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Wednesday, October 10, 2007

Nursing Research Resources

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Nursing Research Resources Slide Transcript
Slide 1: Guide to Nursing Resources EBN : Accessing the Research

Slide 2: Learning Objectives Introduce student to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.

Slide 3: What is EBM? “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2. 06/13/07 IUON - Library Research 3

Slide 4: Evidence Based Medicine EBM Decision Model: \"Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values.\" EBM Cycle: Ask, Acquire, Appraise, Apply and Act

Slide 5: Primary Evidence Primary evidence includes the original reports of research studies and are included in journal citation databases: MEDLINE: randomized controlled trials   CINAHL: research  EMBASE  SCIRUS

Slide 6: Secondary Evidence Secondary evidence is the analysis of research studies and is found in: MEDLINE: meta-analysis, practice guidelines,  consensus development conferences CINAHL: meta-analysis, practice guidelines,  research based nursing practice Cochrane Database of Systematic Reviews  Database of Reviews of Effectiveness (DARE)  National Guidelines Clearinghouse 

Slide 7: Information ‘Pyramid’ EBM journals Cochrane DB Systemic reviews Clinical Practice Guidelines primary research articles CINAHL, Medline Assoc. websites, textbooks Google Adapted from 06/13/07 IUON - Library Research 7

Slide 8: Evolution of Literature Evidence Pyramid Type of Study The base of the pyramid is where information Meta-  usually starts with an idea or laboratory Analysis research. As these ideas turn into drugs and diagnostic tools they are tested in Systematic  laboratories models, then in animals, and Review finally in humans. The human testing may begin with volunteers and go through Randomized  several phases of clinical trials before the Controlled Trial drug or diagnostic tool can be authorized for use within the general population. Cohort studies  Randomized controlled trials are then done to further test the effectiveness and efficacy Case Control studies  of a drug or therapy. Case Series/Case Reports  As you move up the pyramid the amount of available literature decreases, but Animal research/Laboratory  increases in its relevance to the clinical studies setting.

Slide 9: Medical Databases CINAHL Medline   EBSCOhost EBSCOhost   http://  PubMed training  Online  http://  Online training http://

Slide 10: Evidence in MEDLINE Searching for evidence in MEDLINE includes several steps:  formulate a clinical question  run a subject search Ex. heart disease and aspirin  select a strategy to retrieve literature  related to therapy, diagnosis, prognosis, harm/etiology.

Slide 11: Evidence in CINAHL formulate a clinical  question run a subject search  use the Research limit  on the Main Search Page. This is a very effective way to limit  retrieval to research studies in CINAHL. Tutorial: http:// 

Slide 12: Cochrane Database of Systemic Reviews includes the full text of the  regularly updated systematic reviews of the effects of healthcare prepared by The Cochrane  Collaboration can be searched by combing  keywords or phrases. The Browse Topics icon  retrieves a list of Cochrane Groups who prepare and maintain the reviews in respective clinical areas, such as nursing. 

Slide 13: Database of Reviews of Effectiveness (DARE) Database of Reviews of Effectiveness (DARE) a full text database with critical structured abstracts of studies reported in various medical journals.

Slide 14: What is Systemic Review? Systematic reviews are known as the highest level  of evidence in clinical research. Developed countries are developing their medical  guidelines based on the information provided by systematic reviews of effectiveness. Therefore, it is mandatory for all professionals  involved in the delivery of healthcare, to reach to a good understanding about systematic reviews. This web site offers information about what  systematic reviews are, and how to conduct them.

Slide 15: The National Guidelines Clearinghouse includes evidence-based practice guidelines from various health centers and organizations. It can be searched by disease, treatment or organization. The Clearinghouse includes a feature comparing attributes of two or more guidelines.

Slide 16: HealthWeb The Evidence-Based Health Care section of HealthWeb includes a wealth of information about EB organizations, databases and publications. The Tools and Tutorials has many helpful links including the EBM Tool Kit and EBM Toolbox.

