1. Evidence Based Surgical Nursing – Reviewing the Evidence Carl Thompson Dept of Health Sciences, University of York.

2. What is Evidence Based Health Care? Evidence from research Clinical experience Patient preferences Available resources EVIDENCE BASED DECISION

3. How do you focus your question? Need to identify 3 things: Who it is you are interested in - Population What it is you are interested in - Intervention What you are hoping for - Outcome

4. An example…. In patients with opioid induced nausea and vomiting which is the most effective anti-emetic, metoclopramide or haloperidol

8. Finding good quality systematic reviews The Cochrane Library Evidence based nursing Evidence based medicine Evidence based … ACP Journal Club Best Evidence (ACP Journal Club and Evidence Based Medicine)

10. The Cochrane Library completed reviews (CDSR)  complete text of reviews, updated as new research becomes available reviews in progress (CDSR)  Cochrane reviews in progress quality assessed reviews (DARE)  systematic reviews identified by CRD and assessed according to quality criteria

11. Effectiveness information in accessible forms Effective Healthcare Bulletins Effectiveness Matters Clinical Evidence Health Evidence Bulletins Wales regional and national (e.g. Bandolier http://www.jr2.ox.ac.uk:80/Ban dolier/) subject or special interest focused

13. Translating terms into a search Need to know features of databases; indexes Subject indexing - MeSH Truncation/wild cards Combination Sophisticated or basic interfaces

14. Example search, using MEDLINE subject headings #1 substance use disorders/ #2 exp substance dependence/ #3 drug adj addiction #4 or/1-3 #5 exp child/ #6 teenager? or adolescent? or young adj people #7 or/5-6 #8 exp health promotion/ #9 prevent? adj (campaign? or program? or activit?) #10 or/8-9 #11 4 and 7 and 10

15. What’s the effect of focussing?

16. Pre operative smoking cessation Search on Cochrane library and find review of pre operative smoking cessation (no trials – check for updates in the future) Find a review of nurse led smoking cessation (some based in hospital) Rice VH, Stead LF. Nursing interventions for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.

18. Making sense of a review Is it valid? What do the results mean? How (can?) I apply it to my patients?

19. Screening. SCREENING QUESTIONS Is there a clearly focused question? Did the authors look for the appropriate sort of research?

20. Detailed questions Do you think the important, relevant studies were included? Did the review’s authors do enough to assess the quality of the included studies? If the results of the review have been combined, was it reasonable to do so?

21. What are the results? What is the overall result of the review? How precise are the results?

23. Will the results help locally? Can the results be applied to the local population? Were all the important outcomes considered? Are the benefits worth the harms and costs?