POD 3205 Fall 2024 EBM DeYoung PDF

Introduction to Evidence Based Medicine Asking Clinical Questions and Acquiring the Evidence ELIZAB ETH DEYO U NG, MSLIS ASSISTANT PRO F ESSO R, DMU LIB RARY PO D 3205, FAL L 2024 Evidence Based Practice Ask Assess Access Apply Appraise...

Introduction to Evidence Based Medicine Asking Clinical Questions and Acquiring the Evidence ELIZAB ETH DEYO U NG, MSLIS ASSISTANT PRO F ESSO R, DMU LIB RARY PO D 3205, FAL L 2024 Evidence Based Practice Ask Assess Access Apply Appraise 2 Objectives Identify the steps necessary to develop a focused and searchable clinical question (PICOTT) Identify the hierarchical approach to levels of evidence relating to: Therapy Prognosis Diagnosis Harm/etiology Recognize how to locate health science literature based upon the application of relevant search strategies Boolean operators Nesting Study type Scholarly Communication The system through which research and other scholarly writings are created, evaluated for quality, disseminated to the scholarly community, and preserved for future use. The system includes both formal means of communication, such as publication in peer- reviewed journals, and informal channels, such as electronic listservs. -ACRL Research Lifecycle and Types of Information ClinicalTrials.gov Research Primary PubMed/Medline Literature Peer Reviewed Journal article 1st Report of original research Secondary Literature OrthoEvidence Evaluates, summarizes, interprets, or UpToDate analyzes primary information resources Textbooks Foreground vs. Background Questions Background Questions A broad question that involves wanting to gain understanding in a topic Who, What, Where, Why, When? Treatments, diagnostic criteria Summarizes research, is not actual research Best answered by secondary information resources UpToDate Textbooks ClinicalKey How do you diagnose a Jones fracture? Let’s practice! Think of background questions for…  UpToDate Physician-authored clinical decision support resource that assists clinicians with point-of-care decisions. Includes easy-to-search graphics, videos, and a drug compendium. Access through the Library Homepage: https://lib.dmu.edu/home Need Help? Our UpToDate guide: https://lib.dmu.edu/db/uptodate  “Orthopaedic evidence-based summaries, pre-appraised by orthopaedic medical experts.” Evaluate using ACFAS grading system Approximately 360 journals screened for high quality RCT and Meta-Analyses Focuses on evidence that is most likely to influence clinical practice ACE Report = Critically Appraised Paper Access through the library’s list of Collections A-Z: https://dmu.on.worldcat.org/atoztitles/browse/collections Foreground Questions & Primary Information Resources Highly specific questions that can involve a number of clinical variables Can be answered with primary resources and original studies, i.e., journal articles ◦ PubMed ◦ Scopus In the treatment of plantar fasciitis, does dry needling provide better pain reduction when compared to steroid injection in patients over 60? Framing the Clinical Question P = Patient, population, or problem ◦ Who or what are you studying? I (E) = Intervention (Exposure) ◦ What is the treatment, therapy, prognostic factor, or exposure? C = Comparison ◦ What are you measuring against? O = Outcome(s) ◦ What are you trying to accomplish, measure, improve, or effect? Does dry needling offer significant results for pain reduction in patients over 60 in the treatment of plantar fasciitis? Let’s practice! Think of foreground questions for… Types of Clinical/Research Questions Therapy – effect of an intervention Diagnosis – power of a diagnostic test Prognosis – estimating future course of a disease/condition Harm (Etiology) – cause/risk factor of a particular condition Economic Evaluation – costs and alternatives to care PICOTT PICO + T = Type of Question T = Type of Study Does dry needling offer significant results for pain reduction in patients over 60 in the treatment of plantar fasciitis? Type of Question – Therapy Type of Study – Randomized Controlled Trial (RCT), Systematic Review, Meta-Analysis Journal Literature and the Levels of Evidence ACFAS (American College of Foot and Ankle Surgery) Levels of Evidence Rating Modified from Oxford Centre for Evidence-Based Medicine website (www.cebm.net) 5 levels comprised of different types of studies with each succeeding level having a lower value of evidence Different journals, organizations, government publications