Transcript Evidence-based Practice Resources for HINARI Users (Module 7.2) Evidence-based Practice Resources for HINARI Users Instructions - This part of the: course is a PowerPoint demonstration intended.

Evidence-based Practice
Resources for HINARI Users
(Module 7.2)
Evidence-based Practice Resources
for HINARI Users
Instructions - This part of the:
course is a PowerPoint demonstration
intended to introduce you to Evidence-based
Practice and related HINARI resources.
module is off-line and is intended as an
information resource for reference use.
Table of Contents – Part A
• Evidence-based Medicine (EBM)
– Definition
– What, why and how of EBM
– 5 step EBM process – ask, access,
appraise, apply
and access
– Limitations of EBM
Table of Contents – Part B
• HINARI Resources
– Clinical Evidence
– Cochrane Library
– EBM Guidelines
– HINARI EBM Journals
Table of Contents – Part C
• Other (Internet) Resources:
– PubMed’s Clinical Queries and ‘Type of Article’ Limits
– Clinical Practice Guidelines – definition & examples
– Cochrane Library ‘Abstracts’
– PubMed Health – clinical effective research
– Trip Database
– Evidence Updates - BMJ and McMaster University
– Knowledge Translation Learning Modules – Canadian
Institutes of Health Research
– Essential Health Links gateway – annotated links
– Other useful websites
Evidence-based Practice (EBP) Definition
"Evidence-Based Practice requires that
decisions about health care are based on
the best available, current, valid and
relevant evidence. These decisions should
be made by those receiving care, informed
by the tacit and explicit knowledge of
those providing care, within the context of
available resources."
Sicily statement on evidence-based practice. BMC
Medical Education, 2005 Jan 5;5(1):1
What is EBP?
• The integration of best
evidence* from
current research,
patient preferences
and values, and clinical
expertise to clinical
questions (Sackett,
2000) in a timely
fashion.
Best Evidence
EBP
Patient
Values/Local
Conditions
Clinical
Expertise
*Best available evidence is: consistent research evidence with
high quality and quantity
Why EBP?
• To improve care
– To bridge the gap between research & practice
– “Kill as few patients as possible” (O. London)
– A new treatment might have fewer side effects.
– A new treatment could be cheaper or less invasive
– A new treatment may be necessary in case people
develop resistance to existing therapies, etc.
• To keep knowledge and skills current (continuing
education)
• To save time to find the best information
How does EBP help?
A patient comes to a clinic with a fresh dog bite. It looks
clean and the nurse and patient wonder if prophylactic
antibiotics are necessary. The nurse searches PubMed and
found a meta analysis indicating that the average infection
rate for dog bites was 14% and that antibiotics halved this risk
to 7%.
• For every 100 people with dog bites, treatment with antibiotics will
save 7 from infection
• Treating 14 (NNT) people with dog bites will prevent 1 infection
• You explain these numbers to the patient along with possible
consequences and patient decides not to take antibiotics.
On a follow up visit you find out that he did not get infected.
Glasziou P, Del Mar C, Salisbury J. EBP Workbook, 2nd. ed. BMJ Books, 2007.
What are some Barriers for EBP?
•
•
•
•
•
•
Overuse, underuse, misuse of evidence
Time, effort, & skill needed
Access to evidence
Intimidation by senior clinicians
Environment not supportive of EBP
Poor decision making
The 5 Step EBP Process
1.
ASK: Formulate an
answerable clinical question
2.
ACCESS: Track down the best
Evidence
3.
APPRAISE: Appraise the
evidence for its validity and
usefulness
4.
APPLY: Integrate the results
with your clinical expertise
and your patient values/local
conditions
5.
ASSESS: Evaluate the
effectiveness of the process
Ask
Assess
Access
Apply
Appraise
Step 1: ASK
a focused (answerable) clinical question
Ask
• Background questions (What do I know about this?)
• Foreground (Clinical) Questions
P = Patient, population or problem (Who are the patients or
populations? What is the disease?)