Slide 17: Other Search Engines Databases  Medstory  DynaMed  Up-to-Date  Google Scholar  MDConsult  MammaHealth  NursingConsult  MedlinePlus  InfoPOEMS  Kosmix  ReleMed

Slide 18: Steps to answering Clinical Questions using the Medical Literature The Anatomy of the Clinical Question: 1. Formulate a clinical question (\"PICO\" approach): Patient characteristics Intervention being considered Comparison intervention (if any) Outcome of clinical interest

Slide 19: Clinical Question cont. 2. Run your subject search. 3. Select the MEDLINE strategy to answer the question: Therapy, Diagnosis, Prognosis, Harm/Etiology. (including study design/article type)

Slide 20: For Quick Searches A question of... Therapy Limit search to Publication Type - Randomized Controlled Trial pt

Slide 21: In-depth EBM Searches: Therapy exp research design/ or exp clinical trials/ or comparative study/ or placebos/ or multicenter or clinical trial$ Or random$.ti,ab. or (single blind$ or double blind$ or triple blind$3).ti,ab. or placebo$1.ti,ab. or (clinical adjtrial$1).ti,ab. or exp epidemiologic research design/ or (controlled clinical trial or randomized controlled trial).pt. or practice Or feasibility studies/ or clinical protocols/ or exp treatment outcome/ or double blind method/

Slide 22: For Quick Searches A question of... Diagnosis Combine subject search with search for exp \"sensitivity and specificity\"

Slide 23: In-depth EBM Searches: Diagnosis exp \"sensitivity and specificity\"/ or false negative reactions/ or false positive reactions/ or (sensitivity or specificity).ti,ab. or (predictive adj value$1).ti,ab. or (likelihood adj ratio$1).ti,ab. or (false adj (negative$1 or positive$1)).ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or double blind method/ or single blind method/ or practice Or consensus development conference$.pt. or random$.ti,ab. or random allocation/ or (single blind$3 or double blind$3 or triple blind$3).ti,ab.

Slide 24: For Quick Searches A question of... Prognosis Combine subject search with search for exp cohort studies or exp risk

Slide 25: In-depth EBM Searches: Prognosis exp cohort studies/ or prognosis/ or exp mortality/ or exp morbidity/ or (natural adj history).ti,ab. or prognos$.ti,ab. or course.ti,AB or predict$.ti,ab. or exp \"outcome assessment (health care)\"/ or outcome$1.ti,ab. or (inception adj cohort$1).ti,ab. or disease progression/ or exp survival analysis/

Slide 26: For Quick Searches A question of... Harm/Etiology Combine subject search with search for exp cohort studies OR exp risk

Slide 27: In-depth EBM Searches: Harm/Etiology random$.ti,ab. or exp epidemiological studies/ or odds ratio/ or cohort$.ti,ab. or (case$1 adj control$).ti,ab. or risk$.ti,ab. or (odds adj ratio$1).ti,ab. or causa$.ti,ab. or (relative$1 adj risk$).ti,ab. or predispos$.ti,ab. or (randomized controlled trial or controlled clinical trial).pt. or exp risk/ or practice or exp case- control studies/ or exp cohort studies/

Slide 28: For Quick Searches 4. Locate other sources of evidence as necessary. 5. Examine the evidence, critically appraise/evaluate the literature. 6. Apply the evidence + clinical experience + the patient's preferences. 7. Evaluate patient outcomes.

Slide 29: In-depth EBM Searches 4. Once copied, paste it into the search box in MEDLINE. 5. Click \"Perform Search.\" 6. Combine this set with your original search using AND (i.e. 1 AND 2). (EBM filters developed by the Miner Library at the University of Rochester Medical Center) ary/tip_sheets/Cinahl_eb_filters.pdf

Slide 30: Note You can save each of these EBM filters as a separate search in MEDLINE so that they can be run as needed when searching MEDLINE To do this:  Authenticate to a new MEDLINE session with a blank search history.  Copy and paste one EBM filter.  Click \"Perform Search.\"  After retrieving search results, click \"Save Search History.\"  Select \"Permanent,\" and name the search (ex. EBM Therapy or Therapy Filter).

Slide 31: To use save searches: Run your subject search.  Click \"Run Saved Search.\"  Select the EBM filter to run based on the type of question being asked (Therapy, Diagnosis, Prognosis, or Harm/Etiology).  Combine the two searches using AND.

Slide 32: For further clarification and practice check out more online training ‘EBM Toolkit’ based on the series in JAMA: OR From Duke University Medical Center: EVIDENCE BASED MEDICINE TOOLKITS & TUTORIALS

Slide 33: EBM Jeopardy

Slide 34: Thank you Ann Celestine, BA MLS AHIP Library Director

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