1. Objectives Describe how validity, relevance and work impact the usefulness of information for clinicians Recognize when to search for original research and when to search for secondary information Locate each of the following 5 information sources: Systematic Reviews, Clinical Evidence, POEMs, CATs, Clinical Guidelines

2. Why Secondary (Refined, Synthesized) Information? Usefulness = validity x relevance work Clinicians need valid and relevant information The information needs to be quickly and easily accessible The following equation was developed by Slawson and Shaughnessy 1

3. Why Secondary Information? Usefulness refers to how useful the information is to the physician in making clinical decisions Validity is the scientific rigor of the information. Randomized Controlled Trials (RCTs) are the strongest type of design in clinical studies. Relevance refers to how directly the research evaluates the effectiveness of medical care on a patient. Work refers to the amount of time and effort required to access the information 2

4. Five sources of “refined” information Systematic Reviews Validity – Only research with the highest level of scientific validity are selected for inclusion (RCTs) (high) Relevance – They are aimed at answering a specific clinical question (high) Work – They are easily located in the Cochrane Library or through OVID’s EBM Reviews database (low)

5. Five sources of “refined” information Clinical Evidence Validity – Starts with a clinical question then determines if the answer can be supported by current, high level (i.e. valid) scientific research (some high, some low, but all clearly indicated) Relevance – Because it starts with a clinical question it is highly relevant to patient outcomes (high) Work – Fairly small database at this time. Easier to browse within a subject area than to search (medium)

6. Five sources of “refined” information POEMs (Patient Oriented Evidence that Matters) Validity –Papers selected are screened for their scientific validity (high) Relevance – Articles must contain outcomes that patients care about and information that has the potential to change the practice of physicians. (high) Work – Difficult to locate because at this point individual journals must be searched (medium)

7. Five sources of “refined” information CATs (Critically Appraised Topics) Validity –The appraisal includes a statement regarding the scientific rigor of the study (low- high) Relevance – Relevance will depend on the paper being appraised. (low-high) Work – Easily located in ACP Journal Club which is indexed in the EBM Reviews database. (low)

8. Five sources of “refined” information Practice Guidelines Validity – Varies from guideline to guideline. Very important to ensure that guidelines are based on high quality evidence. (medium – high) Relevance – Designed specifically for use by clinicians (high) Work – Available on many publicly accessible sites (low)

9. Drilling Through the Evidence Grandage KK, Slawson DC, Shaughnessy AF. When less is more: a practical approach to searching for evidence-based answers. J Med Libr Assoc. 2002; 90: 298-304.

10. Where do you look for information? You have to prepare a research grant. You’ve just taken the history of a patient and suspect they have Chronic obstructive pulmonary disease (COPD). You have verified that they have COPD and want to know what the current best intervention is. Medline (PubMed or OVID) Textbook Systematic Review, Cochrane Library, POEM, CAT, Clinical Evidence or Practice Guideline

11. Locating Secondary Information Systematic Reviews – Cochrane Database of Systematic Reviews (CDSR) and Database of Reviews of Effect (DARE) – available from EBM Reviews or Cochrane Library Clinical Evidence – Quick links on the Medicine Outreach Web Page http://www.lib.uwo.ca/taylor/outreach/ http://www.lib.uwo.ca/taylor/outreach/

12. Locating Secondary Information POEMs – BMJ, Journal of Family Practice and American Family Physician (title search in library catalogue) CATs – ACP Journal Club (indexed in EBM Reviews database). For other sites see: http://www.lib.uwo.ca/taylor/outreach/ under the “EBM” tab http://www.lib.uwo.ca/taylor/outreach/ Clinical Guidelines – On the Medical Outreach web page, look under the “EBM” tab

13. References 1. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract 1994; 39: 489-499. 2. Grandage KK, Slawson DC, Shaughnessy AF. When less is more: a practical approach to searching for evidence- based answers. J Med Libr Assoc. 2002; 90: 298-304.