1. Evidence Based Information Retrieval for Nursing 2017
Sandra A. Martin, M.L.I.S.
Instructor of Library Services
Health Sciences Resource Coordinator
John Vaughan Library Room 305B –

2. 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 and by appointment

5. From the NSU Libraries Home Page

6. From the Health Professions page, click on Nursing

7. 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

8. Technical Issues Check your browser Check your Internet Carrier
Google Chrome works best with our resources
Check your Internet Carrier
Satellite Systems are frequently erratic or go down entirely during inclement weather
Wireless Hotspot
You need at least 3G
Please access the Library Resources for Nursing page directly from Chrome. Access via Blackboard can be slow.

9. 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 Nursing 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

10. Learning Objectives
To familiarize students with the information retrieval process for evidence-based research & patient care
To enable students to use synthesized/filtered/pre-appraised resources to answer clinical questions
To enable students to use the 6S hierarchy of organization of evidence to plan search strategies

11. 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

12. 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

13. 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. .

14. 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

15. 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

16. 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

17. 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.

18. 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.

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

20. Well Built Questions include Elements of PICO Model
P - Patient or population
I - Intervention
C - Comparison Intervention
O - Outcome

21. Therapy/Prevention Questions
In patients with urinary catheters [patient], are antibiotic coated catheters [intervention] versus standard catheters [comparison intervention] effective to reduce or prevent catheter associated urinary tract infections [outcome]?

22. Evidence Based Search Strategy
Includes search terms from the clinical question
Matches best study design for type of question
Retrieves answers at highest levels of evidence

23. 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

24. 3. Highest Level of Evidence – 6S Hierarchy

25. New Search 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”, evidence summaries, e.g., UpToDate and Joanna Briggs Institute
filter the journal literature and “point to” current studies of higher quality
include a formal system for grading the quality of the evidence and recommendations for practice
increase ease of accessing and understanding clinical research information

28. Evidence Summaries UptoDate
Evidence based summaries of over 10,000 topics in over 22 specialties
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

29. 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

30. JBI Systematic Review

31. Overview of Online Resources
Research and Clinical Databases
e-Journals
E-Books
Consumer Health Information

32. Journal Article Databases
Clinical Key for Nursing (includes MEDLINE), UpToDate, Joanna Briggs Institute, CINAHL Complete, and and Science Direct are most frequently used resources to find journal articles on nursing topics.
Search this section when you need articles on subjects, e.g., electronic medical record, nursing education, pressure ulcers, etc.
Databases in this section provide links to full text journal articles and other resources
You must start at the library’s Nursing web page to access our subscribed full text

33. Clinical Key for Nursing
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

34. 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.

35. Databases - CINAHL Complete
CINAHL stands for Cumulative Index to Nursing and Allied Health Literature
Core research tool that contains full text of more than1,400 journals
Not all journals are peer reviewed. Limit search results to “academic journals”
Check the box next to “suggest subject terms” and search CINAHL headings for best results, e.g., search “mentorship” to find articles on “mentoring”
View the brief video to get started

36. Databases – Nursing@Ovid
Comprehensive, integrated Nursing and Allied Health portal with full text from 1946 to the current week
Content includes nursing practice, education, research, and administration
Based on the nursing and allied health subset of Ovid MEDLINE
Ovid Nursing Subject Thesaurus provides search terms included in MeSH (medical subject headings) as well as those unique to nursing

37. Databases – Science Direct
Scientific database produced by Elsevier
Provides journal articles from over 2,500 peer reviewed journals and chapters from almost 20,000 books in all life sciences disciplines
Contains full text of nursing journals not found in other databases
Choose “Advanced Search” to narrow your search results to full text in selected time periods

38. Additional Research Databases
Health and Psychosocial Instruments – assists researchers in identifying tests, questionnaires, rating scales in health and psychosocial sciences. Does not include full text of the instruments
National Library of Medicine – provides access to hundreds of databases covering a wide range of biomedical information resources
Native Health Databases – contains citations and abstracts of documents pertaining to the health care of North American indigenous peoples

39. e-Books
R2 Digital Library – Nursing and allied health books from Doody’s Core Titles in the Health Sciences
- full text of nursing and health sciences books published by Lippincott Williams & Wilkins, American Nurses Association (ANA), Joanna Briggs Institute, Jones-Bartlett, and Springer Publishing
ClinicalKey for Nursing – full text of nursing books and handbooks published by Elsevier
Access Medicine - text of leading medical and health sciences books from McGraw-Hill
ClinicalKey for Nursing and Access Medicine contain full text monographs for the health care professional and the patient of all FDA approved drugs

40. 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
ClinicalKey for Nursing - includes patient education handouts produced by Elsevier
Access Medicine – contains patient education materials for adults and children and includes handouts for drugs and medicines

41. Search Multiple Databases – Findings May Differ

42. If you need Help, contact Sandra