Transcript All about Evidence: Defining, Finding and Using

Finding the Evidence:
Search Basics
Ilo-Katryn Maimets
[email protected]
416-736-2100 x33927
Steacie Library room 102K
Evidence-Based Health Care
“The integration of best research evidence with
clinical expertise and patient values to
facilitate clinical decision making”
(Sackett et al., 2000)
AGENDA
A. Sources of Information – Library website
a. Databases & More
B. Study Design – Hierarchy of Evidence
C. Conducting a Literature Search
a. Search tips and Boolean Logic
b. Keyword searching
c. Subject heading searching
D. Steps in Evidence-based practice
E. Levels of Pre-Appraised Evidence
A. Identify Sources of Information
• Select Sources that will most likely answer the question:
– If the information is most likely found in Medical or
Nursing research journals then start your search in a
database that indexes that kind of research:
• Cinahl (Nursing and Allied Health)
• Medline(OVID) and PubMed
• SCOPUS (interdisciplinary - indexes part of Embase)
• Web of Science (very interdisciplinary)
– Note that sometimes relevant research is indexed in:
• PsychINFO (psychology)
• Eric (education)
A. Sources of Nursing Information
in the York Library Website:
www.library.yorku.ca
Access the Research Guides
Research Guides
• Use the Research Guides to locate:
– General/Getting Started: Dictionaries,
Encyclopaedias and e-books
– Articles/Finding articles:
• Links to Databases
• Systematic Reviews and Evidence-based Practice
Resources
– Advanced/Advanced Research:
• Association and organizations
• Webguides and other resources
– Other Related Research Guides and Resources
Nursing Research Guide
http://researchguides.library.yorku.ca/nursing
B. Study Design:
The hierarchy of Evidence
Study Designs: descriptive and analytic
Centre for Evidence Based Medicine, University of Oxford
http://www.cebm.net/index.aspx?o=1039
Hierarchy of Evidence: Study Design
http://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2289252
Connie Schardt, Medical Centre Library, Duke University
Meta
Analyses
Secondary studies which review
original research
Systematic
Reviews
Randomized Controlled
Trials
Experimental designs
Cohort Studies
Case Control Studies
Case reports / case series
Observational reports
and studies
Case Reports
• Reports of observations of diseases, adverse
reactions or unexpected events
– E.g. observations in the 1980s of a rare cancer
combined with pneumonia led to the discovery of
HIV-AIDS
• However, there are no controls and so there is
no statistical validity, and you cannot draw
conclusions or make statistical comparisons.
Case Control Studies
• These are used to examine Harm questions
– Begin with an outcome or issue
– Look backwards in time to identify a possible
exposure, or risk factor
– E.g. observations of lung cancer incidence in the
1950s led to an examination of patient records
that uncovered links to cigarette smoking
Peto R. Darby S. Deo H. Silcocks P. Whitley E. Doll R. (2000) Smoking, smoking cessation, and lung cancer in the
UK since 1950: combination of national statistics with two case-control studies. BMJ. 321(7257):323-9.
Case Control Studies
• Are quick, inexpensive, convenient and ethical
because the patient already has the condition.
• However, evidence is based on recall which
may be biased, or on past records which may
not be complete because they were created
before knowing what the questions were.
• There may be confounders that are common
to both groups
• It is difficult to choose appropriate controls.
Cohort studies
• Involve 2 or more populations:
– Exposed: having a specific condition or receiving a
particular treatment over time
– Non-Exposed: group that has not been affected by the
condition or treatment being studied
• Follow the populations forward in time – sometimes
for many years to determine the effect of the
exposure.
• E.g. long-term effectiveness of influenza vaccines in
community dwelling elderly people
Nichol KL, Nordin JD, Nelson DB, Mullooly JP, & Hak E. (2007). Effectiveness of influenza vaccine in the
community-dwelling elderly. New England Journal of Medicine, 357(14):1373-1381.
