1. 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.edumarti004@nsuok.edu – 918-444-3263 1

2. 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 2

3. 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 3

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5. http://library.nsuok.edu/collegesh/healthpr/dn/index.html 5

6. From the NSU Libraries Home Page, Click on “Health Professions” 6

7. From the Health Professions Page, Click on Nutritional Sciences 7

8. 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 problemstobey@nsuok.edu Contact Sandra Martin at marti004@nsuok.edu for search assistancemarti004@nsuok.edu 8

9. Technical Issues Check your browser  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 9

10. 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 ill@nsuok.edu

11. 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 4S hierarchy of organization of evidence to plan search strategies

12. www.cebm.net “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” 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. Patient Concerns Clinical Expertise Best research evidence EBM What is EBM?

13. EBM Process – 5 Steps 1. ASK: Convert need for information into answerable question 2. ACQUIRE: Find best evidence to answer the question 3. APPRAISE: Critically appraise evidence for validity, impact, and applicability 4. APPLY: Integrate evidence with clinical expertise and patient values 5. ASSESS: Evaluate own effectiveness

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

15. 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

16. 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.

17. 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

18. 2. Best Study Design for Type of Question Type of QuestionStudy Design Therapy/preventionRandomized controlled trials DiagnosisProspective cohort, blind comparison to a gold standard PrognosisCohort, Case Control, Case Series Etiology/HarmCohort, Case Control, Case Series

19. Information Retrieval to conduct Research Comprehensive in scope and time  All levels of resources  Current and Retrospective  Background and Foreground Information 19

20. Background Questions Generally ask who, what, why, where or how about a single concept 20

21. 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? 21

22. Foreground Questions Usually compare two or more concepts – theories, drugs, treatments, tests, harms or benefits of two approaches 22

23. Foreground (Clinical) Question In post menopausal women with osteoporosis, is calcium plus vitamin D more effective than vitamin D alone in reducing the risk of hip fracture?

24. 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 24

25. Begin Search at Highest Level of Evidence - Critically Appraised Content Evidence Based Summaries UpToDate, Joanna Briggs Institute Clinical Key for Nursing Clinical Key for Nursing Cochrane Database of Systematic Reviews, Clinical Key for Nursing, Joanna Briggs Institute Clinical Key for Nursing, MEDLINE, CINAHL Complete, Science Direct SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36 http://ebm.bmj.com/cgi/reprint/6/2/36

26. 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

27. Point-of-Care Resources Evidence based textbooks –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 –Formal systems used to grade strength of recommendations and quality of evidence

28. 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

30. UTD – Smart Search Interface

32. UTD – fast, current, peer reviewed

33. UTD – simple search, quick answers

34. Databases – Clinical Key for Nursing All in one resource provides access to e-Journals, e- Books, MEDLINE, images, videos, and more Unique features include full text “disease overviews” with links to related topics and resources Smart Search interface includes:  Autosuggest search terms to quickly display concepts, procedures, and drugs related to your topic  The most current, clinically relevant answers at the top of your search Full text monographs of all FDA approved drugs and patient education handouts 34

35. Databases – Clinical Key for Nursing 35

36. Databases – ClinicalKey for Nursing 36

37. 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 for Nursing, Joanna Briggs Institute

38. Cochrane Database of Systematic Reviews Part of the Cochrane Library (1996) 916 completed reviews, 1905 protocols Among the highest level of evidence upon which to base treatment decisions – the Gold Standard Includes Dx since 2008 Access through OVID 38

39. Appraisal Required by User

40. Primary (Original) Studies Articles that report results of original research investigations Conclusions supported by data and reproducible methodology Require time to acquire and appraise Good Sources: MEDLINE (Clinical Key or Ovid), CINAHL Complete, Science Direct

41. Databases – Ovid MEDLINE Premier biomedical database from the National Library of Medicine Provides journal articles in over 5,000 journals from 1946 to present in medicine, nursing, health care system, and allied health care practice, education, and research Useful to find articles on the relation of nutrition disorders to medical problems, e.g. “intake of fruits and vegetables to prevent cardiovascular diseases” 41

42. Use MEDLINE to locate Articles that report results of primary (original) studies Conclusions supported by data and reproducible methodology Hints:  In Ovid MEDLINE, search the Daily Update, and In-Process segments simultaneously with desired range of years  Search keywords along with subject headings

43. 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 43

44. Databases - CINAHL Complete 44

45. 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 45

46. 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 Clinical Key for Nursing - includes patient education handouts produced by Elsevier Access Medicine – provides comprehensive patient education materials in pdf format for adults and children 46

47. Databases – MEDLINEPlus National Institute’s of Health’s web site for patients and families Produced by the National Library of Medicine Contains current, reliable, well-written information summaries and videos about diseases, conditions, and wellness issues Widely used in major hospitals and medical centers 47

48. Take Home Points Focused research questions reveal your search terms Start your search at top of 4S hierarchy and work down Be aware of the filter, i.e., levels of evidence, speed of updating Look at more than one resource in the hierarchy. Findings may differ Assess validity (methodology) of the studies and applicability (how well they support) your research purpose

49. Tracking Down the Full Text If your database search does not provide a link to full text of a relevant article:  Print a list of the citations  Click on the Library e-Journals link on the Nutritional Sciences web page  Enter full title of the journal in the search box  Click on link to database that contains the full text 49

50. Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra (email preferred) 50

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