Evidence-Based Practice: An introduction for new librarians
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The document serves as an introduction to evidence-based practice (EBP) for new librarians, outlining key roles and objectives, including formulating clinical questions and identifying appropriate evidence sources. It emphasizes the importance of EBP in improving patient outcomes and healthcare delivery, highlighting various resources such as UpToDate, DynaMed, and the Joanna Briggs Institute. The document also covers the EBP cycle, types of clinical questions, and the significance of using well-structured information sources to enhance decision-making in clinical practice.
![Your time to shine…
“[W]hen clinicians use information resources to answer
clinical questions, the resources they choose provide the
best evidence only about 50% of the time” (McKibbon et
al., 2008)
Librarians enable users to navigate, and benefit from, a
growing body of evidence-based information.](https://image.slidesharecdn.com/glis671final-150626192230-lva1-app6892/85/Evidence-Based-Practice-An-introduction-for-new-librarians-5-320.jpg)
![What is a clinical question?
A question that is “directly
relevant to the problem at
hand… [and] phrased to
facilitate searching for a
precise answer.”
(Richardson, Wilson, Nishikawa & Hayward, 1995)](https://image.slidesharecdn.com/glis671final-150626192230-lva1-app6892/85/Evidence-Based-Practice-An-introduction-for-new-librarians-8-320.jpg)
Evidence-Based Practice: An introduction for new librarians
- 1. Evidence Based Practice: An introduction for new librarians GLIS 671 February 18, 2015 Presenter: Pamela Harrison Email: pamela.harrison@mcgill.ca
- 2. Session objectives By the end of this session, you will be able to: Articulate the role of the librarian in evidence-based practice Formulate a searchable clinical question Identify the best type of evidence for your question Practice using following EBP resources: UpToDate Dynamed Turning Research Into Practice Joanna Briggs Institute EBP Database
- 3. Why Evidence Based Practice (EBP)? • EBP is a highly accepted idea that better evidence in practice leads to improved patient outcomes • EBP has increased emphasis worldwide on improving patient safety and quality of care • EBP provides the need to continue to advance healthcare delivery with well-equipped, knowledgeable health care providers and patients
- 5. Your time to shine… “[W]hen clinicians use information resources to answer clinical questions, the resources they choose provide the best evidence only about 50% of the time” (McKibbon et al., 2008) Librarians enable users to navigate, and benefit from, a growing body of evidence-based information.
- 6. Evidence-based practice cycle (and where librarians fit in) Appraising the evidence Incorporating evidence into decision-making Evaluating the Process Formulating the clinical question Searching the evidence Your patient for whom you are uncertain about therapy, diagnosis, or prognosis 1 2 3
- 7. Evidence-based practice cycle (and where librarians fit in) Appraising the evidence Incorporating evidence into decision-making Evaluating the Process Formulating the clinical question Searching the evidence Your patient for whom you are uncertain about therapy, diagnosis, or prognosis
- 8. What is a clinical question? A question that is “directly relevant to the problem at hand… [and] phrased to facilitate searching for a precise answer.” (Richardson, Wilson, Nishikawa & Hayward, 1995)
- 9. Can a 70-year old with suspected receive platelets before undergoing a lumbar puncture? pancytopenic patient meningitis How many questions do you see? Image source: http://pixabay.com/en/question-stickman-stick-figure-151792/
- 10. Background and foreground questions Source: (Guyatt et al., 2008) Chapter 3: Background and Foreground Questions What is pancytopenia? What is meningitis? Can a 70-year old pancytopenic patient with suspected meningitis receive platelets before undergoing a lumbar puncture?
- 11. Who What Where Why How Verb Condition Treatment Background questions What are they? • Where do you search? Textbook collections: AccessMedicine, STAT!Ref
- 12. Foreground questions Tend to be more specific and complex compared to background questions. Ask for specific knowledge to inform clinical decisions. Questions typically concern a specific patient (eg: elderly) or particular population (eg: patient with diabetes). Review: What is one tool that is useful for searching foreground questions?
