1. Searching for the Best Evidence Liz Bayley Health Sciences Library Evidence Informed Decision Making Workshop May 3, 2011

2. Searching for the Best Evidence What we are hoping you will get out of this session An overview of the resources available to you to find the research evidence An understanding of the different levels of “pre-appraised” sources of evidence An introduction to some new tools A feeling of excitement to explore them

3. Searching for the Best Evidence Clinical state, setting, and circumstances Research evidence Health care resources Clinical Expertise Clinical Decisions Patient values, preferences and actions Research evidence

4. Searching for the Best Evidence Steps of EIDM 1.Formulate an answerable question 2.Conduct an efficient literature search 3.Critically appraise the evidence 4.Apply the results in health care decisions 5.Evaluate the outcome

5. Searching for the Best Evidence P opulation / Situation I ntervention / Exposure C omparison O utcome T ype of study Framing the QUANTITATIVE Question

6. Searching for the Best Evidence Framing the QUALITATIVE Question P opulation S ituation Type of study

7. Searching for the Best Evidence PICO(T) and PS(T) can be used to: Structure your search Evaluate your results for relevancy

8. Searching for the Best Evidence “Pre-Appraised Evidence” FULL DISCLOSURE! DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101 Previously finding high quality evidence required: sophisticated searching know-how the application of critical appraisal skills Pre-appraised resources: filtered to include only those studies that are of higher quality regularly updated so that the evidence is current

9. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101 Summaries Synopses of Studies

10. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

11. Searching for the Best Evidence to keep up with the literature to update higher levels in the hierarchy to contribute to decisions if no higher level of pre-appraised evidence is available Studies

12. Searching for the Best Evidence FROM CANADIAN PRESS (APRIL 18, 2010)

13. Searching for the Best Evidence

14. Searching for the Best Evidence Searching for studies can be challenging: Often get large results Difficult to separate out the research articles Solution: Using “filters” to limit to studies with particular research methodologies

15. Searching for the Best Evidence http://pubmed.gov

16. Searching for the Best Evidence PubMed Clinical Queries

17. Searching for the Best Evidence Clinical Queries Filter Table

18. Searching for the Best Evidence http://pubmed.gov Topic-Specific Queries

19. Searching for the Best Evidence PubMed Topic-Specific Queries

20. Searching for the Best Evidence PubMed Health Services Research (HSR) Queries

22. CINAHL – Clinical Queries

23. Searching for the Best Evidence Congratulations, you have found some studies, but No guarantee of quality Still need to be critically appraised

24. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

25. Searching for the Best Evidence Synopses “Succinct descriptions of an individual study or a systematic review.” (Haynes, 2001) - may include a commentary by an expert EXAMPLES: Evidence-based abstract journals (including Evidence-Based Nursing before 2010) Database of Abstracts of Reviews of Effects health-evidence.ca

26. Synopsis of a Single Study: ACP Journal Club http://www.acpjc.org/

27. Synopsis of a Single Study: ACP Journal Club

28. You have found a synopsis of a study But should you change practice based on a single study? Especially if it is a small study? But the different studies give different results Or even better, you have found several synopses

29. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

30. Searching for the Best Evidence Syntheses: Systematic Reviews & Meta-analyses / Metasyntheses Systematic consolidation of the literature on a specific topic: comprehensive identification of studies review of study relevance evaluation of methodologic quality extraction of data analysis of data drawing of conclusions

31. Searching for the Best Evidence Sources of Systematic Reviews The Cochrane Library Agency for Healthcare Research and Quality (AHRQ) Health care journals –Can use the “Systematic Review” filter in PubMed Clinical queries

32. Searching for the Best Evidence

33. Searching for the Best Evidence

35. Searching for the Best Evidence

36. Searching for the Best Evidence http://www2.cochrane.org/reviews/

37. Searching for the Best Evidence Cochrane Review “Plain Language Summary”

38. Searching for the Best Evidence http://www.campbellcollaboration.org/

39. As with single studies, with Systematic Reviews: Still no guarantee of quality, although Cochrane reviews are considered high quality Still need to be critically appraised

40. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

41. Searching for the Best Evidence http://www.crd.york.ac.uk/crdweb/ DARE: Database of Abstracts of Reviews of Effects

42. Searching for the Best Evidence

43. Searching for the Best Evidence

44. Searching for the Best Evidence http://health-evidence.ca

45. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

46. Searching for the Best Evidence Summaries "These include clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating.” Points to look for: How the search for evidence was carried out Currency Explicit levels of evidence Explicit connection of recommendations to the evidence

47. Searching for the Best Evidence Clinical Practice Guidelines systematically developed statements to assist in making decisions about appropriate health care for specific circumstances an attempt to distill a large body of knowledge into a convenient readily usable format

48. Searching for the Best Evidence Clinical Practice Guidelines Best Practice Guidelines Project RNAO (Registered Nurses Association of Ontario) funded by the Ontario Ministry of Health development, implementation and evaluation of best practice guidelines for nursing

49. Searching for the Best Evidence RNAO Best Practice Guidelines

51. Searching for the Best Evidence RNAO Best Practice Guidelines

52. Searching for the Best Evidence National Guideline Clearinghouse http://www.guideline.gov/

55. Searching for the Best Evidence

56. Searching for the Best Evidence National Guidelines Clearinghouse: Levels of Evidence for Recommendations Ia Evidence obtained from meta-analysis or systematic review of randomized controlled trials Ib Evidence obtained from at least one randomized controlled trial IIa Evidence obtained from at least one well-designed controlled study without randomization IIb Evidence obtained from at least one other type of well- designed quasi-experimental study without randomization III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies IV Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities

57. Searching for the Best Evidence http://www.clinicalevidence.com From BMJ Interventions (therapy) only Summarizes all interventions, and rates them as: beneficial  harmful Background information in “About this condition” Limited coverage of conditions, but growing

59. Clinical Evidence uses GRADE - Grading of Recommendations, Assessment, Development and Evaluations

60. Searching for the Best Evidence ACP PIER (Physicians Information and Education Resource) American College of Physicians Through STAT!Ref Adult only – no pediatrics or Obs/Gyn Includes diagnosis, therapy and patient education – with evidence supporting all recommendations Includes Complementary and Alternative Medicine

61. Searching for the Best Evidence ACP PIER

62. Searching for the Best Evidence PIER

63. Searching for the Best Evidence

64. Searching for the Best Evidence PIER

65. Searching for the Best Evidence PIER

66. Searching for the Best Evidence PIER

67. Searching for the Best Evidence

68. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

69. Searching for the Best Evidence Systems “An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

70. Searching for the Best Evidence Hierarchy of Pre-appraised Evidence Types of Resources Computerized decision support systems Evidence-based textbooks Clinical practice guidelines DARE, healthevidence.ca Evidence-based journal abstracts Systematic reviews Evidence-based journal abstracts Original published articles in journals Systems Synopses of Syntheses Syntheses Studies Summaries Synopses of Studies Adapted from DiCenso, Bayley and Haynes (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3 OR Evidence-Based Nursing, 12,99-101

71. Searching for the Best Evidence TRIP (Turning Research into Practice) http://www.tripdatabase.com

72. TRIP – Searching across the hierarchy

73. Searching for the Best Evidence Staying Current –Nursing + : best evidence for nursing care –OBESITY + –Public Health +

74. http://www.nccmt.ca/tools/public_health_plus-eng.html

75. Searching for the Best Evidence Does 6s work for Public Health?

76. http://hsl.mcmaster.ca

77. http://hsl.mcmaster.ca/resources/topic/eb/nurse.html

78. Searching for the Best Evidence LibAccess Username: eidm2011 Password: eidm Valid until: May 31, 2011

79. Searching for the Best Evidence Liz Bayley HSC-2B28 905-525-9140, ext. 22545 bayleyl@mcmaster.ca Laura Banfield HSC-2B33 905-525-9140, ext. 20239 banfie@mcmaster.ca