I = Intervention (What do you want to do with this patient
(e.g. treat, diagnose, observe)?
C = Comparison intervention (What is the alternative to the
intervention (e.g. placebo, different drug, nothing?)
O = Outcome (What are the relevant outcomes (e.g.
morbidity, mortality, death, complications)?
Why should I use PICO?
•
•
•
To help define problem in clarify it in your own mind
To prepare for searching
To ask patient centered questions. Treatment of
Pneumococcal Pneumonia SHOULD be different for
– Terminal Cancer Patient
– Elderly, Severely Demented Patient
– Young, mother of 2 children
• Developing the question requires:
– Some background knowledge of the condition
– Understanding of the patient and what are the outcomes
and beliefs that matter to this patient
• Death? Disability? Quality of life? Cost? Improvement
of symptoms?
Example: Intervention Questions
• Identify background questions, create a PICO
and a focused clinical question for this case:
54 year old male patient was diagnosed with
intermediate grade prostate cancer and wants
to know whether to get a radical
prostatectomy or radiation treatment. He is
concerned about death from prostate cancer
and also risks of impotence and incontinence.
Formulate the Clinical Question
• PICO
P - 54 year old male with intermediate grade prostate cancer
I - radical prostatectomy
C- radiation treatment
O- reduce risk of mortality, impotence, and incontinence
• Focused clinical question
In 54 year old male patients with intermediate grade prostate
cancer is radical prostatectomy more effective compared to
radiation treatment in reducing the risk of mortality,
impotence, and incontinence?
EBP Step 1a:
Classify the type of the question
• What is the treatment?
Question of INTERVENTION/PREVENTION
• What causes the problem?
Question of ETIOLOGY, RISK
• Does this person have the problem?
Question of DIAGNOSIS
• Who (and how likely) will get the problem?
Question of PROGNOSIS
Etiology and Risk Questions
What causes a disease or health condition?
• The reverse of intervention questions-they deal with
harmful outcomes of an activity or exposure (public
health issues)
• Develop a clinical question for the case:
S. is a smoker and just found out that she is 3
months pregnant. She quit smoking immediately. But
she is worried if her developing baby was harmed
and if the baby is at risk for having developmental
problems. She is asking you if smoking during the
first trimester can harm her baby?
Etiology or Risk Questions
• P-babies of mothers who smoke
I-smoking in first trimester
C-nothing
O-increase risk of developmental problems
• Question: Are babies of mothers who smoke
during their first trimester at an increased risk
of developmental disabilities?
Diagnosis Questions
• These questions are concerned with how accurate a
diagnostic test is in various groups and in comparison
to other tests or usually to a “gold standard test”.
As part of your clinic assessment of elderly patients,
there is a hearing check. You think that a simple
whispered voice test is very accurate compared to
other methods. You want to do a literature search.
What is your question? (1)
Glasziou P, Del Mar C, Salisbury J. EBP Workbook, 2nd. ed. BMJ Books, 2007.
Example
• P-elderly people
I-whispered voice test
C-no test (or other tests)
O-accurate diagnosis of hearing problems
• Question: In elderly people, does the
whispered voice compared to other tests give
an accurate diagnosis of hearing problems?
Glasziou P, Del Mar C, Salisbury J. EBP Workbook, 2nd. ed. BMJ Books, 2007.
Templates for EBP Questions
• For a therapy: In _______(P), what is the effect of _______(I) on
______(O) compared with _______(C)?
• For etiology: Are ____ (P) who have _______ (I) at ___
(Increased/decreased) risk for/of_______ (O) compared with ______ (P)
with/without ______ (C)?
• Diagnosis or diagnostic test: Are (is) _________ (I) more accurate in
diagnosing ________ (P) compared with ______ (C) for _______ (O)?
• Prevention: For ________ (P) does the use of ______ (I) reduce the future
risk of ________ (O) compared with _________ (C)?
• Prognosis: Does __________ (I) influence ________ (O) in patients who
have _______ (P)?
Melnyk B. & Fineout-Overholt E. (2005). Evidence-based practice in nursing & healthcare. New York: Lippincott
Williams & Wilkins.
