1. EBP: Library Tools for Clinical Content Christina L. Wissinger MS, MLIS Clinical Informationist

2. Library Resources http://www.welch.jhu.edu/index.cfm  Research Assistance and Instruction provided by department Informationist/Librarian  Performing Searching, Creating Search Strategies, Database Education, Citation Management Software Training, Systematic Reviews consultation etc.  Weldoc Interlibrary Loan and Document Delivery Services  Free to Hopkins Affiliates  Find It  Access to electronic holdings via the databases  Off campus access  Library log in  VPN through My JHU  My Welch

3. How to access full-text  Find It is the link to full text from within the databases  Weldoc is used to obtain articles the library does not own electronically and is FREE to Hopkins affiliates.  Off Campus access allows you to link to the Hopkins subscriptions from off site.  Note: You need a library barcode to set up a Weldoc account

4. Evidence Based Practice  Study Designs  Levels of Evidence  The EBP Process  EBP Literature Resources

5. Levels of Evidence: Study design Medical Center Library, Duke University Stronger Weaker

6. Levels of Evidence for Treatment 1a: Systematic reviews of randomized controlled trials 1b: Individual randomized controlled trials (with narrow confidence interval) 1c: All or none randomized controlled trials 2a: Systematic reviews … of cohort studies 2b: Cohort studies or low quality randomized controlled trials (<80% follow-up) 2c: 'Outcomes' Research 3a: Systematic review … of case-control studies 3b: Individual case-control study 4: Case-series (and poor quality cohort and case-control studies) 5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or 'first principles' Edited from UK Centre for Evidence Based Medicine http://minerva.minervation.com/cebm/http://minerva.minervation.com/cebm/ Stronger Weaker

7. EBP: Steps 1. Refine the clinical question 2. Find the best evidence 3. Critically appraise the evidence 4. Integrate the critically appraised information with your clinical expertise 5. Evaluate steps 1-4 for effectiveness and efficiency Sackett, et al, Evidence-Based Medicine, 2000 p. 3-4

8. First Steps for searching the EBP literature  EBM Subject guides http://www.welch.jhu.edu/internet/ebr.html  EBP databases  National Guidelines Clearinghouse - EBM practice guidelines  Cochrane - Systematic reviews of literature on specific subjects  PubMed Clinical Queries - Evidence Based filters for Medline (must use MeSH)

9. Subject Specific Databases with EBP Literature  Orthopedics and Rehabilitation Subject Guide  http://www.welch.jhu.edu/eresources/eresources_subject_action_alpha.cfm?wmesh_id=59  PEDro : The Physiotherapy Evidence Database -(Physical Therapy Systematic Reviews)  CINAHL : Cumulative Index to Nursing and Allied Health Literature – (use the evidence based medicine limit)

10. First Steps for Searching the Medical Literature  PubMed  EMBASE  The Cochrane Library

11. PubMed Searching Techniques  Boolean  AND, OR, NOT  MeSH – Medical Subject Heading used to refine a search  [MeSH] – Searching indexing terms  [MAJR]- Searching as a Major indexing term  Keywords  [All Fields] – Searching for the keywords in every field  Limits  Age, Publication type, Language, Gender etc.

12. PubMed Searching Techniques  Use PubMed Clinical Queries to limit to EBP literature  Find your MeSH terms first then cut and past them into Clinical Queries search box  MyNCBI  Set up search alerts  Save Searches  Save Collections  Limited Customization of PubMed layout

13. The Cochrane Library  Search using Keywords and MeSH  MeSH searches must be created one term at a time  Cochrane Contains:  Cochrane Database of Systematic Reviews  Summaries of the best evidence available  Cochrane Central Register of Controlled Trials  Track down the original studies  Health Technology Assessment Database  Completed and ongoing health technology assessments from around the world, looking at the medical, social, ethical and economic implications of health technologies (e.g. pharmaceuticals, vaccines, medical and surgical procedures) with a view to informing policy decisions..  NHS Economic Evaluation Database  Provides information on cost alongside information on effectiveness

