EXSS-36100 Medical Science II Laura Kuo lkuo@ithaca.edu March 1, 2012

Outline – Class 1 What is evidence-based practice? How do you build a good clinical question? What are the bibliographic databases to search? MEDLINE CINAHL Cochrane Database of Systematic Reviews Search strategies Keyword vs Subject Heading Boolean Limits Search History

Outline – Class 2 Brief Review and Continuation of Class 1 How do you build a good clinical question? Search strategies Developing PICO on Your Own Practice Searching on Your Own

What is Evidence-based Practice? Clinical Expertise Patients’ Preferences Research Evidence

What do we mean by “evidence”? The evidence pyramid is used to illustrate the evolution of the literature. As you move up the pyramid the amount of available literature decreases, but … increases in its relevance for application in clinical settings. Image: http://library.downstate.edu/EBM2/2100.htm

Evidence-based Practice: The Process

A well-built clinical question Patient, population, or problem Intervention, prognostic factor, or exposure Comparison or intervention Outcomes to measure or be achieved

Types of Clinical Questions Once the basic parameters of the clinical question are established, what type of question is it? THERAPY/INTERVENION – RCT, Meta-Analysis, Systematic Reviews OUTCOME – Self-Report Instruments, Patient Centered Measures, Quality of Life DIAGNOSIS PROGNOSIS HARM / ETIOLOGY

Clinical Scenario As an athletic trainer you’re interested in learning various treatment approaches for tennis elbow (Lateral Humeral Epicondylitides/Lateral Humeral Epicondylitis). More specifically, you’re curious to know which ones actually work, or does the pain associated with tennis elbow disappear on its own over time (aka “wait and see”). You’ve heard of everything from Leech Therapy to Surgery, so you’re going to search the literature and find the evidence.

Example (cont.) P I C O Clinical Question: Type of Study:

Searching the Literature - Strategies Before going online, PREPARE! Identify the relevant database(s) to search Formulate a clear research or clinical question Identify the key concept(s) of the question, relevant synonym and alternate terms or spelling Use Boolean operators to show concept relationships Apply limits (date, language, age, human…)