EBP Step1b:
Decide on the best type of study for question
For each type of question there is a hierarchy of evidence
Therapy/Prevention
RCT>cohort > case control > case series
What should I do about this
problem?
Diagnosis
Does this person have the
problem?
Etiology/Harm
cross-sectional study with blind comparison
to a gold standard
RCT > cohort > case control > case series
What causes the problem?
Prognosis/Prediction
Who will get the problem?
RCT >cohort study > case control > case
series
Frequency and Rate
cohort study > cross-sectional study
How common is the problem?
NOTE: A well designed systematic review of RCTS (randomized
controlled trials) is best as it is least biased therefore more valid.
Hierarchy of Study Designs for Intervention
Least
• Randomized Controlled Trial
Experimental
• Cohort Studies
Observational
• Case-Controlled Studies
Observational
• Case reports/Clinical Observations
Observational
Bias
Most
Bias
To recognize the type of study ask the questions:
1. Is intervention randomly assigned? Yes-RCT; No-Observational study
2. When were the outcomes determined?
• After the exposure-cohort study (prospective study)
• During the exposure-cross-sectional study
• Before the exposure-case-control study (retrospective study based on recall)
EBP Step 2: ACCESS
Track Down the Best Evidence
Access
1. Start “hunting” from the best resource: Match your question
to the best medical information resource for this question.
•
Well designed Systematic Reviews¹ can be a great place
to start they contain commentary about validity
¹A systematic review involves the application of scientific
strategies, in ways that limit bias, to the assembly, critical
appraisal, and synthesis of all relevant studies that
address a specific clinical question.
Cook DJ, Mulrow CD, Haynes RB. Annals of Internal
Medicine March 1, 1997; 126 (5) 376.
Track Down
Hierarchy of Evidence- Access evidence at
the level that will give you the best evidence
Filtered & Critically Appraised
Expert Opinion and Not Filtered
Background info.
Most clinically relevant (at the top) Least clinically relevant (at the bottom)
Why not get info only from
textbooks and review articles?
• Texts and review articles?
– Dated – perhaps by several years
– Often biased
• Author chooses article that he/she agrees with (or has
written)
• Author chooses articles of his/her friends
• Author does not identify all the relevant literature
• Review’s methods are not explained
• These resources help with background knowledge
(learn about disease) not foreground (answer the
specific clinical question for this patient)
Why not get info only from
guidelines?
• They can assure standards of care but:
– Can be biased
– May not always be developed by experienced
experts
– Are not always evidence-based
– Can work for most patients but not for all
– Can work in some circumstances but not in all
– Can be dated
– There may not be guidelines for everything
Filtered and Critically Appraised
Evidence-Based Resources
• The Cochrane Library by The Cochrane Collaboration
via Wiley
– Independent non-for-profit international collaboration
– Reviews are among the studies of highest scientific evidence
– Minimum Bias: Evidence is included/excluded on the basis of
explicit quality criteria
– Reviews involve exhaustive searches for all RCT, both
published and unpublished, on a particular topic
– Abstracts searchable for free on the Internet; complete
database is available via HINARI for most countries
– 1995-
Benefits for using not-evaluated databases
for EBM research (PubMed, Cinahl)
•
•
•
•
Create comprehensive search strategies
Conduct systematic reviews of the literature
Conduct synonym searching utilizing thesauri
Set up and distribute alerts relating to evidencebased medicine
• Limit to specific populations & publication types
• Utilize EBM built-in filters (search strategies)
EBP Step 3: Appraise:
Appraise
Determine if the results are valid and useful
• Appraisal principles (primary and secondary research)
– What is the PICO of the study? Does it match my
question?
– How well was the study done? Is it biased?
– What do the results mean? Are they real and
relevant?
• More: University of Oxford’s Center of EBM:
http://www.cebm.net/index.aspx?o=1157
• Tools for evaluating studies can be found in the
Evaluating the Evidence section in the EBM tutorial at:
http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm
EBP Step 4: APPLY:
Integrate the results with your clinical
expertise and your patient values
Apply
• Question to ask:
– Is the intervention feasible in my settings?
