1. Evidence-based Practice Resources for HINARI Users
This module explains why HINARI users might want to start by searching evidence-based resources and highlights HINARI, as well as, freely available resources that support evidence-based practice.

2. Evidence-based Practice Resources for HINARI Users
Instructions - This part of the:
course is a PowerPoint demonstration intended to introduce you to Evidence-based Practice and related HINARI resources.
module is off-line and is intended as an information resource for reference use.

3. Table of Contents
Evidence-based Medicine (EBM) definition, background and resources
Clinical Evidence
Cochrane Library
EBM Guidelines
HINARI EBM Journals
Searching for EBM articles in
a specific journal (Science Direct)
HINARI/PubMed’s Clinical Queries
Summary

4. What is evidence-based health care?
Using the best available evidence (research) to answer questions and support decision making
Research Evidence
Evidence from research constitutes the knowledge component of decision making. Practitioners must also take into account local conditions/resources/constraints as well as the preferences of individuals or populations.
Practitioner’s Experience
Local Conditions
Patient/Community Preferences & Values

5. Evidence-based Practice Definition
"Evidence-Based Practice requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources."
Sicily statement on evidence-based practice. BMC Medical Education, 2005 Jan 5;5(1):1

6. Evidence-based Medicine (EBM) Definition
"The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
Sackett, D. et al. Evidence-based Medicine - What it is and what it isn't. BMJ 1996;312(7023):71 (13 January) 1996.
Much of the work in evidence-based practice started with clinical medicine, and the definition here is often quoted.

7. Why use Evidence-based Resources?
Aims to locate current clinical knowledge on a topic
Can save time finding ‘the best’ information
Identifies Systematic Reviews¹
Often contains commentary about validity
A good ‘first place’ to start your search
¹A systematic review involves the application of scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific clinical question.
Cook DJ, Mulrow CD, Haynes RB. Annals of Internal Medicine March 1, 1997; 126 (5) 376.
Evidence-based resources are relatively new. They are attempts to bring to the fore the current knowledge on a specific topic to answer important clinical and other questions. Systematic Reviews are an attempt to provide an overview, and often a synthesis, of all methodologically valid studies on a topic, often with an evaluation and commentary. Specifically EBM resources are a good place to start an efficient search for the “best evidence.”

8. Evidence-based Practice Process
Formulate answerable questions
Find the best evidence
Critically evaluate the evidence
Integrate the evidence, using patient values, in the decision-making process
Evaluate performance
Although we will focus on using HINARI resources to find the best evidence, the EBM process includes other, important steps shown on this slide.

9. If you are interested in learning more about EBM, go to the online tutorial Introduction to Evidence-Based Medicine from the Health Sciences Library, University of North Carolina (USA):

10. From the HINARI Reference Sources drop down menu, we also can find tutorials for learning more about EBM. In this example, we will link to BMJ Learning.

11. From the BMJ Learning’s Browse our modules listing, we have clicked on Clinical Epidemiology and located four EBM-related tutorials.
Four learning resources are available.

12. Logging on to HINARI 1
To access the HINARI Evidence-based Medicine resources, we must Login to the HINARI website using the URL

13. Logging into HINARI 2
We will need to enter our HINARI User Name and Password in the appropriate boxes, then click on the Login button.
Note: If you do not properly sign on, you will not have access to Evidence-based Medicine resources that are located in the Reference Sources drop down menu.

14. From the Reference Sources drop down menu, there are three valuable EBM- related sites. First, we will click on the Clinical Evidence link, a resource for informing treatment decisions and improving patient care. It is published by the BMJ Publishing group.
Most of the evidence-based resources deal with clinical questions so we will look at those first. Later, we’ll look at resources useful to public health practitioners. Of course, there is some overlap between the two areas of interest. We’ll start by looking at the resource called Clinical Evidence.

15. In the Clinical Evidence site, you can search by Sections, Full review list or (keyword) Search this site.
Also note that there is a Clinical Evidence Userguide in multiple languages and links to the Latest updated reviews.
Take a minute to look at the various features of this resource. Note that there are 3 ways to search, by general section (e.g., Infectious Diseases), Full review (browse titles of individual reviews, e.g., AIDS: Tuberculosis in people with HIV), and Search (use keywords here). Note also, the availability of a Userguide.

16. Using the Search this site option, we have completed a keyword search for tuberculosis and identified 73 documents.
The links include clinical evidence Guidelines, Keypoints, Interventions and Updates about this topic.
Searching the term tuberculosis results in 73 matches. Perhaps we should limit our search to be more specific.

17. We have further limited this search by combining tuberculosis and HIV
We have further limited this search by combining tuberculosis and HIV. This has resulted in 56 documents. We will click on the link to Tuberculosis in people with HIV.
Adding HIV to the Search box results in 56 matches. You can keep adding terms, with , of course, the possibility of missing some useful articles.