14. EMBASE  Europe's PubMed  Excellent source for drug information  Contains Medline (PubMed) and EMBASE literature  Uses EMTREE instead of MeSH  Exp/ - EMTREE term  mj/ - Major Focus  Limits  Age, Publication type, Language, Gender etc.  Use the Evidence Based Medicine Limits to find EBP Literature

15. RefWorks  Store citations from various databases  Create bibliographies in over 800 citations styles  Write N Cite – Creates in text citations in over 800 styles  Create Group Accounts for collaborations

16. Case Studies: Use PubMed, EMBASE & Cochrane  Research Question 1  Rehabilitation therapy treatment strategies for ataxia  Research Question 2  Evidence for exercises to assist with improvement in fine motor control.  Is there any evidence that exercises such as manipulating pins, other small objects, or doing screwing tasks or lacing tasks really create improvement in them over time given initial impairment.

17. Research Question 1  PubMed  EBP Search Strategy:  use the MeSH term "Ataxia"[Mesh] in Clinical Queries using the Therapy Filter  Literature Search Strategies:  Option 1: Use the MeSH term with the subheading "Ataxia/therapy"[MAJR]  Option 2: Use the MeSH term "Ataxia"[MAJR] and the subheading for Therapy or the MeSH term "Rehabilitation"[MAJR]  Use the EBP limits (Meta-Analysis[ptyp] OR Practice Guideline[ptyp] OR Randomized Controlled Trial[ptyp] OR Controlled Clinical Trial[ptyp])  Limit your searches to Human and English

18. Research Question 1  EMBASE EBP Search Strategy  Use the Emtree terms for 'ataxia'/exp/mj AND ('therapy'/exp/mj OR 'rehabilitation'/exp/mj)  Use Evidence Based Medicine Limits  ([cochrane review]/lim OR [controlled clinical trial]/lim OR [meta analysis]/lim OR [randomized controlled trial]/lim OR [systematic review]/lim)  Limit your search to Humans and English

19. Research Question 1  Cochrane Searches are EBP if you use the review tab  Go to the MeSH search and run the search for ataxia  Next run the search for rehabilitation  Go to Search History and combine the searches with an AND

20. Research Question 2  PubMed  EBP Search Strategy:  use the MeSH terms ("Exercise"[MeSH] AND "Motor Skills"[MeSH]) in Clinical Queries using the Therapy Filter  Literature Search Strategies:  use the MeSH terms ("Exercise"[MAJR] AND "Motor Skills"[MAJR])  use the EBP limits (Meta-Analysis[ptyp] OR Practice Guideline[ptyp] OR Randomized Controlled Trial[ptyp] OR Controlled Clinical Trial[ptyp])  Limit your searches to Human and English

21. Research Question 2  EMBASE EBP Search Strategy  Use the EMTREE terms for 'motor performance'/exp/mj AND 'exercise'/exp/mj  Use Evidence Based Medicine Limits  ([cochrane review]/lim OR [controlled clinical trial]/lim OR [meta analysis]/lim OR [randomized controlled trial]/lim OR [systematic review]/lim)  Limit your search to Humans and English

22. Research Question 2  Cochrane Searches are EBP if you use the review tab  Go to the MeSH search and run the search for motor skills  Next run the search for exercise  Go to Search History and combine the searches with an AND

23. Your Informationist/Librarian  Please do not hesitate to contact me for assistance. I’m here to help and to support your work!  Christina L. Wissinger, MS, MLIS Clinical Informationist Welch Medical Library 1900 E. Monument Street, Room 214 410-502-6812 clw@jhmi.edu clw@jhmi.edu  http://www.welch.jhu.edu/liaison/CLW.html http://www.welch.jhu.edu/liaison/CLW.html  PMR Portal - https://infosuite.welch.jhmi.edu/PMR/https://infosuite.welch.jhmi.edu/PMR/