– What alternatives are available?
– Is my patient so different then those in the study that the
results cannot apply ?
– Will the potential benefits outweigh the potential harms of
treatment ?
– What does my patient think? What are his cultural beliefs?
– Individual decision making/group decision making/choice
– Explaining risks and benefits to patients:
https://docs.google.com/View?id=d7k3gkg_679hnvn54c8
• Visual Rx: http://www.nntonline.net/visualrx/
EBP Step 5: ASSESS
Assess
Evaluate the effectiveness of the process.
How am I doing?
•
•
•
•
Am I asking questions?
Am I writing down my information needs?
What is my success rate in the EBM steps?
How is my searching going? Am I becoming more
efficient?
• Am I periodically syncing (checking) my skills and
knowledge with new developments?
• Teach others EBP skills
• Keep a record of your questions
Limitations of EBP
• Limited scope of evidence-it will never be
complete
• The quality of research available
• Keeping it patient centered, cost effective
• Evidence from Randomized Controlled Trials
for real life patients
• Communicating uncertainties
• Decision making
Table of Contents – Part B
• HINARI Resources
– Cochrane Library
– EBM Guidelines
– Essential Evidence Plus
– HINARI EBM Journals
If you are interested in learning more about EBM, go
to the online tutorial Introduction to Evidence-Based
Medicine from the Health Sciences Library, University
of North Carolina (USA):
http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm
To access the HINARI Evidence-based
Medicine resources, we must Login to
the HINARI website using the URL
http://www.who.int/hinari/
You need to enter your HINARI User Name and Password in the
appropriate boxes, then click on the Login button. To have
access to the full text articles, you must properly sign in.
If you do not use the Internet Explorer Web browser, this slide
will not appear (as of 01 April 2014). If you use Internet
Explorer, you will continue to have a two-step login process.
Repeat the Login process on this
2nd page and you will be redirected
to the HINARI Contents page.
Remember - If you fail to use the Login
page, you will have a second option on
the Content page and we will open the
Reference Sources page.
From the Reference Sources A-Z list, we now will
click on the Cochrane Library link. The Cochrane
Library contains high-quality, independent
evidence including reliable evidence from
Cochrane and other systematic reviews and
clinical trials. It is published by John Wiley.
Note the full-text reviews are available to Band 1
only while Abstracts can be accessed by all users.
The Cochrane Library
COCHRANE LIBRARY : The Cochrane Collaboration.
Oxford: Update Software;
1996-. Updated quarterly.
• Cochrane Database of Systematic Reviews (CDSR)
– High-quality pre-evaluated systematic reviews from
all over the world
– International, not-for-profit organization
– Complete reviews and protocols (reviews that are
still in progress)
– CDSR abstracts are in Medline but there is no link to
full-text of the review
Note: As of April 2013, the Cochrane Libraries is
available to all Group A & Group B institutions.
The initial page of this site has a title,
abstract or keyword option Search engine.
You also can Browse Cochrane Database
by broad subject heading . The initial page
also highlights New and Updated
Cochrane Reviews. We will go to the
Advanced Search.
Also from the initial page, there is a link to
the Cochrane Journal Club.
We have opened the Advanced Search option where you
can specify search fields and have the ability to combine
terms using AND/OR/NOT operators.
In this text Advanced Search, we have combined
diarrhea child* using the Search All Text option with the
wildcard (*) used to locate the terms child and children.
Note that you also can complete a MeSH Search, look at
your Search History or Saved Searches.
The Advanced Search results for diarrhea child*
has retrieved 451 records from the Cochrane
Database of Systematic Reviews. You have the
option to Export All Results (save).
Note: if the results of your search are too many,
you can narrow it by limiting the keyword search
to Title instead of Search All Text.
The screen displays the Abstract of the first
systematic review listed in the search - Oral
zinc for treating diarrhoea in children.