Cohort studies
• Observations are of people in their natural
settings
• Evidence is strengthened by natural time
sequence – exposure occurs before the
outcome
• Ethical in that patients self-select (this may
also be a source of bias)
• Possible confounders
• Long follow-up – often many years even
decades.
Randomized Controlled Trials
• True experimental design that introduces a therapeutic
randomized/control-placebo intervention
• Follows subjects forward in time to determine the effects of
interventions
• Randomization is key and involves randomly assigning
individuals to groups
• Less prone to bias, best for establishing efficacy
• May present ethical dilemmas
• Is very expensive and time-consuming
Müller O, Traoré C, Kouyaté B, Yé Y, Frey C, Coulibaly B, et al. (2006). Effects of insecticide-treated bednets
during early infancy in an African area of intense malaria transmission: A randomized controlled trial. Bulletin
of the World Health Organization, 84(2):120-126.
Systematic Reviews
• Secondary research that:
– Focusses on a clinical topic
– Involves a thorough review of the literature,
published and unpublished
– Studies are subject to detailed scrutiny of their
quality for inclusion
– Summarizes data for drawing conclusions that
inform practice.
Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane
Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005312.
Meta Analysis
• Mathematically/statistically pools the data
from individual studies
– Sources of data can be the articles included in a
systematic review or from otherwise selected
primary studies, both peer-reviewed and grey
literature
• Present results as if it were from a large study
Bahekar AA, Singh S, Saha S, Molnar J, Arora R. (2007). The prevalence and incidence of coronary
heart disease is significantly increased in periodontitis: A meta-analysis. American Heart Journal,
154(5): 830-7.
Systematic Review/Meta Analysis
• Exhaustively reviews the current literature
• Articles are critically evaluated for inclusion
• Pooled data allows validation of findings in small
studies
• Publication bias may be a problem as negative
results are less often published than positive results
• Conducting them is very time consuming and so also
expensive
• Data parameters and collection methods are not
always the same from study to study, and so studies
cannot be easily combined.
Study Design: Hierarchy of Evidence
http://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2289252
Connie Schardt, Medical Centre Library, Duke University
Meta
Analyses
Secondary studies which review
original research
Systematic
Reviews
Randomized Controlled
Trials
Experimental designs
Cohort Studies
Case Control Studies
Case reports / case series
Observational reports
and studies
Qualitative vs. Quantitative
• EBP started as part of medicine to determine
best practices in quantitatively measurable
procedures, effects, etc. However, in nursing,
many questions are asked that cannot be
answered by quantitative data.
– For example: what is the lived experience of
women identified as carriers of the BRCA gene?
• In most EBP rating scales, qualitative evidence
is deemed to be low on the scale for quality
and validity
Quantitative Study Designs
based on question type
DiCenzo, Guyatt, Ciliska, 2005, pg 28
1. Healthcare interventions: treatment,
prevention, therapy
2. Harm: causation or etiology
3. Prognosis: future course of the condition
4. Diagnosis/assessment
5. Economics: economic efficiency of
healthcare programs or interventions
Qualitative Study Designs:
DiCenzo, Guyatt, Ciliska, 2005, pg 32
• Case studies: involves studying a number of
related cases in depth to inquire into an
observed phenomenon. The belief is that
understanding them will lead to a deeper
understanding of a larger collection of cases.
• Ethnography: involves studying people within
a culture in an intensive, ongoing,
participatory way. The researcher is immersed
in the culture for the duration of the study.
Qualitative Study Designs:
DiCenzo, Guyatt, Ciliska, 2005, pg 32
• Grounded Theory: involves discovering
meanings that people assign to people and
objects or situations that they interact with.
The purpose is to develop a theory to account
for individual differences. Interviews and
observation are used to collect data
• Phenomenology: examines the daily lived
experience of people. Data are collected
through in-depth interviews.
Qualitative Systematic Reviews:
• Do not use statistical methods to combine
findings and data
• Adhere to a systematic process for retrieving
sources, selecting sources, and critiquing
sources
• Their purpose is to synthesize the findings
from multiple studies, and this process is
called Meta-synthesis.
