How to Find the Evidence

AcquireBest available evidenceAskClinically relevant questionEvidence –based clinicalpractice is “…theconscientious, explicit, andjudicious use of current bestevidence in making decisionsabout the care of individualpatients. ” ~David Sackett, MDAssess patientdilemmaReflection ofprocess stepsAppraiseQuality & importanceApplyEvidence in patient care

Nancy Kime, DCKaren Goodell, M.A.•Master’s in Library Science,specializing in medical librarianship

Finding the Evidence:Where can I find reliableand useful answers to myclinical questions?Ms. Karen GoodellDr. Nancy KimeDr. Lia Nightingale

Finding the EvidenceWhat?Why?• To keep up-to-date• To answer clinical questions

Finding the EvidenceDownloaded from flickr.com/photos/will-lion/2595497078. Used with permission byCreative Commons License

Finding the EvidenceUsefulness = Relevance X Validity ↑Work ↓Relevance = applicability to your patientor your topicValidity = quality of the researchRosser, W., Slawson, D. & Shaughnessy, A. Information mastery: Evidence-based familymedicine, Vol 1, London: B.C. Decker, 2004.

MetaanalysisSystematicreviews1. Filtered summariesRandomized controltrialsCohort studiesCase-controlled studies2. OriginalresearcharticlesCase study/Case seriesAnimal research or laboratory studies3. Websites4. Books

1. Filtered Summaries• Meta-analysis• New statistical interpretation of results fromseveral original research articles• Systematic review• Overview of multiple research articlesusing explicit & reproducible searchstrategies

1. Filtered Summaries• DynaMed• National Guideline Clearinghouse –www.guidelines.gov• TRIP database – www.tripdatabase.com• Natural Standard Database

2. Original ResearchArticles• Randomized control trials• Placebo-controlled, double blind studies• Cohort studies/Case-controlled trials• Observational• Compares those with disease to thosewithout (case-control)• Compares those exposed to those without& determine if disease develops over time(cohort)

2. Original Research• Case study/seriesArticles• Detailed report of symptoms, diagnosis,treatment and follow-up of a single patient(case study) or several patients (caseseries)• Animal/Lab research

2. Original ResearchArticles• PubMed Clinical Queries• TRIP database –www.tripdatabase.com• Google Scholar –http://scholar.google.com

3. Websites• eMedicine – www.emedicine.com• Medscape – www.medscape.com• .org and .edu websites are also helpful

4. Books• Depends on the type of informationneeded• Background information – basic reference• Symptoms – e.g. Netter’s OrthopaedicClinical Examination• Treatment – e.g. Conn’s Current Therapyor Souza’s Differential Diagnosis andManagement for the Chiropractor

Search Strategy• Analyze the question for main concepts• Think of synonyms for the mainconcepts• Think of alternative spellings,abbreviations, and multiple endings• Use subject headings for the database– usually gives more focused resultsthan a keyword search

Search Strategy• Subject Headings – PubMed and manymedical databases use Medical SubjectHeadings (MeSH)• These can be searched throughPubMed

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How do I keep up todate???

Push vs. PullAlerts – sent directly to your inbox• DynaMed (Available through PalmerLibrary’s Databases page)• BMJ Evidence Updates:http://plus.mcmaster.ca/EvidenceUpdates

Table of contents ofrelevant journals:(Access all these through PalmerLibrary’s A-Z list)• Chiropractic and Manual Therapies• JMPT• Manual Therapy• Spine

Patient Case• Your patient is a 67 year old Caucasianfemale. She is concerned with a recentdiagnosis of osteoporosis and wants yourinput. Will her new schedule of walkingthe mall 3x weekly at a moderate pace beenough to slow or reverse the effects ofher osteoporosis.

PICO• What do you want to know?• Questions about diagnosis/diagnostictests• Questions about the condition• Common treatments• Specific question to guide advise topatient (application of the data)

Small Group Activity• Create a PICO• Indicate which database(s) would bemost useful• Indicate which search terms will you use

Resources• w3.palmer.edu/ctlpowerpointsevidence-based practice web sites• Library Serviceshelp with literature searcheshelp researching clinical questionsone-on-one database tutoring