1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Define systematic review. Identify what is the systematic review. State the purpose of systematic review. Describe how to conduct systematic review. Explain the characteristics of systematic review. Discuss Cochrane collaborations & library.

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 A summary of the medical literature that uses clear methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Review Is an article that summarizes a number of different primary studies and may draw conclusions about the effectiveness of a particular intervention. A review may or may not be systematic. continue

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Systematic review (systematic overview) A review of the evidence on a clearly formulated question that uses systematic and clear methods to identify, select and critically appraise relevant primary research, and to remove and analyze data from the studies that are included in the review by using statistical methods (meta- analysis).

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 A systematic review that uses quantitative methods to make and summarize the results.

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Systematic Reviews takes many shapes and forms, depending on the type and expertise of the audience. - Chapters in textbooks. - Report to expert committees. - State of the art reviews for clinical journals.

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 The main purpose of systematic reviews is to bring their audience rapidly up to speed with the current information of specific clinical areas.

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 State objectives and hypotheses. Outline eligibility criteria, stating types of study, types of participants, types of interventions and outcomes to be examined. continue

11. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Perform a comprehensive search of all relevant sources for potentially eligible studies. Examine the studies to decide eligibility.

12. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 Construct a table describing the characteristics of the included studies. Assess methodological quality of included studies.

13. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 Extract data (with a second investigator if possible) with involvement of investigators if necessary. Analyse results of included studies, using statistical synthesis of data (meta-analysis ), if appropriate. Prepare a report of review, stating aims, materials and methods, and describing results and conclusions.

14. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 Summary of steps in conducting systemic literature reviews

15. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 Need much information to make the right decision. Not enough time – busy physician & nurses.

16. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 It is an international organization. It prepares, maintains and promotes the accessibility of systematic reviews of the effects of health care interventions.

17. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17 Illustrates a systematic review of data from 7 randomized controlled trials (RCT) comparing one health care treatment with a placebo. Each horizontal line represents results of one trial.

18. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 18 Characteristics of Cochrane Reviews 1. High quality, 2. Up-to-date systematic reviews 3. Intended to help decision makers to cope with the large volume of literature by summarizing the reliable evidence of the benefits and risks of healthcare. continue

19. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 19 4. limit bias and reduce chance effects, thus providing more reliable results for drawing decisions about health care.

20. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 20 The target audience for Cochrane reviews are people making decisions about healthcare. It has 15 centers worldwide, with 7000 members. Each subject area in health care is covered by a specialized Cochrane review group.

21. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 21 Determining the objectives and eligibility criteria for including trials. Identifying studies that are likely to meet the eligibility criteria. Tabulating the characteristics and assessing the methodological quality of each study identified.

22. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 22 Excluding studies that do not meet the eligibility criteria. Compiling the most complete set of data feasible, involving the investigators if possible. Analyzing the results of eligible studies, using a meta-analysis or statistical synthesis of data if appropriate and possible.

23. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 23 - Performing sensitivity analyses if appropriate and possible. preparing a structured report of the review that states the aims of the review, describes the materials and methods used and reports the results.

24. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 24 Evidence –based. Easily accessible. Internationally developed. Quality controlled. Clinically useful. Periodically updated.

25. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 25 The Cochrane Library is the product of the Collaboration's work and includes reports and protocols of over 1000 systematic reviews produced within the Collaboration, abstracts of over 1800 reviews summarized and critically appraised by the Centre for Reviews. The Cochrane Library is the most comprehensive source of updated systematic review.

26. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 26 Is treatment effective? Is accepted practice "best” practice? What is the best treatment?

27. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 27 - To obtain general health care information -To answer queries on causation, prognosis & epidemiology. -To search for clinical practice guidelines.

28. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 28 Illustrates a systematic review of data from 7 randomized controlled trials (RCT) comparing one health care treatment with a placebo.

29. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 29

30. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 30 Step One Identify the Burning Question  An example of a unit based clinical question might be: ? How do I assess pain in a ventilated non-communicative patient ?

31. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 31 Step Two Collect Most Relevant and Best Evidence  How do I find current research on pain in this patient population?  Find what is in the literature!  Literature Search  How do I do that at Shands?

32. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 32 Now let’s show you how to begin a search of the literature at Shands from your computer desktop

33. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 33 Getting Started on your Literature Search Click on Internet Explorer on desktop

34. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 34 In the address bar, type in www.borland.ufl.eduwww.borland.ufl.edu Press Enter or click Press Enter or click

35. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 35 You will arrive at the Borland Health Sciences Library Main Page

36. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 36 Once you arrive at the Borland Library main page you will be able to begin your search by using various Databases

37. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 37 Databases  PubMed - a comprehensive database that searches multiple medical sources  CINAHL – a nursing focused database: Cumulative Index of Nursing and Allied Health Literature  There are several databases available but, we will use these three in this module

38. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 38 At the Borland Health Sciences Library Site you can double - click on: PubMed

39. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 39 At the PubMed site, type in your search word/s  Search Word/s are areas of interest on a specific clinical topic or problem.  Example: “Pain assessment in the ventilated patient”

40. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 40 PUBMED is a database that searches multiple medical sources At the PubMed site, type in your search word/s

41. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 41 We found 9 articles on this initial search Use the scroll bar to view more

42. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 42 on the blue author names and you will go to the article !

43. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 43 You can change your search word combination to get additional articles

44. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 44 Sometimes you will have access to the entire article by clicking on Full Text or Online

45. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 45 Other times you may have to go to the library and find the journal “in print”

46. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 46 Cochrane Library Access: On Databases page, enter cochrane. Effectiveness of using acupuncture for low back pain efficacy of asthma self-management education on health outcomes in children

47. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 47 Cochrane: Search Results Tips: click on Cochrane Reviews to see systematic reviews: Click on Other Reviews for an abstract of review of an individual RCT; Click on Clinical Trials to see individual RCT.

48. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 48 CINAHL The use of probiotics to treat urinary tract infections Tips: Perform a subject search using CINAHL Headings; Limit search results to special interest: evidence-based practice

49. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 49 Let’s Try a Different Method of Searching the Literature Start at the Borland Health Sciences Library Main Page and Click on

50. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 50 This Page Will Appear after clicking on A Commonly Used Database for Nursing is CINAHL (Click Here)

51. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 51 After clicking on the button, enter your search terms

52. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 52 On the Dropdown Box Select

53. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 53 If you know the author you can also change how you search by selecting in the drop down menu Press or click on Press or click on

54. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 54 This Slide Displays the First 4 Articles Related to Your Search Word/s Use the Scroll Bar to view additional results

55. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 55 Click on the …or if you’re lucky click

56. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 56 Cochrane Database of Systematic Reviews (CDSR). Database of Abstracts of Reviews of Effectiveness (DARE). Cochrane Central Register of Controlled Trials (CENTRAL). Cochrane Database of Methodology Reviews contains articles on research synthesis and systematic reviews.

57. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 57 Name Two Databases That Can be Accessed Through Borland Library to Complete a Literature Search ? 1.Google & YahooGoogle & Yahoo 2.PubMed & CINAHLPubMed & CINAHL 3.NurseMed & PubMedNurseMed & PubMed 4.Medscape & YahooMedscape & Yahoo

58. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 58 Literature Review This is Just Some of the Literature Found in Our Search:  Gelinas, C., Fortier, M., Viens, C., Fillion, L., & Puntillo, K. (2004, March). Pain assessment and management in critically ill intubated patients: a retrospective study. American Journal of Critical Care, 13(2), 126-135.  Jones, K. R., Fink, R., Hutt, E., Vojir, C., Pepper, G. A., & Scott- Cawiezell, J. et al. (2005, December). Measuring pain intensity in nursing home residents. Journal of Pain and Symptom Management, 30(6), 519-527.  Pasero, C., & McCaffery, M. (2005, October). No self-report means no pain - intensity rating: assessing pain in patients who cannot provide a report. AJN, 105(10), 50-53.  Young, J., Siffleet, J., Nikoletti, S., & Shaw, T. (2006). Use of a behavioral pain scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive and Critical Care Nursing, 22, 32-39.

59. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 59 There are two main problems with systematic reviews published in paper journals:

60. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 60 In reviewing the evidence one wishes to be assured that the systematic review is up to date. In a paper journal, a systematic review can only be current up to the date of publication. This means that studies published subsequently will not have been included and these may change the Results and Conclusions of the systematic review.

61. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 61 Systematic reviews require a lot of work, particularly in the searching for appropriate studies and their critical appraisal.

62. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 62 Systematic reviews are rigorous methods to reduce bias and can provide reliable summaries of relevant research evidence. The Cochrane library, which is updated every 3 months, electronically, includes a database of up to date systematic reviews across the whole of health care

63. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 63 Meta-analysis is a statistical technique used in systematic reviews. It can answer the questions” dose this intervention have a beneficial effect ? And if so, ‘What is the size of that effect?

64. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 64 Thanks for your attention