Levine and Feldman, 2006, pg 178
Qualitative Meta-Syntheses:
• Uses data from different qualitative studies
that are linked because they are about the
same or a related by topic. The methodologies
used can be different.
• Is neither an integrated review nor a
secondary analysis of primary data.
• Rather it is an analysis of the findings of these
studies
Integrative Reviews:
• Are similar to qualitative systematic reviews,
however, they use broader, often less rigorous
methods to systematically combine the results of a
body of studies.
Stevens, 2002, pg 530
• “The integrative review method is an approach that
allows for the inclusion of diverse methodologies
(i.e. experimental and non-experimental research)
and has the potential to play a greater role in
evidence-based practice for nursing”
Whittemore, 2005, pg 547
http://users.phhp.ufl.edu/rbauer/ebpp/whittemore_knafl_05.pdf
Realist Syntheses:
• Focus is on understanding and analyzing the
mechanisms by which an intervention works
or fails to work
• Provides an explanation rather than a
judgement about implementation and success
of an intervention
• Accounts for not just outcomes but also
context of the intervention
• By nature, RSs are well suited to complex
implementation interventions
Realist Syntheses:
• Implementation interventions are by nature
complex and multi-faceted.
• When developing and implementing an
intervention, there is an underlying theory
about how it should work.
• Deterministic theories cannot always explain
or predict implementation outcomes in every
context.
http://www.ccsr.ac.uk/methods/publications/RMPmethods2.pdf
Narrative Synthesis:
• Method to synthesize research in the context of
systematic reviews that uses a narrative approach to
summarize findings.
• Does not exclude numerical analyses and can occur
alongside Meta-analyses
• Combines heterogeneous studies, and has not (yet)
been developed according to consensual structurally
and thematically coherent framework to describe a
complex body of evidence
What kind of study is this?
Good place to start – not exhaustive
Health Sciences Library, McMaster University.
Tips for Searching for the Evidence [Internet] [cited
2012 1/8/2012]. Available from:
http://hsl.mcmaster.ca/education/nursing/ebn/search.htm
C. Conducting a Literature Search
a. Search tips and Boolean Logic
The logic of searching - Tips
• Booleans, Brackets, Truncation, Quotation
marks
– These features apply to most but not all Health
and Science Databases
– If you are not sure, always check the Help Menu
to see the syntax for the database you are
searching
The logic of searching
Use Boolean Logic to put together your search
terms:
AND
OR
NOT
Boolean Logic: AND
AND: Finds those citations that contain both
search terms joined by AND
AND is used to find the intersection of different
concepts
isolation AND depression
Boolean Logic: AND
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Isolation
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Depression
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isolation AND depression
Boolean Logic: OR and brackets: ()
OR: Finds citations with ANY search terms
joined by OR
OR is used to join synonyms and related terms
of the same concept:
isolation OR quarantine
read: either isolation OR quarantine OR both
N.B. use brackets if you have more than one
term for a concept: (isolation OR quarantine)
Boolean Logic: OR
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Isolation
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Quarantine
q
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iiq
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(isolation OR quarantine)
Boolean Logic: NOT
NOT: Finds citations that DO NOT contain these
search terms (check the database syntax to see what is
used for the exclusion term e.g. some use BUTNOT)
NOT is used to exclude a set of results when you
find that you are too many false hits on an
unrelated topic
(Isolation OR quarantine) NOT seclusion
Boolean Logic: NOT
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Isolation
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Quarantine
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sq
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NOT sq
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Seclusions
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Seclusion
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(isolation OR quarantine)
Truncation and Wildcard
• Truncation symbol: * To use truncation, enter the root of
a search term and replace the endings with an *.
– Example: typing nurs* will find the words nursing, nurse, or
nurses as well as nursery, nurseries etc.
• Wildcard symbol: ? To use the wildcard, replace each
unknown character with a ?.