use different levels of evidence models and assign different numbers Types of Questions Types of Studies  Levels of Evidence Pyramid Meta- Analysis Evidence Syntheses Systematic Review Randomized Therapy, Diagnosis Controlled Trial Cohort Prognosis, Harm Case Control Case Series / Case Report Generally, our confidence in the strength of the evidence increases the higher you are on the hierarchy (Stronger methodology) Less risk of bias Systematic Review: A specific research methodology where authors ask a specific clinical question (PICO), perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. May included a meta-analysis. Meta-analysis: A statistical technique that pools the results of several studies in a single weighted estimate to provide an estimate of the effect. May be conducted as part of a systematic review. Randomized Controlled Trials “An experiment in which individuals are randomly allocated to receive or not receive an experimental diagnostic, preventive, therapeutic, or palliative procedure and then followed up to determine the effect of the intervention” Experimental study (researcher controls the interventions/independent variables) Randomly divide participants into two groups (experimental or treatment group vs. no control [different treatment or placebo] group) 24 Cohort Study Non-experimental (observational) study, also called longitudinal A group of people (a cohort) who do not have the disease/problem of interest are followed over time The only research method that can establish the absolute risk of contracting a disease. By following all members of the cohort, the relationship between risk factors and eventual outcomes can be observed Best form of investigation when experimental study can’t be performed due to ethical reasons Prospective cohort studies (which track participants forward in time) are more reliable than retrospective (historical) cohort studies. Exposure/Intervention Outcome Case Control “A study designed to determine the association between an exposure and outcome in which patients are sampled by outcome. Those with the outcome (cases) are compared to those without the outcome (controls) with respect to exposure to the suspected harmful agent.” Nonexperimental (observational) study Retrospective study (compares medical records) Exposure / What factors may be Problem/ associated with the Outcome problem? Case Report/Case Series “A report of a study of a collection of patients treated in a similar manner, without a control group. For example, a clinician might describe the characteristics of an outcome for 25 consecutive patients with diabetes who received education for prevention of foot ulcers.” Non-experimental (observational) study – No control/comparison group Patients not followed over time Often used to report unique/rare diseases or events Cannot establish cause/effect relationship What is PubMed? “PubMed comprises over 34 million citations for biomedical literature from MEDLINE, life science journals, and online books.” Be sure to access it through the Library Webpage! Need help? Look at our guide: https://lib.dmu.edu/db/pubmed NLM “Best practices for searching” Be specific! Do not ask questions or use complete sentences Do not use punctuation or “quotation marks” Use keywords or phrases Acronyms are usually problematic – spell them out! From Question to Search Strategy In the treatment of plantar fasciitis, does dry needling provide better pain reduction when compared to steroid injection in patients over 60? 36 (heel pain OR plantar fasciitis) AND (acupuncture OR dry needling) AND (steroids OR corticosteroids)  Recommend typing Boolean in CAPS. Search engines may ignore operators in lower case NOT is only for very rare or specific circumstances. How Does PubMed Know the LOE? Study type in one of two fields: Publication types / MeSH terms Publication types are mostly added to records by human intervention = time delay EXCEPTION: Systematic Reviews = search strategy Limit to Evidence Option 1: Articles Types filter  Limit to Evidence Option 2: Enter the correct phrase Meta- Search: meta analysis Analysis Systematic Select the Systematic Reviews article type filter OR try the PubMed Clinical Queries Review Randomized Search: randomized controlled trial OR limit to Therapy in PubMed Clinical Queries Control Trial Cohort Case Control Case Series / Case Report Need Help? [email protected] [email protected] Library Website DPM Guide EBP Guide