- 13. P I C O Patient problem or Population Intervention Comparison, if any Outcome Recall the definition of a clinical question: “phrased to facilitate searching for a precise answer” (Richardson, Wilson, Nishikawa & Hayward, 1995)
- 14. Example scenario Ms. X is a 25 year old woman diagnosed with bulimia nervosa. She is reluctant to take medication and does not believe in psychotherapy. She has mixed feelings regarding her eating behaviors and any form of treatment and is afraid to relinquish control. There is no imminent risk. You consider recommending self- help programs as an initial treatment.
- 15. Background questions: What is bulimia nervosa? What are standard treatments for this condition? What synonyms do I need to know for my search?
- 16. Foreground question: P: I: C: O: Patient with bulimia nervosa Self-help Psychotherapy Reduced binging and purging In patients with bulimia nervosa, is self- help as effective as psychotherapy in reducing binging and purging?
- 17. Your turn! Working in pairs, Ask 1 background question Identify the PICO for this scenario Mr. N is a 34-year-old diagnosed with multiple sclerosis, who is experiencing increasing levels of fatigue. He lives in a rural area, and is unable to attend the energy management classes in the closest city. Your colleague has mentioned online energy management support groups. You wonder whether these groups might provide similar help for Mr. N in managing his energy levels.
- 18. Evidence-based practice cycle (and where librarians fit in) Appraising the evidence Incorporating evidence into decision-making Evaluating the Process Formulating the clinical question Searching the evidence Your patient for whom you are uncertain about therapy, diagnosis, or prognosis
- 19. Types of evidence Type of Question Best Evidence Health care interventions: treatment, prevention Quantitative: Systematic review of randomized control trials (RCTs); or a single RCT Harm or Etiology Quantitative: Observational study - cohort or case control Prognosis Quantitative: Observational study - cohort, case control Diagnosis or Assessment Quantitative: Comparison to the current gold standard Economics Quantitative: Cost-effectiveness study Meaning Qualitative: case study, ethnography, grounded theory, phenomenologic approach
- 21. Levels of Evidence (resource dependent) Ia: Evidence obtained from a meta-analysis or systematic review of RCTs. Ib: Evidence obtained from at least one RCT. IIa: Evidence obtained from at least one well-designed controlled study without randomization. IIb: Evidence obtained from at least one other type of well- designed quasi-experimental study, without randomization. III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies. IV: Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities.
- 22. Helpful explanation of study design Check out the study design illustrations at http://library.downstate.edu/EBM2/research.htm
- 23. Point of Care Resources The “go to” resources for health professionals, including medical students and residents, when seeking answers to clinical questions Dynamed: provides clinically-organized (ie. disease) summaries for more than 3,400 health topics. DynaMed editors monitor the content of over 500 medical journals on a daily basis. Each article is evaluated for clinical relevance and scientific validity. The new evidence is then integrated with existing content, and overall conclusions are changed as appropriate, thus representing a synthesis of the best available evidence. Level of evidence UpToDate: is an evidence-based, physician-authored clinical decision support resource which helps health professionals and students to make the right point-of-care decisions. Similar to Dynamed, editors and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into evidence-based recommendations that are proven to improve patient care and quality. Level of evidence
- 24. TRIP: Turning Research into Practice TRIP is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care. Online since 1997, TRIP has developed into an authoritative source of evidence-based content. Their motto is “Find evidence fast” Users can search across a variety of content types including images, videos, patient information, educational courses and even news.
- 25. Joanna Briggs Institute EBP Database Joanna Briggs Institute EBP Database is produced in Adelaide, Australia and is largely used by nursing and allied health professionals. It provides a wide range of resources including over 3,000 records across seven publication types: Systematic Reviews and Protocols (SRs in preparation) Best Practice Information Sheets and Technical Reports Evidence-Based Recommended Practices Evidence Summaries Consumer Information Sheets Arranged into 14 subject based “nodes” which allow users to filter information JBI levels of evidence -> find at joannabriggs.org
- 26. Your turn You are interested in dressings for venous ulcers (leg ulcers). Using different EBP resources, what types of evidence can you find?
