1. Speech Language Pathology 4543
Sandra A. Martin, M.L.I.S.
Instructor of Library Services
Health Sciences Resource Coordinator
John Vaughan Library Room 305B –

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

3. 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Withdrawn when first case report of severe malformations appeared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Withdrawn following legal cases in the US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 Blackwell Publishing

4. Learning Objectives
To provide a mechanism for students to access the most current speech language pathology and health care information
To familiarize students with specific information resources and services to support the speech language pathology curriculum
To familiarize students with the information retrieval process for evidence-based research and patient care

5. 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

8. From the NSU Libraries Home Page

9. From the Health Professions Page, Click on Speech Language Pathology

10. 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 to report technical problems
Contact Sandra Martin at for search assistance

11. Technical Issues Check your browser Check your Internet Carrier
Chrome works best with our online resources
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 is sometimes slow. Please access the Library Resources for SLP page directly from your browser

12. 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 SLP Web Page
Complete and submit the online registration form
Complete the online request form
Provide complete information about the journal article or book that you need. Indicate your status as a health professions student and include your contact information
If you have questions or need assistance, contact: or

13. Overview of Online Resources
Research and Clinical Databases
e-Journals
e-Books
Evidence-Based Resources

14. Journal Article Databases
CINAHL Complete, ClinicalKey, and MEDLINE, are most frequently used resources to find journal articles on SLP topics
Search these resources when you need articles on subjects, e.g., aphasia, stuttering, stroke, etc.
Databases in this section provide links to full text journal articles and other resources
You must start at the library’s SLP web page to access our subscribed full text

15. 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 “fluency disorders” for “stuttering”
Full text of ASHA journals included
View the brief videol to get started

16. Databases - CINAHL Complete

17. ASHA Journals
Click on the individual ASHA journal titles from the SLP web page
Open the year, volume, and issue you need
Click on the PDF full text icon to display the article

18. Clinical Key
“All in one” database with full text access to 1,000 books and 500 journals in every medical and surgical specialty
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

19. 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
Clinical Key includes “user friendly” interface. Natural language processing of keywords eliminate complicated searches

20. Database Features – Clinical Key

21. 3 Sections in Search Results Screen

22. CK Contains Full Text in “all” Specialties

23. Add one term at a time to narrow topic

24. Limit by Document Type and Specialty

25. Export Images to PowerPoint
The effects of exercise are intimately related to ongoing pathophysiology. During the initial period following traumatic brain injury (TBI), multiple pathophysiological responses are occurring that make the brain more vulnerable to further damage. Exercise at this time may exacerbate ongoing pathophysiology (inner pale red circle). It is likely that the duration of this period is dependent on multiple factors. This includes variables associated with the injury per se, as well as individual characteristics that are likely to encompass genetic and environmental influences. Once initial pathophysiological responses have resolved (outer blue circle), exercise exerts positive effects by providing protection and facilitating recovery. Brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF).
The interplay between neuropathology and activity based rehabilitation after traumatic brain injury
Kreber, Lisa A., Brain Research, Volume 1640, Part A,
Copyright © Elsevier B.V.

26. Science Direct
Peer reviewed journal articles and book chapters published by Elsevier in both subscription and open access resources
Includes full text of Clinical Key journals published before 2007
Does not include MEDLINE
Does include full text of journals not found in MEDLINE searches
Good for scientific & technical journals

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

28. Research Project Examples
Is speech and language therapy more effective than no treatment in improving functional communication in patients with aphasia following stroke?
Evaluate the effectiveness of constraint induced aphasia therapy for patients following stroke.

29. Background vs. Foreground Questions
Asking questions about your proposed topic helps to clarify your knowledge gap
Clarifying type of question helps to determine which sources are most likely to have the answers you need

30. Begin with Background Questions – who, what, how, why, etc.
What are the signs & symptoms, causes, incidence & prevalence of aphasia?
What percentage of stroke survivors experience aphasia?
What percentage of strokes are ischemic?
What is the clinical presentation of ischemic stroke?

31. Answers to Background Questions
ClinicalKey
Topic/Disease Overviews
First Consult Summaries
Book Chapters
UpToDate Evidence Summaries
e-Books

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

33. Foreground Question
In adult patients with chronic aphasia following stroke, [patient] does constraint induced aphasia therapy [intervention] versus no therapy [comparison intervention] stimulate language recovery [outcome]?
PICO Model: Patient, Intervention, Comparison Intervention, Outcome

34. Answers to Foreground Questions
Require precise information about complex issues
Sources should provide current, original clinical research data
ASHA Evidence Maps
ClinicalKey – First Consult, Randomized Control Trials, Systematic Reviews
UpToDate Evidence Summaries
Cochrane Systematic Reviews

35. 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.

36. 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. .

37. 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

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

39. 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

40. 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.

41. New EBM Tools Target High-Quality Studies
MEDLINE - major source of “primary” literature, BUT
Process of searching, selecting, evaluating original research is time consuming and requires critical appraisal skills
Filtered/Synthesized/Evaluated resources - “secondary” literature, e.g., evidence summaries and systematic reviews
Speed application of evidence at “point-of-care”
Grade strength of treatment recommendations
Rate quality of research evidence
Pre-appraised tools have undergone a filtering process to include only those studies that are regularly updated and of higher quality

42. ClinicalKey Contains All “Evidence” Levels

43. ClinicalKey – First Consult Evidence Summary

44. UpToDate Evidence Summary

46. ASHA Evidence Map - Aphasia

47. ASHA - Aphasia

48. If you need Help, contact Sandra