To access the full-text review, click on the Full
PDF hypertext link in the left column. Other
options are Summary and Standard.
Also note the hypertext links to specific
sections of the systematic review.
We have displayed the Abstract of the
systematic review that includes the
Background, Objectives, Search strategy,
Selection criteria, Data collection and
analysis and Main Results.
The final section of the Abstract is titled Plain
language summary. This section is useful for
disseminating the results to groups of health
workers and patients.
Also note the Main results and author’s
conclusions (the ‘bottom line’) as these
sections discuss the review’s results and how
they should be used.
We have displayed the PDF Full version of
the Oral zinc for treating diarrhoea in children
systematic review. Other options include
Summary and Standard files.
Note: The url that contains http://hinarigw.who.int/whalecom... shows that we have
logged in to HINARI properly and will have
access to the full-text version of this review.
From the Advanced Search page of the Cochrane
Library, we have clicked on the Cochrane Reviews:
By Topic hyperlink. This has displayed the Topics for
Cochrane Reviews. From this extensive list, you have
another option for locating subject- specific material.
Note that there are other search lists including an A-Z
list, Updated Reviews and New Reviews.
For more training material, you can click on
The Cochrane Library Help hyperlink. We
have opened the Search Manual. Another
option is a listing of Web Updates.
We now access the third Reference
Sources option for evidence-based
health information - EBM Guidelines.
From the Reference Sources list, we have
opened the initial page of EBM Guidelines
Evidence-Based Medicine. Also published by
John Wiley, this resource is a collection of
clinical guidelines for primary care combined
with evidence-based research.
You can Search by keyword or Browse
database contents by EBM Guidelines,
Evidence summaries, Pictures, Audio samples,
Videos and Programs.
We have completed a keyword search for Influenza. The
results page includes summaries of the key issues
including Related resources and References and links to
important websites.
Also included are links to the Evidence summaries.
We have displayed the first Evidence summary.
Each link contains a brief review of the study and
notes the reference(s).
From the Reference Sources list, we
have opened the initial page of Essential
Evidence Plus. Also published by John
Wiley, it includes access to Cochrane
Library and also a series of databases
and tools to access the EBM material.
By keyword, you can Search all or some
of the databases.
We have opened the EBMG
evidence summaries database
that, via broad subject categories,
has access to 4312 articles.
We have opened the initial page of
EBMG evidence summaries listing
for Infectious disease. Material is
listed by either a summary view or
expanded view that includes a
sentence describing each entry.
We have opened the (PatientOriented Evidence that Matters
listing) POEMs research
summaries database that, has
4500+ articles and is organized
by Date or Category.
From the Reference Sources list, we have
opened the initial page of EBM Guidelines
Evidence-Based Medicine. Also published by
John Wiley, this resource is a collection of
clinical guidelines for primary care combined
with evidence-based research.
You can Search by keyword or Browse
database contents by EBM Guidelines,
Evidence summaries, Pictures, Audio samples,
Videos and Programs.
HINARI Evidence-Based Journals
(other journals may have EBM articles)
We have browsed the ‘E’ in the HINARI Find journals by title
list and it notes several journals for evidence-based practice.
Table of Contents – Part C
• Other (Internet) Resources:
– HINARI/PubMed’s Clinical Queries (Clinical Study
Categories & Systematic Reviews citations) and ‘Type
of Article’ Limits (Meta-Analysis, Randomized Control
Trial & Clinical Practice)
– Clinical Practice Guidelines
– BestBETS
– PubMed Health – clinical effective research
– Trip Database
– Evidence Updates - BMJ and McMaster University
– Knowledge Translation Learning Modules – Canadian
Institutes of Health Research
– Essential Health Links gateway – annotated links
• Summary
We now search for evidence-based articles using
PubMed. From the main HINARI webpage, go to
PubMed by clicking on Search inside HINARI fulltext using PubMed.
Remember you must login to HINARI to have
access to the full-text articles.
Open the Clinical Queries box. This search
tool assigns filters to keyword searches - to
locate articles on Clinical Studies, Systematic
Reviews and Medical Genetics.
