1. Evidence Based Information Retrieval for Research, Presentations, and Patient Care
Sandra A. Martin, M.L.I.S.
Health Sciences Resource Coordinator
Optometry Librarian
Instructor of Library Services
John Vaughan Library Room 305B –

3. Learning Objectives
To familiarize residents with the information retrieval process for evidence-based research and patient care
To enable residents to use peer reviewed scientific information, and
To enable residents to use synthesized/filtered/pre-appraised resources
For the purposes of answering clinical questions and engaging in scholarly activities, such as lectures, presentations, publications, posters, or research

4. Optometric Residency Definition and Standards Effective July 1, 2017 Adopted by the Accreditation Council on Optometric Education (ACOE)
Evidence-Based Clinical Decision Making: The utilization of the best peer-reviewed current scientific information integrated with clinical expertise in making an individual decision about the care of a patient
Standard II. Curriculum
2.4.5 The resident must research and analyze current scientific information and integrate this knowledge into patient care through evidence-based clinical decision making.
2.4.6 The resident must promote and disseminate knowledge through scholarly activities, such as lectures, presentations, publications, posters, or research.

5. Existing knowledge can prevent…
Waste
Errors
Poor quality clinical care
Poor patient experience
Adoption of interventions of low value
Failure to adopt interventions of high value
Source: Sir Muir Gray, Chief Knowledge Officer of Britain’s National Health Service. Quoted on

6. 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. .

7. 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
Importance of evidence as integral aspect of practice and education now included in educational standards for medicine and allied health professions

8. 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

9. 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

10. 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.

11. 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.
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.

12. Predatory Journals reported in PubMed
Articles from “predatory” journals, that are not part of MEDLINE, have been reported in PubMed
When you search PubMed (publicly accessible platform), you retrieve MEDLINE articles AND articles from PubMed Central and other collections that are NOT indexed in MEDLINE
References:
Manca A, Martinez G, Cugusi L, Dragone D, Mercuro G, Deriu F. Predatory open access in rehabilitation. Arch Phys Med Rehabil 2017, 98:
Manca A, Martinez G, Cugusi L, Dragone D, Dvir Z, Deriu F. The surge of predatory open-access in neurosciences and neurology. Neuroscience 2017, 20:166-73
Manca A, Cugusi L, Dvir Z, Deriu, F. PubMed should raise the bar for journal inclusion. The Lancet 2017, 390:734-35
According to Manca and colleagues, their analysis of predatory publishing in the neurosciences showed that over 10% of predatory journals in three subdisciplines are indexed in PubMed.

13. Predatory Journals
Accept manuscripts that are flawed in terms of scientific quality without peer review and publish them by receiving charges
May claim to be included in directories and indexes when they are not
May include faculty on their editorial boards who have not agreed to serve
Basically operate vanity presses with no interest in promoting scholarship

14. Recommended Platforms to search MEDLINE available at http://library
Clinical Key includes “user friendly” interface to MEDLINE. Natural language processing of keywords eliminates complicated searches
OVID MEDLINE maps keywords to medical subject headings and includes tools to facilitate precise search strategies
When searching MEDLINE on both platforms, you are searching only journals that are “indexed for MEDLINE”

15. New EBM 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, 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

16. 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.

17. ClinicalKey Contains Sources at all “Evidence” Levels

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