Evidence-Based Practice Resources For HINARI Users: (Module 7.2)
Evidence-Based Practice Resources For HINARI Users: (Module 7.2)
Evidence-Based Practice Resources For HINARI Users: (Module 7.2)
• 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, 2 nd. 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
Experimental
Observational
Observational
Observational
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published and unpublished, on a particular topic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 evidence-
based medicine
• Limit to specific populations & publication types
• Utilize EBM built-in filters (search strategies)
EBP Step 3: Appraise: Appraise
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.
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