Note: for these PubMed applications, all
individuals will have access to the free full text
articles. The examples are from
HINARI/PubMed searches and, for those
properly logged in, will also include access to
articles from HINARI participating publishers.
On the PubMed Clinical Queries page,
we have entered the type 2 diabetes
AND developing countries search.
The default search results for the Clinical Study
Categories are Category: Therapy and Scope: Broad.
Other options in the Category drop down menu are
Etiology, Diagnosis, Prognosis and Clinical Prediction
Guides. There are 142 articles for Therapy: Broad
and 20 articles for Systematic Reviews.
Note: you can go directly to PubMed Clinical Queries.
The direct link to PubMed Clinical Queries is
http://www.ncbi.nlm.nih.gov/pubmed/clinical
For the Scope option, we will enter Narrow
and for the same type 2 diabetes AND
developing countries search.
The Therapy (Category) and Narrow (Scope) type 2
diabetes AND developing countries search has resulted
in 11 citations. We now will click on the See all option
(bottom of the page).
Note that the results for Systematic Reviews and Medical
Genetics also are displayed.
We have displayed all 11 articles for this search
including 7 HINARI and 8 Free Full Text articles.
Remember - you can access the full-text articles by
clicking on these Filters or changing the display from
Summary to Abstract.
Note that the specific search is listed in the Search
box including the AND (Therapy/Narrow[filter]) for
clinical studies categories and systematic reviews.
After returning to the search results on the
Clinical Queries page, we have clicked on
the See all option for the systematic
reviews results. The type 2 diabetes AND
developing countries AND systematic [sb]
search resulted in 20 articles.
If you have a MY NCBI account, you can add Meta-analysis, Randomized
Control Trials and Systematic Reviews to your Filters. Go to Manage Filters,
click on Properties option and put each term in the Search with terms box.
When you save a PubMed search, you will be sent an email listing new
articles on the specific topic with these filters. Remember that you will need
to go to HINARI to get the full-text articles.
In this example, Free Full Text, HINARI, Meta-analysis and Systematic
Reviews are listed in Filters.
Another tools from PubMed is using the Filters option – see
left-column. We have checked the Meta-Analysis box in the
Article Types section and entered hypertension in the
PubMed Search box. The search Results number is 1239.
Note the Filters activated: Meta-Analysis line below the
Results number.
Filters can be activated from any search results page.
Remember to clear them before beginning other searches.
Now displayed are the results of a
hypertension search with the
Systematic Reviews Article Type filter
activated. The citations for this search
include 1158 Free Full text and 2368
HINARI articles.
Now displayed are the results of a
hypertension search with the
Randomized Controlled Trial Article
Type filter activated. The citations for
this search include 2862 Free Full text
and 6667 HINARI articles.
The final displayed search are the
results of a hypertension and
developing countries search with the
Meta-Analysis, Systematic Reviews and
Randomized Controlled Trial Article
Type filters activated. The citations for
this search total 64.
Definition Clinical Practice Guidelines
‘Clinical practice guidelines are statements
that include recommendations intended to
optimize patient care that are informed by
a systematic review of evidence and an
assessment of the benefits and harms of
alternative care options’
- National Guideline Clearinghouse, U.S. Department of Human
and Health Services www.guideline.gov/about/inclusioncriteria.aspx October 8, 2013
Overview of Guidelines
• Describe a range of generally accepted
approaches for the diagnosis, management, or
prevention of specific diseases or conditions
• Define practices that meet the needs of most
patients in most circumstances
• Are recommendations that are based on
evidence from a rigorous systematic review and
synthesis of the published medical literature
• Primarily for use by clinicians--physicians, nurses,
and other health professionals in clinical practice
Using the Filters option, we now will
activate the Practice Guideline Article
types filter and enter malaria treatment in
the PubMed Search box. You can click on
more than 1 box in the Article types
section.
The results of this search are 31 citations.
Note the Limits Activated: Practice
Guidelines text below the results line.
Remember that you must remove this
before beginning another PubMed search.