– For example, type wom?n to find all citations containing woman
or women.
– NB: the wildcard replaces a single character, so behavio?r will
only retrieve behaviour and not behavior because the number of
characters do not match
• Note that different databases may have different symbols and techniques for
Wildcard and Truncation
Phrase searching
• MEDLINE and CINAHL- the search: well being will find
well and being anywhere in the text fields
In Medline, to find the phrase well being
search: well being
Searching well adjN being will find articles where well
and being are within N words from each other in any
order
In CINAHL, to find the exact phrase well being
search: ”well being”
Different databases may have additional operators such as
Adjacency Operators – check the Help Files for these
Boolean Logic: Test Example
Which phrases would you find with the search:
Isolat* AND depress*
1. Isolation is associated with falls
2. Quarantine is required for SARS
3. Isolation can trigger depression
4. Isolation is associated with adverse effects
5. Is depression an outcome of isolation?
Test Example
Which article(s) would you find with the search
Isolat* OR quarantin*
1. Patients with MRSA are isolated
2. In vitro protein isolation
3. Quarantine prevents the spread of rabies
4. DNA purification is a complex process
5. Both isolation and quarantine can have
detrimental effects on emotional well-being
Use Brackets to
Group Together Search Terms
Which phrases would you find with the search:
(isolat* OR quarantin*) AND (depress*) NOT seclu*
•
•
•
•
Isolation can lead to depression
Quarantining patients with MRIs can trigger depressive
symptoms
Rabies was isolated from quarantined raccoons
Does severe depression warrant seclusion?
Conducting a Literature Search
1.
2.
3.
4.
Identify a problem for investigation
Develop a structured research question
Identify key concepts in the question
Develop a Keyword search strategy by identifying
searchable terms:
a)
b)
5.
6.
7.
8.
9.
10.
Find keywords: synonyms & related terms for each concept
Combine with Boolean Logic
Subject Heading Search – using MeSH or equivalent
Select sources of evidence e.g. databases
Test search with vocabulary suitable to the database
Modify your search strategy if necessary
Run the search
Retrieve articles and appraise them for suitability
Define the Problem
• Determine a Problem that you want to
investigate:
• Example Problem:
Current practice requires that patients with
multidrug-resistant infections be place in
isolation. However, isolation has recently been
associated with adverse effects on patients’
mental well-being.
Ask a Structured Question
• Develop a Question that will focus the
information you will be gathering
• Example Structured Question:
Does patient isolation increase the
incidence of depression?
Identify Key Concepts
• What are the main concepts in your question?
Does patient isolation increase
the incidence of depression?
Concept 1: patient
Concept 2: isolation
Concept 3: depression
C. Conducting a Literature Search
b. Keyword searching
b. Developing a Search Strategy
a. Identify keywords from the concepts
Q: Does patient isolation increase
the incidence of depression?
Concept 1:
Patient
Concept 2:
Isolation
Quarantine
Concept 3:
Depression
Mental health
Mental wellbeing
Mental well being
Mental well-being
Psychological impact
4. Develop a KW Search Strategy
• Combine synonyms within each concept with
OR:
Concept 1:
Concept 2:
Concept 3:
Concept 3a:
Concept 3b:
patient
isolation OR quarantine
depression
mental OR psychological
health OR wellbeing OR wellbeing OR well being OR impact
Develop a Search Strategy
• Identify alternate endings for each word:
Concept 1:
Concept 2:
Concept 3:
Concept 3a:
patient[s]
isolat[ion, ed] OR quarantin[e, ed]
depress[ion, ed]
mental[ly] OR psycholog[y, ical,
ically]
Concept 3b: health[y] OR health[y] OR wellbeing
OR well-being OR well being OR
impact
4. Develop a KW Search Strategy
• Replace different endings with truncation symbol *
and insert quotation marks to search for phrases:
Concept 1:
Concept 2:
Concept 3:
Concept 3a:
Concept 3b:
patient*
isolat* OR quarantin*
depressi*
mental* OR psychologic*
health* OR wellbeing OR wellbeing OR “well being” OR impact*
4. Develop a KW Search Strategy
Patient* AND (Isolat* OR quarantin*) AND
(depressi* OR ((mental* OR psychologic*) AND
(wellbeing OR “well being” OR well-being OR
health* OR impact*)))
N.B. Make sure all of your brackets “add up”
Run this search in all the databases you have selected
N.B. Some databases don’t support nested Booleans
Run your search!
