Lecture 2 , Searching and Appraising for Best Research Evidence (1).pdf

Evidence Based Practice Searching and Appraising for Best Research Evidence 10/27/2019 5 Steps for EBP 1. Ask a focused clinical question 2. Search for the best research evidence 3. Appraise the quality of the research evidence 4. Integrate the research evidence with information about the patient...

Evidence Based Practice Searching and Appraising for Best Research Evidence 10/27/2019 5 Steps for EBP 1. Ask a focused clinical question 2. Search for the best research evidence 3. Appraise the quality of the research evidence 4. Integrate the research evidence with information about the patient and clinical expertise 5. Reflect on the process to improve the future USC “Evidence Pyramid” Here Better Less Good Not all published studies are equal… Medical Articles per Year 2500000 5,000? per day 2000000 1500000 1,500 per day 1000000 500000 95 per day 0 Biomedical MEDLINE Trials Diagnostic? Our Clinical Question in The PICO Format • Patient: middle-aged, African American woman with type 2 diabetes • Intervention: clinic attendance • Comparison: no clinic attendance • Outcome: hemoglobin A1c levels 2) Search for the best research evidence • For the above PICO-formatted statement, the following four search terms are identified: type 2 diabetes, clinic attendance, African American, and hemoglobin A1c. 2) Search for the best research evidence To locate the best evidence, consider limiting the search to the following three characteristics: • Publication type: Limit the search to publication types with higher levels of evidence, such as systematic reviews, metaanalyses, randomized controlled trials, and practice guidelines. • Date: Since medical information can quickly become outdated, limit your search to the most recent evidence available. • Population characteristics: Use the available limits features to match the patient or problem, such as age and gender. .‫ مثل العمر والجنس‬،‫استخدم ميزات الحدود املتاحة ملطابقة املريض أو املشكلة‬ 2) Search for the best research evidence • Constructing search strategies in research databases is different from conducting Google searches. Research databases support the use of particular connector words, sometimes referred to as Boolean operators. The connector words used with research databases are “and,” “or,” and “not.” • In the sample PICO-formatted question, the evidence being searched for includes the presence of all four search terms (type 2 diabetes, clinic attendance, African American, and hemoglobin A1c), which calls for the “and” connector: type 2 diabetes AND clinic attendance AND African Americans AND hemoglobin A1c. 2) Search for the best research evidence • Use the “or” connector when either search term is desired. It is frequently used when synonyms or additional terms for the same word are needed, for example: hemoglobin A1c OR glycosylated hemoglobin. 2) Search for the best research evidence • The “not” connector is used to exclude a term and can sometimes be helpful in eliminating irrelevant items, for example: type 2 diabetes—NOT type 1 diabetes. Be sure to use the “not” connector carefully, though, because it can exclude desired articles from a search. In our PICO scenario, for example, using the “not” connector would eliminate any articles that included both type 1 and type 2 diabetes because only type 1 diabetes was used as the “not” connector. 2) Search for the best research evidence • Available Clinical Information Resources Below are several examples of clinical information resources to aid in your search for literature on evidence-based practice, such as systematic reviews, evidence-based journals, and databases. 2) Search for the best research evidence Available Clinical Information Resources Research Databases Examples: • PubMed provides free access to the National Library of Medicine’s Medline database and is the premier source of biomedical literature in the United States, with more than 21 million citations. Within PubMed, PubMed Central provides free access to 2.4 million full-text journal articles. • Cumulative Index to Nursing and Allied Health Literature (CINAHL) indexes journal articles from nursing, biomedical, consumer health, rehabilitation sciences, sports medicine, fitness, preventive medicine, and other allied health sciences. It’s is a subscription database and is available through many academic and medical libraries. 2) Search for the best research evidence Available Clinical Information Resources • Systematic reviews: The Cochrane Library includes Cochrane Reviews and the Database of Abstracts of Reviews of Effects. PubMed Clinical Queries, which is free, also searches specifically for systematic reviews. 2) Search for the best research evidence Available Clinical Information Resources ‫مهممممة‬- ‫يركز على مجال التغذية أكثر من أي قاعدة بحث أخرى‬ • Evidence Analysis Library (EAL): - Introduced in 2004, the Academy’s EAL is available free to members. - Academy members develop the content, which includes bibliographies, conclusion statements, and grades for the evidence, as well as summaries and specific information on the major findings, methodology and quality of each study. - The EAL includes guidelines on many major nutritionrelated diseases and conditions. 2) Search for the best research evidence Available Clinical Information Resources • Practice guidelines: - The National Guideline Clearinghouse is a free Web-based database of clinical guidelines from the federal Agency for Healthcare Research and Quality. -Professional organizations also provide highquality practice guidelines. For example, clinical practice recommendations on diabetes are published annually as a supplement to the January edition of Diabetes Care and are available free of charge from the American Diabetes Association. 2) Search for the best research evidence Available Clinical Information Resources Evidence-Based Journals example: • Evidence-Based Medicine (published by BMJ) is available by subscription. It identifies key clinical articles and provides critical appraisals from more than 100 international medical journals. It is available in the digital library for KSAU-HS users!! • Evidence-Based Complementary and Alternative Medicine is a free, open-access journal. 2) Search for the best research evidence Available Clinical Information Resources ‫طريقة ممتازة للبحث فيها شات للتواصل مع أخصائيني تغذية‬ • Point-of-care information products: - These are defined as “electronic bedside information tools that provide summarized medical information for use by health care professionals.” - Point-of care electronic information products frequently are accessed through mobile devices including tablet computers and smartphones, and are used to help guide clinicians’ decision-making. - Examples include UpToDate, First Consult, ACP PIER, DynaMed, and Clinical Evidence. 5 Steps for EBP 1. Ask a focused clinical question 2. Search for the best research evidence 3. Appraise the quality of the research evidence 4. Integrate the research evidence with information about the patient and clinical expertise 5. Reflect on the process to improve the future We Must Critically Appraise the Integrity of Each Source of Evidence Clinical Expertise Best Research Evidence Patient’s Unique Values and Circumstances The Good News… You have tools to assist you in critically appraising the evidence. Thank You