Examples of Clinical Practice
Guidelines documents from the
Kenya, South Africa and Uganda.
apps.who.int/medicinedocs/documents/s16427e/s16427e.pdf
Medecins Sans Frontieres
www.health.go.ug/docs/ucg_2010.pdf
www.kznhealth.gov.za/research/guideline2.pdf
Additional CPG resources
• National Guideline Clearinghouse (USA)
http://www.guideline.gov/
• Open Clinical: Clinical Practice Guidelines
http://www.openclinical.org/guidelines.html
• About Clinical Practice Guidelines
http://www.nhlbi.nih.gov/guidelines/about.htm#what
We have opened the initial issue –
April 2012 - of Systematic Reviews,
an open access journal published
by BioMed Central. This and
subsequent issues can be access
from the above url.
We have opened the BestBETS site
which contains numerous Best Evidence
Topics. Originally having a emergency
medicine focus, BETs for cardiology,
nursing and pediatrics now are included.
This slide discusses Best
Evidence Topic (BET) Format.
Each BET is analyzed with a 3
part question and answered with
a standardized Report Format.
We have opened the SEARCH BETs
option and completed a search for
cardiac arrest. Note the color coded
Status list for all the BETs.
This is an example of how each BETs
record is displayed including the Three
Part Question, Clinical Scenario,
Search Strategy Search Outcome
Relevant Paper(s) plus Comments.
A second option for accessing
the material is to Browse BET
Categories by Topic or Specialty.
A third option is to Search Critical
Appraisals which are one page
summaries of the evidence related
to a particular clinical question.
PubMed Health specializes in reviews of clinical
effective research – which finds answers to ‘What
Works’ in medicine and health care. It is based on
systematic reviews of clinical trials.
PubMed Health is a service provided by the National
Center for Biotechnology Information (NCBI) at the
U.S. National Library of Medicine (NLM).
From the Contents drop down menu, you can
access PubMed Health’s information in the
following categories: For consumers,
Executive summaries, Clinical guides and Full
text reviews. We will open the Executive
summaries option. Note also that PubMed
Health contains a Medical encyclopedia.
The Executive Summaries Results is
organized via an A-Z alphabetical listing.
This format also is used for the other
options in the Contents drop down menu.
We have entered HIV AND pregnancy in
the keyword search box.
For the HIV AND pregnancy search, there are 368
Results displayed in PubMed Health. The initial
display is in the Summary format. By clicking on the
title, the Abstract will be displayed.
The Refine your search option organizes the results
by the categories in Contents drop down menu.
Also note the Medical Encyclopedia links to key
concepts in the search results.
When available, PubMed Health contains
links to full-text documents. Displayed in
this slide are the titles from the H listing
for the Full Text Reviews. We will open
the HIV in Pregnant Women document.
The Full Text Review contains a
Structured Abstract and then links to the
various sections of the Review (next slide).
We have displayed the AIDS
(Acquired immune deficiency
syndrome) definition from the
A.D.A.M. Medical Encyclopedia.
Question for next two resources
• Both Trip Database and Evidence Updates are
aggregators that search various EBM tools for
results to keyword searches.
• The problem is that the results are often
resources that are fee-based and users are
asked for their username and password or
requested to pay a fee.
• Many of the cited articles will be available in
HINARI.
Trip Database is a clinical search tool
for health professionals to identify
quality clinical evidence for clinical
practice. It allows simultaneous
searching of multiple sites which
speeds up the question answering
process.
Registration is required but free and
gives the users additional resources.
We have completed a search
for malaria AND bednets. The
results are displayed with, in
some cases, links to Full Text.
Preview goes to source – in this
case PubMed… We have
completed a search for malaria
AND bednets. The results are
displayed with, in some cases,
links to Full Text.
We have completed a search
for malaria AND bednets. The
results are displayed with, in
some cases, links to Full Text.
Access to the full-text article will
be if it is a free full text one or
your institution has access via
HINARI or a subscription.
For this search, we checked
4 boxes and now will Export
selected links as a CVS file.