Set Limits
• If you find you get
very many results,
chances are that a
systematic review
has already been
conducted to
synthesize the
evidence.
• Limit your search to
the available limits
OR select Additional
Limits to focus your
search
C. Conducting a Literature Search
c. Subject heading searching
Medical Subject Headings (MeSH)
• Make searching in MEDLINE so powerful.
• MeSH are specific terms that are used to index
articles in MEDLINE.
– They are hierarchically organized and linked to express
the specificity of topics so that narrower terms are more
granular, and broader terms are more general.
– They provide a consistent way to find articles that are
about the same topic but use different terminology.
• CINAHL also features MeSH headings as well
as CINAHL subject headings
Subject Heading searching:
Medline and CINAHL
Keyword
search:
cancer
Citations
Cancer
Neoplasms
Tumor
Tumour
Tumours
GERD
Abstract
mentions
esophageal
cancer
Subject Heading searching:
Medline and CINAHL
Keyword
search:
cancer
Map to SH
Citations
Cancer
Neoplasms
Tumor
Tumour
Tumours
GERD
Abstract
mentions
esophageal
cancer
Subject Heading searching:
Medline and CINAHL
Keyword
search:
MeSH
cancer
neoplasms
Map to SH
Citations
Cancer
Neoplasms
Tumor
Tumour
Tumours
GERD
Abstract
mentions
esophageal
cancer
Strategy for Subject Searching in
Medline and CINAHL:
– Identify each concept in the topic and its synonyms
– Search one term (KW) at a time to find Subject
Headings that match the concepts
• combine subject headings for one concept with OR
• combine Different concepts with AND
– Initially try to keep your search broad to ensure that
you find enough relevant articles.
– Once you have determined how many results you
have and assessed their quality, you can refine your
search with
• subheadings AND/OR limits
Medline(Ovid) Clinical Queries
•
•
•
•
•
•
•
Reviews
Therapy
Diagnosis
Prognosis
Causation-Etiology
Economics
Clinical Prediction
Guides
• Qualitative
• Costs
• Maximizes sensitivity
• Maximizes specificity
• Best balance of
sensitivity and
Specificity
Databases: PubMed
• Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical
– Results of searches are limited to specific clinical
research areas:
• Clinical Study Categories:
–
–
–
–
–
Therapy
Diagnosis
Etiology
Prognosis
Clinical Prediction guides
• Two types of retrieval emphasis:
– specific
– sensitivity
Databases: CINAHL (EbscoHost)
• Clinical Queries include:
–
–
–
–
–
Therapy
Prognosis
Review
Qualitative
Causation (Etiology)
• Emphasis – strategies
– High sensitivity
– High specificity
– Best Balance
Databases: EBM Reviews(Ovid)
• Includes six databases:
– 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
• Search with keywords
Manage your references with
RefWorks (Medline)
Step 1: Select a reference by
clicking in the checkbox
Step 2: click Export in the
toolbar
Step 3: This opens a window
for exporting directly to
RefWorks
Step 4: Click Save
The RefWorks Login
window will open
Step 5: Log into RefWorks
to complete the export
See RefWorks handout for
more details
Manage your references with
RefWorks (CINAHL)
Step 1: Select a reference by
clicking Add to Folder
Step 2: Go to Folder View
Step 3: Export opens a window
for exporting directly to
RefWorks
Step 4: Click Save
The RefWorks Login
window will open
Step 5: Log into RefWorks to
complete the export
See RefWorks handout for
more details
RefWorks Information
D. Steps in Evidence-Based Practice
D. Steps in Evidence-Based Practice
1. Observe and analyse the situation
2. Ask a focused question from a clinical observation that can
be answered through research and other evidence sources.