- 27. Want to learn more about EBP? Life sciences librarians have produced an extensive list of EBP resources located at http://www.mcgill.ca/library/find/subjects/health/evidence
- 28. Works cited Guyatt, G., Meade, M.O., Richardson & S., Jaeschke, R. (2008). Chapter 3. What is the question? Three ways to use the medical literature. In: Guyatt G, Rennie D, Meade MO, Cook DJ, eds. Users’ Guides to the Medical Literature: A Manual for Evidence- Based Clinical Practice. 2nd ed. New York, NY: McGraw-Hill; 2008. Retrieved from http://www.jamaevidence.com/content/334813 McKibbon A, Wyer P, Jaeschke R, Hunt D. (2008). Chapter 4. Finding the evidence: Four categories of information sources and how clinicians use them. In: Guyatt G, Rennie D, Meade MO, Cook DJ, eds. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd ed. New York, NY: McGraw-Hill. Retrieved from http://www.jamaevidence.com/content/3348229 Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: a key to evidence-based decisions. ACP J Club, 123(3), A12-3. Retrieved from http://www.lusiada.br/cursos/posgraduacao/mestrado-clinica- medica/images/artigos/key-evidence-based-decisions.pdf
- 29. Thank you! Any questions?
Editor's Notes
- #3: Cdn practice compare
- #5: Clinical expertise: what heathcare provider (physician) has learned in school, from experience, and from colleagues and mentors. Patient values and preferences: e.g. cases where evidence and clinical experience support blood transfusion, but patient decides against this treatment for religious reasons Best available evidence = your time to shine!!
- #7: Clinical situation not research question EBP cycle: Uncertainty in diagnosis, therapy, prognosis, or controversies 2. Clinical question 3. Levels of evidence 4. Drawing conclusions that impact practice Library involved in these
- #9: - Article that first put PICO out
- #12: Background knowledge questions are general questions about conditions, illnesses, syndromes and patterns of disease, and pathophysiology. They are usually composed of a question root (what, where, why, when, how) + a verb + a condition. (http://www.ebm.med.ualberta.ca/EbmIntro.html) - What is the typical progression for Parkinsons’ Disease?
- #14: Have them create their pico
- #17: Talk about synonyms – self-help
- #19: Clinical situation not research question
- #21: Go to PubMed Search: bulimia (MeSH) & self-help Then go to clinical queries “bulimia nervosa” and “self help” – show CQ Therapy filter how is isolating toward the top of the triangle Other sources we can go to for high-level evidence Tradeoff – evidence life cycle – first appears in conference papers, then in studies, then in textbooks/summaries/syntheses (6s triangle) Look at a few of these today: uptodate & dynamed (PoC tools) -> value added tools because evidence is graded for you TRIP database, Joanna Briggs
- #22: Skeleton – is resource dependent (we will look at separate LoE schemas for UTD, Dyn
- #24: Dynamed (search bulimia) end of every sentence attached to ref Show level of evidence breakdown (reference to other LoE – APA, NICE – also Dyn LoE) Search within: self-help Note: these searches are broad (you may only search the disease or condition) UTD – controversy – mentioned on several groups - not unique to UTD – reliance a problem (certain areas updated more frequently than others) - problems with conflict of interest (http://jme.bmj.com/content/early/2014/02/03/medethics-2013-101625.abstract) - UTD responded to this - cost an issue – many med schools have dropped it - note: grade for recommendations – see bulimia psychopharm
- #25: Clinical search engine; broad searching therefore can combine concepts Use boolean logic and quotation marks to restrict results Note guidelines – broken down by country/region
- #26: NOTE: Uses British spelling