LIBRARY RESOURCESEVIDENCE BASED PRACTICECLINICAL NURSE FELLOWSHIP PROGRAM

Michelle DeMarsHealth Sciences Librarian

Michelle.DeMars@csulb.edu

BY THE END OF THIS SESSION YOU WILL:

• Be able to identify the 5 stages of Evidence Based Practice• Identify and develop PICOT questions• Use keywords from your question to search the databases• Refine search: limiters, Boolean operators, synonyms• Know how to locate journal articles in databases• Evaluate your results to find the best evidence available

THE 5 STAGES OF EVIDENCE BASED PRACTICE

ASK

FIND

EVALUATE

APPLY

REVIEW

ASK: DEVELOP A CLEARLY WORDED CLINICAL

QUESTION USING PICO(T)

The PICOT question format is a consistent "formula" for developing answerable, researchable questions.

P: Population/disease ( i.e. age, gender, ethnicity, with a certain disorder)

I : Intervention or Variable of Interest (disease, risk behavior, etc.)

C: Comparison: (could be a placebo or alternative treatment)

O: Outcome: (risk of disease)

T: Time: The time it takes to demonstrate an outcome (e.g. the time it takes to achieve an outcome or how long participants are observed).

Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.

PICO(T)A concerned new mother comes in with her

premature infant. She is concerned about the baby’s weight gain and growth. She wants to

know if she should start feeding her baby formula or just continue with breastfeeding.

Patient, problem or population

Intervention

Comparison

Outcome

Premature Infants

Breastfeeding

Formula Feeding

Development/Growth

ASK YE SHALL FIND: DIFFERENT TYPES OF CLINICAL QUESTIONS &

DIFFERENT TYPES OF STUDIESIn addition to composing a well-built clinical question,

one must keep in mind the type of question and the type of study that would provide the best evidence

Most common types of questions Types of StudiesDiagnosisHow to select and interpret diagnositc testsTherapyHow to select treatments that have more benefit than riskPrognosisHow to estimate a patient’s clinical course over timeEtiologyHow to identify causes for disease

Remember the higher up you go on the pyramid the more rigorous the studies are and often have less bias.

FIND:SEARCHING FOR THE EVIDENCE

• Use keywords from your PICOT question to search the databases

• Determine the level of evidence that best answers the question

• Select relevant databases to search• Refine search: subject headings, Boolean operators, limit

your results

SEARCH AND EVALUATEUse Databases like PubMed, CINAHL and Cochrane to find the best

evidence

TODAY WE LEARNED

To identify the 5 stages of Evidence Based Practice• To identify and develop PICOT questions• To use keywords from your question to search the

databases• To refine search: limiters, Boolean operators, synonyms• To know how to locate journal articles in databases• To evaluate your results to find the best evidence

available

THANK YOU!

MICHELLE M. DEMARSHEALTH SCIENCES LIBRARIAN

MICHELLE.DEMARS@CSULB.EDU

RESOURCES FOR FURTHER RESEARCH

Duke University Library EBP Page: http://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2289252http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036074

Worksheet Exampleshttp://www.cebm.net/index.aspx?o=1157 (Centre for Evidence-Based Medicine)http://tinyurl.com/82zmjlw (Duke University Medical Center Library)

COCHRANE LIBRARY

Collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about groups in The Cochrane Collaboration.• Cochrane Database of Systematic Reviews• Cochrane Central Register of Controlled Trials• Cochrane Methodology Register• Database of Abstracts of Reviews of Effects• Health Technology Assessment Database• NHS Economic Evaluation Database• About The Cochrane Collaboration