based on PICO:
OR
based on PS:
–
–
–
–
Patient or Problem
Intervention or treatment
Comparator or Control
Outcome
– Patient
– Situation
based on PCD:
Levine and Feldman, 2006, pg 232
– Patient
– Cues
– Differential diagnosis
D. Steps in Evidence-Based Practice
3. Search for the best evidence available from the Hierarchy
of Pre-processed Evidence
4. Appraise it for validity and suitability to answer the
questions by asking:
–
–
–
What is the validity of the evidence I have uncovered?
Are the results of the studies clinically, (educationally OR
administratively depending on your question) significant or
important?
Is the evidence usable with my population of patients, (students
OR nurses) in the setting in which I practice?
Levine and Feldman, 2006
D. Steps in Evidence-Based Practice
5. Integrate the evidence with clinical expertise and
patient’s perspectives in the care of the patient
–
–
Clinical expertise refers to our assessment of the patient’s
condition through subjective history-taking combined with the
objective findings of lab results and physical examination
results.
Patients’ perspectives include their belief and value systems
combined with their life choices and treatment choices.
6. Evaluate effectiveness of the care/treatment and
whole process
–
This includes self-evaluation as an integral part of reviewing
the process we have just gone through to answer the
question.
Levine and Feldman, 2006
E. Levels of Pre-Appraised Evidence
Levels of Pre-Appraised Evidence
including Quantitative and Qualitative Studies
modified from Levine and Feldman, 2006, pg 179
1.
2.
3.
4.
5.
6.
7.
8.
Evidence from a quantitative systematic review or meta-analysis of all
relevant Randomized Controlled Trials or Evidence-Based Clinical
Practice Guidelines based on systematic reviews of RCTs
Evidence from at least one well-designed Randomized Controlled Trial
Evidence from well-designed controlled trials without randomization
Evidence from well-designed case-control and cohort studies
Evidence from Meta-synthesis i.e. systematic reviews of descriptive and
qualitative studies
Evidence from integrative reviews
Evidence from a single descriptive or qualitative study
Evidence from opinion of authorities or expert committees
Types of Studies for Types of
Questions
Therapy
Randomized controlled trial (RCT),
cohort, case control, case series
Diagnosis
Cohort studies with comparison to
gold standard test
Prognosis
Cohort studies, case control, case
series
Etiology/Harm
RCT, cohort studies, case control, case
series
Prevention
RCT, cohort studies, case control, case
series
Cost
Economic analysis
http://www.ebbp.org/course_outlines/searching_for_evidence/#AA
Levels of Pre-Appraised Evidence
Quantitative Studies
http://libguides.ucalgary.ca/nurs385
http://www.library.ualberta.ca/uploads/HealthSciences/200717155.pdf
1. Computerized Decision Support Systems
Systems Links best evidence with electronic patient records
Summaries
2. Recommended Practice Guidelines
3. Summarizes findings in a high-quality
Synopses of Syntheses systematic review to answer a focused
clinical question
Synthesis
Synopses of Single Studies
Studies
4. Systematic Review consolidates
literature on a specific topic
5. Synopsis of single high-quality
study that can inform practice
6. Single Peer-reviewed
articles
6. Studies
• Primary studies are the least critically appraised of all
the levels of evidence, and so are the last resource to
use if there are no higher levels of evidence
available.
• They include Quantitative and Qualitative Research
articles with Randomized Control Trials (RCT)
considered to be the highest level
• Can be accessed through databases such as:
–
–
–
–
CINAHL
MEDLINE(Ovid and PubMed)
Proquest Nursing and Allied Health
Embase (accessed from SCOPUS)
5. Synopses of Studies
• Synposes of Single Studies provide a brief,
sufficiently detailed summary of a high-quality
study that can inform clinical practice.
