EBP: Library Tools for Clinical Content

Christina L. Wissinger MS, MLISClinical Informationist

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.

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

Levels of Evidence: Study design

Medical Center Library, Duke University

Stronger

Weaker

Levels of Evidence for Treatment

1a: Systematic reviews of randomized controlled trials1b: Individual randomized controlled trials

(with narrow confidence interval) 1c: All or none randomized controlled trials

2a: Systematic reviews … of cohort studies2b: 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/

Stronger

Weaker

EBP: Steps

4 Incorporate into Patient Care

1 Refine Question

2 Select Sources

2 Formulate Query

2 Perform Search

5Evaluate Process

No

Y es2Evaluate results:

Satisfactory?

3 Critically Appraise: Strong?

Y es

No

1. Refine the clinical question

2. Find the best evidence 3. Critically appraise

the evidence4. Integrate the critically

appraised informationwith your clinical expertise

5. Evaluate steps 1-4 for effectiveness and efficiency

Sackett, et al, Evidence-Based Medicine, 2000

p. 3-4

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)

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)

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

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.

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

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

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

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

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.

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

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

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

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

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

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

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, MLISClinical InformationistWelch Medical Library1900 E. Monument Street, Room 214410-502-6812clw@jhmi.edu

http://www.welch.jhu.edu/liaison/CLW.html PMR Portal -

https://infosuite.welch.jhmi.edu/PMR/