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 –

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. 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

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

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 to report technical problems
Contact Sandra Martin at for search assistance

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The library link from within Blackboard does not work well. Please access the Library Resources for Nutritional Sciences page directly from your browser

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: or

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 6S hierarchy of organization of evidence to plan search strategies

12. 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.

13. 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

14. “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

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
Therapy/prevention
Randomized controlled trials
Diagnosis
Prospective cohort, blind comparison to a gold standard
Prognosis
Cohort, Case Control, Case Series
Etiology/Harm

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

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

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?

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

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

24. 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

25. 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

27. 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

28. 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

29. 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

30. 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

32. UTD – Smart Search Interface

34. UTD – fast, current, peer reviewed

35. UTD – simple search, quick answers

36. 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

37. ClinicalKey “Autosuggest” displays search term choices

38. CK First Consult Summary

39. 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

40. 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

43. CK Search for Systematic Reviews

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

45. 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

46. 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

47. 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

48. ClinicalKey “Autosuggest” displays search term choices

49. Easy to add additional search terms and select source types

50. 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

51. 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

52. Databases - CINAHL Complete

53. 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

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

55. Science Direct Full Text in Journals not Found in Other Databases

56. 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 under “e-Journals”

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58. 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

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

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