18. The initial page of HIV: treating tuberculosis initially displays Interventions based on clinical questions. Note that also you have access to Key points, About this condition, Updates, Guidelines and References. We will click on the Guidelines hyperlink.

19. The Guidelines page contains the title, name of organization and hyperlink to 10 documents from key health agencies. The guidelines have been sourced from the National Guidelines Clearinghouse (USA).

20. We have clicked on the Full review list option and displayed the topics under the A alphabetical list.
This A-Z subject access contains an extensive list of topics and clinical evidence material.

21. From the Reference Sources drop down menu, we now will click on the Cochrane Library link. The Cochrane Library contains high-quality, independent evidence including reliable evidence from Cochrane and other systematic reviews and clinical trials. It is published by John Wiley.
Note the full-text reviews are available to Band 1 only while Abstracts can be accessed by all users.
Next we are going to look at one of the first and most respected evidence-based information resources, The Cochrane Library. Also, technically the Reference Sources drop down, no?

22. Besides a keyword and other options Search engine, you can search by the Advanced Search option, complete a MeSH Search, look at your Search History or Saved Searches.
Also from the initial page, there are links to the Cochrane Journal Club and sections for Clinicians, Researchers, Patients and Policy Makers.
Take a minute to review the main page of the Cochrane Library. Note in the upper right you can browse Cochrane Reviews and there are other sources as well, such as individual clinical trials. There is a search box and field options for searching. One can also click on Advanced Search to construct a search by filling in boxes and making selections.

23. We have opened the Advanced Search option where you can specify search fields and have the ability to combine terms using AND/OR/NOT operators.
In this text Advanced Search, we have combined diarrhea AND child* using the Search All Text option with the wildcard (*) used to locate the terms child and children.
Here we see the Advanced Search box and search for items that discuss both diarrhea AND children. Note the ability to put a wildcard * at the end of child to search for child, children.

24. The Advanced Search results for diarrhea AND child
The Advanced Search results for diarrhea AND child* has retrieved 444 records from the Cochrane Database of Systematic Reviews. You have the option to Export All Results (save).
Note: if the results of your search are too many, you can narrow it by limiting the keyword search to Title instead of Search All Text.
Note that we retrieved more than 400 Systematic Reviews and it might be smart to further restrict the search with more terms, realizing that you might miss some good articles. For our purposes, though, let’s look at the record about oral zinc (note that variations of the spelling of diarrhoea are accounted for).

25. Also note the hypertext links to the entire systematic review.
The initial screen displays the Abstract of the first systematic review listed in the search - Oral zinc for treating diarrhoea in children.
To access the full-text review, click on the Full PDF hypertext link in the left column. Other options are Summary and Standard.
Also note the hypertext links to the entire systematic review.
This is the information about who did the systematic review and when it was last updated. If we click on Summary, we’ll see the following .

26. We have displayed the Abstract of the systematic review that includes the Background, Objectives, Search strategy, Selection criteria, Data collection and analysis and Main Results.
Summary which gives a good overview of purpose, methodology, results, conclusions and a plane language summary (next slide).

27. The final section of the Abstract is titled Plain language summary
The final section of the Abstract is titled Plain language summary. This section is useful for disseminating the results to groups of health workers and patients.
Also note the Main results and author’s conclusions (the ‘bottom line’) as these sections discuss the review’s results and how they should be used.

28. We have displayed the PDF Full version of the Oral zinc for treating diarrhoea in children systematic review. Other options include Summary and Standard files.
Note: The url that contains gw.who.int/whalecom... shows that we have logged in to HINARI properly and will have access to the full-text version of this review.

29. From the initial page of the Cochrane Library, we have clicked on the Cochrane Reviews: By Topic hyperlink. This has displayed the Topics for Cochrane Reviews. From this extensive list, you have another option for locating subject- specific material.

30. For more training materials, we can click on The Cochrane Library Help hyperlink. We can access a list of User Guides, Quick Reference Guides plus other teaching tools. These resources are in multiple languages and downloadable as PDF files.

31. If your institution does not have access to Cochrane…
If your institution does not have access to Cochrane…. Access to the Abstracts is free from a link at:

32. After accessing the Cochrane Collaboration (http://www. cochrane
After accessing the Cochrane Collaboration ( click on the Cochrane Library link. This will give you access to the Library’s search options and the abstracts but not the full-text articles.
On this site, click on The Cochrane Library.
Click here

33. We now access the third Reference Sources option for evidence-based health information - EBM Guidelines.
Let’s look at another resource, EBM Guidelines.

