catheters [intervention] versus standard catheters [comparison intervention] effective to reduce or prevent catheter associated urinary tract infections [outcome]?

Evidence Based Search Strategy Includes search terms from the clinical question Matches best study design for type of question Retrieves answers at highest levels 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

3. Highest Level of Evidence – 6S Hierarchy

New Search Tools Target High-Quality Studies MEDLINE - major source of “primary” literature, BUT Process of searching, selecting, evaluating original research can be time consuming and requires critical appraisal skills Filtered/Synthesized/Evaluated resources - “secondary” literature”, evidence summaries, e.g., UpToDate and Joanna Briggs Institute filter the journal literature and “point to” current studies of higher quality include a formal system for grading the quality of the evidence and recommendations for practice increase ease of accessing and understanding clinical research information

Evidence Summaries UptoDate Evidence based summaries of over 10,000 topics in over 22 specialties 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

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

JBI Systematic Review

Overview of Online Resources Research and Clinical Databases e-Journals E-Books Consumer Health Information

Journal Article Databases Clinical Key for Nursing (includes MEDLINE), UpToDate, Joanna Briggs Institute, CINAHL Complete, and Nursing@Ovid, and Science Direct are most frequently used resources to find journal articles on nursing topics. Search this section when you need articles on subjects, e.g., electronic medical record, nursing education, pressure ulcers, etc. Databases in this section provide links to full text journal articles and other resources You must start at the library’s Nursing web page to access our subscribed full text http://library.nsuok.edu/collegesh/healthpr/nursing/index.html

Clinical Key for Nursing Access to information at all levels from topic overview to evidence-based data in one search Includes full text journal articles, book chapters, MEDLINE citations, videos, images, drug monographs No complicated search strategies or Boolean connectors View the brief video to get started Easier than Google – but with reliable, evidence-based results

MEDLINE 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 from 1946-present Inclusion of a journal in MEDLINE is a quality measure. “Indexed for MEDLINE” denotes validation of journal legitimacy and quality. The decision of whether or not to index a journal for this service is an important one and is made by the Director of the National Library of Medicine, based on considerations of both scientific policy and scientific quality. Over 5,600 titles are indexed and included in the MEDLINE database. The LSTRC meets three times a year to review journal applications. https://www.nlm.nih.gov/pubs/factsheets/jsel.html Scientific merit of a journal's content is the primary consideration in selecting journals for indexing. The validity, importance, originality, and contribution to the coverage of the field of the overall contents of each title are the key factors considered in recommending a title for indexing, whatever the intended purpose and audience.

Databases - CINAHL Complete CINAHL stands for Cumulative Index to Nursing and Allied Health Literature Core research tool that contains full text of more than1,400 journals Not all journals are peer reviewed. Limit search results to “academic journals” Check the box next to “suggest subject terms” and search CINAHL headings for best results, e.g., search “mentorship” to find articles on “mentoring” View the brief video to get started

Databases – Nursing@Ovid Comprehensive, integrated Nursing and Allied Health portal with full text from 1946 to the current week Content includes nursing practice, education, research, and administration Based on the nursing and allied health subset of Ovid MEDLINE Ovid Nursing Subject Thesaurus provides search terms included in MeSH (medical subject headings) as well as those unique to nursing

Databases – Science Direct Scientific database produced by Elsevier Provides journal articles from over 2,500 peer reviewed journals and chapters from almost 20,000 books in all life sciences disciplines Contains full text of nursing journals not found in other databases Choose “Advanced Search” to narrow your search results to full text in selected time periods

Additional Research Databases Health and Psychosocial Instruments – assists researchers in identifying tests, questionnaires, rating scales in health and psychosocial sciences. Does not include full text of the instruments National Library of Medicine – provides access to hundreds of databases covering a wide range of biomedical information resources Native Health Databases – contains citations and abstracts of documents pertaining to the health care of North American indigenous peoples

e-Books R2 Digital Library – Nursing and allied health books from Doody’s Core Titles in the Health Sciences Books@Ovid - full text of nursing and health sciences books published by Lippincott Williams & Wilkins, American Nurses Association (ANA), Joanna Briggs Institute, Jones-Bartlett, and Springer Publishing ClinicalKey for Nursing – full text of nursing books and handbooks published by Elsevier Access Medicine - text of leading medical and health sciences books from McGraw-Hill ClinicalKey for Nursing and Access Medicine contain full text monographs for the health care professional and the patient of all FDA approved drugs

Consumer Health Resources Current, authoritative, peer-reviewed, and evidence-based resources written specifically for the layperson MEDLINEPlus – the National Institutes of Health’s web site for patients and families Joanna Briggs Database - provides full text consumer information sheets ClinicalKey for Nursing - includes patient education handouts produced by Elsevier Access Medicine – contains patient education materials for adults and children and includes handouts for drugs and medicines

Search Multiple Databases – Findings May Differ

If you need Help, contact Sandra