– Evidence-based nursing (open access journal)
– Evidence-based midwifery
– Bandolier (UK)
– Health Services/Technology Assessment Texts
(HSTAT) (NLM-US)
– ACP Journal Club
4. Sytheses/Systematic Reviews
/Meta-analyses/Integrative Reviews
• Systematic Reviews summarize and analyze
the primary literature on a specific topic.
•
•
•
•
Identify all relevant studies
Review study relevance and Evaluate methodologies
Extract and analyze data
Draw conclusions based on common findings, themes
• Examples:
• Nursing+ (McMaster University)
• Evidence Based Medicine Reviews : Cochrane DSR, ACP Journal
Club, DARE and CCTR
• Joanna Briggs Institute – Systematic Reviews
• The Cochrane Library (public) access from YorkU: EBM Reviews
• CINAHL and MELDINE
4. Systematic Reviews
• “Systematic reviews provide a summary of the
literature on a particular topic.
• They summarize …, appraise and communicate the
results and implications of otherwise unmanageable
quantities of research.
• Systematic reviews bring together separately
conducted studies (sometimes with conflicting
findings) and synthesize the results.
• In this way they contribute to the evaluation of both
existing and new technologies and practices.”
Canadian Best Practices Portal
3. Synopses of Synthesis
Short summaries of high-quality systematic
reviews including commentary on the
methodology and clinical applications of the
review
• They are short but often offer enough
information to support clinical decisions
–
–
–
–
–
Canadian Best Practices Portal
Worldviews on Evidence-Based Nursing (journal)
Centre for Reviews and Dissemination
Database of Abstracts of Reviews of Effects (DARE)
www.health-evidence.ca
(DiCenso A, Bayley L, & Haynes RB. 2009)
2. Summaries
“Summaries integrate best available evidence
from the lower layers (drawing on syntheses
as much as possible) to provide a full range of
evidence concerning management options for
a given health problem.”
(Haynes, 2006 p 162)
2. Summaries
• Recommended Practice Guidelines integrate
evidence-based information about specific
nursing issues and provide regular updates:
– CNO Compendium of Standards of Practice for
Nurses in Ontario
– RNAO Nursing Best Practice Guidelines
– The Canadian Best Practices Portal
– National Guideline Clearinghouse
– Joanna Briggs Best Practice Information Sheets
1. Systems
• Computerized Decision Support Systems
– Evidence-based clinical information systems
integrate and summarize all relevant and
important research evidence about a clinical
problem.
– Are updated as new evidence becomes available
– Link best evidence with electronic patient records
– E.g. UpToDate and MedWeaver
Levels of Pre-Appraised Evidence
http://libguides.ucalgary.ca/nurs385
www.oahpp.ca
Computerized Decision Support Systems
Systems Links best evidence with electronic patient records
Summaries
Recommended Practice Guidelines
Summarizes findings in a high-quality
Synopses of Syntheses systematic review to answer a focused
clinical question
Synthesis
Synopses of Single Studies
Studies
Systematic Review consolidates
literature on a specific topic
Synopsis of a single high-quality
study that can inform practice
Single peer-reviewed articles
References
• Evidence based nursing : A guide to clinical practice (c2005).
In DiCenso A., (Ed.), . St. Louis, MO ;: Mosby.
• Evidence-based medicine: Mini manual. (2007). Retrieved
5/31/2013, 2013, from
http://www.library.ualberta.ca/uploads/HealthSciences/2007
17155.pdf
• Teaching evidence-based practice in nursing : A guide for
academic and clinical settings (c2006). In Levin R. F., Feldman
H. R.(Eds.), . New York: Springer Pub. Co.
• Whittemore, R., & Knafl, K. (2005). The integrative review:
Updated methodology. Journal of Advanced Nursing, 52(5),
546-553. doi: 10.1111/j.1365-2648.2005.03621.x
Thank you!
Questions or Comments?
Ilo-Katryn Maimets
[email protected]
416-736-2100 x33927