34. This is the initial page of EBM Guidelines Evidence-Based Medicine
This is the initial page of EBM Guidelines Evidence-Based Medicine. Also published by John Wiley, this resource is a collection of clinical guidelines for primary care combined with evidence-based research.
You can Search by keyword or Browse database contents by EBM Guidelines, Evidence summaries, Pictures, Audio samples, Videos and Programs.

35. We have completed a keyword search for Influenza
We have completed a keyword search for Influenza. The results page includes summaries of the key issues including Related resources and References and links to important websites.
Also included are links to the Evidence summaries.

36. We have displayed the first Evidence summary
We have displayed the first Evidence summary. Each link contains a brief review of the study and notes the reference(s).

37. HINARI Evidence-Based Journals (other journals may have EBM articles)
We have browsed the ‘E’ in the HINARI Find journals by title list and it notes several journals for evidence-based practice.

38. From the A-Z Find journals by title list, we have accessed the Evidence-based Healthcare and Public Health journal. In this journal, we will search MRSA (Methicillin-resistant Staphylococcus aureus) in the All fields box.
Let’s search the journal Evidence-based Healthcare and Public Health for the term ‘MRSA’.

39. The search results list 5 articles on MRSA related topics.
We can see that there are 5 ‘hits’ for malaria and it would be a better search to specify a disease, such as MRSA.

40. We now search for evidence-based articles using PubMed
We now search for evidence-based articles using PubMed. From the main HINARI webpage, go to PubMed by clicking on Search HINARI journal articles through PubMed (Medline).
Remember you must login to HINARI to have access to the full-text articles.

41. Open the Clinical Queries box
Open the Clinical Queries box. This search tool assigns filters to keyword searches - to locate articles on Clinical Studies, Systematic Reviews and Medical Genetics.

42. To use the Search by Clinical Study Category, you would type a disease or procedure in the Search box and select one Category and Scope per search. You only can use one Category or Scope bullet per search.
For this search, we have entered Type 2 diabetes and developing countries and selected therapy (Category) and narrow, specific search (Scope).

43. The narrow Clinical Study search resulted in 7 articles on type 2 diabetes and developing countries.
Note that the specific search is listed in the Search box and Search details display.

44. Now, we complete the same search in the Find Systematic Reviews box.

45. The type 2 diabetes and developing countries AND systematic reviews search resulted in 11 articles.
Note the Free Full Text and HINARI filters that list 2 and 8 articles. You can access the full-text articles by clicking on these Filters or changing the display from Summary to Abstract.

46. Another option for locating evidence-based practice in PubMed is in the Limits option. After entering your terms in the PubMed search box, click on the Meta-Analysis and/or Randomized Controlled Trials Type of Article drop down menu.
A Meta-Analysis is a statistical method that combines the results of several studies that address a set of related research hypotheses.
A Randomized Controlled Trial (RCT) is a type of scientific experiment most commonly used in testing the efficacy or effectiveness of a health-care service or health technologies.

47. If you have a MY NCBI account, you can add Meta-analysis and Systematic Reviews to your Filters. Open Search for Filters, enter the terms in the Search box and then add these to My Filters. When you save a PubMed search, you will be sent an listing new articles on the specific topic. Remember that you will need to go to HINARI to get the full-text articles.
In this example, Free Full Text, HINARI, Meta-analysis and Systematic Reviews are listed in My PubMed Filters.

48. Additional Evidence-based Health Resources
National Guidelines Clearinghouse
DARE: Database of Abstracts of Reviews of Effects
health-evidence.ca
The Campbell Library
McMaster PLUS collection
Listed here are some freely available websites that are useful resources for finding clinical and public health evidence.

49. Review/Summary
Evidence-based practice depends on knowing the most recent, valid scientific knowledge.
This involves finding the ‘best’ studies.
Sometimes others have evaluated the quality of the studies, including methodology; many new evidence-based tools mentioned in this tutorial provide evaluation.
Here are some general comments to remember about evidence-based practice. We hope that this tutorial has led to a better understanding of what evidence-based practice is and how to efficiently find good evidence using HINARI resources.

50. When there is no evaluation available, it is essential to evaluate the validity of the study.
Tools for evaluating studies can be found in the Evaluating the Evidence section in the EBM tutorial mentioned earlier and found at:

51. It is always important to consider studies in terms of applicability to and values of the local patient/situation.
Evidence-based practice is a developing field and new, useful resources are continuously being developed.

52. Research Evidence
Practitioner’s Experience
Local Conditions
Patient/Community Preferences & Values
This is the end of the Evidence-based Medicine for HINARI Users module.
The material initially was developed by: Gale G. Hannigan, PhD, MLS, MPH; Professor & Medical Informatics Education Librarian, Texas A&M University.
There is a workbook that accompanies this module. The workbook will take you through a live session covering the topics included in this demonstration with working examples.
Updated