The report is displayed as an Excel
spreadsheet with the title, url, publication
and date of each checked citation.
Access to full-text journal articles will
depend on whether they are free full text
articles or if your institution is eligible for
HINARI or has a subscription.
We have displayed
the Advanced Search
for the trip database.
EvidenceUPDATES contain a searchable
database, an email alerting system and links
to selected evidence-based resources.
Registration is required but free.
We have entered
chloroquine resistance in
the tool’s search box.
For this search there are 14 matches
that note the citation information plus
type of article (e.g. Review, Original).
Access to the full-text article again
will be if it is a free full text one or
your institution has access via
HINARI or a subscription.
EvidenceUPDATES contain options
to Download Citations including to
several commercial reference
manager softwares. We will
download to the Text File option.
In the Text File option, the
abstracts for the checked results
are listed in a Notepad file.
EvidenceUPDATES also contains an
Advanced Search option that initially is based
on disciplines, categories and populations.
From the drop down menu, subcategories for
each broad discipline will be displayed.
The Canadian Institutes of Health
Research web site contains four
Knowledge Translation Learning
Modules. Several of these online
courses are relevant for evidence
based practice and use of knowledge
to make informed health decisions.
The Essential Health Links gateway
contains annotated links to numerous
Evidence-Based Medicine resources
available on the Internet.
Additional Evidence-based Health Resources
• Bandolier Knowledge: Oxford University
http://www.medicine.ox.ac.uk/bandolier/knowledge.html
• The Campbell Library
http://www.campbellcollaboration.org/library.php
• DARE: Database of Abstracts of Reviews of Effects
http://www.crd.york.ac.uk/crdweb/
• Duke University Medical Center Library: EBM
http://www.mclibrary.duke.edu/subject/ebm?tab=contents
• EBM Librarian
https://sites.google.com/site/ebmlibrarian/
• McMaster PLUS collection
http://hiru.mcmaster.ca/hiru/HIRU_McMaster_PLUS
_projects.aspx
• National Guidelines Clearinghouse
http://www.guideline.gov/
• Nesbit Guide Evidence-Based Resources
http://www.urmc.rochester.edu/hslt/miner/digital_libr
ary/evidence_based_resources.cfm
Review –
5 Steps to evidence-based health care
• Step 1: Formulate your question - define
the population, the intervention, what
to compare this intervention to, as well
the outcome (PICO format)
• Step 2: Search for the evidence – find previous
studies or research conducted
• Step 3: Appraise the evidence - use a set of
criteria, evaluate the quality of the studies found
during the search; highest quality studies are
included in a systematic review
• Step 4: Put the evidence into practice - use
the evidence to improve practice (e.g.,
through the development of guidelines and
protocols that can be used in practice)
• Step 5: Monitor what has been done – to
ensure that it is effective; provide feedback for
the progress of performance
Dr. Frode Forland, Royal Tropical Institute (KIT)
www.elsevier.com/connect/5-steps-to-evidence-based-healthcare-in-africa October 8, 2013
Appendix 1
Appendix 1 – Contains four case studies for
developing Evidence-Based Practice curriculum:
experimental cancer research, EBP
curriculum for pharmacy students, health
literacy for pharmacy students and
outreach activity for early intervention
providers
Developed by:
Irena Bond, Library Manager
Associate Professor of Library and Learning Resources
Massachusetts College of Pharmacy and Health Sciences
Research Evidence
Practitioner’s Experience
Local Conditions
Patient/Community Preferences
& Values
This is the end of the Evidence-based Medicine for HINARI Users module.
The material initially was developed by: Gale G. Hannigan, PhD, MLS, MPH;
Professor & Medical Informatics Education Librarian, Texas A&M University.
Material revised and enhanced by Irena Bond, Library Manager, Associate
Professor of Library and Learning Resources, Massachusetts College of
Pharmacy and Health Sciences.
There is a workbook that accompanies this module. The workbook will take you
through a live session covering the topics included in this demonstration with
working examples.
Updated 2014 01