EBM: Module 3

Systematic reviews and meta-analyses are considered the _____ for use in EBP

"gold standard"

Patient-centered Interprofessional Practice

(IP); looking at the interaction among the patient/population, individual practitioners, and collaborative team members

NLM (National Library of Medicine)

An entity within the National Institutes of Health. It is the world's largest biomedical library. The NLM administers PubMed, Clinicaltrials.gov, MedlinePlus, and other health information resources.

Patient-Centered EBP Process (steps 1-5)

1. Formulate a focused question 2. Locate relevant evidence 3. Appraise trustworthiness 4. Make collaborative patient-centered decision *incorporate evidence with clinical experience, clinical context, and patient needs/values 5. Evaluate results of action taken

To organize relevant qualitative and quantitative evidence, organize into 5 columns:

1. level of evidence 2. date of publication 3. name of resource and/or document 4. continual access? (yes/no) 5. relevance to PPAARE (rate 1-3)

Abstract

A brief overview of a publication that outlines the major topics; limited in terms of the number of words that can be included; usually structured according to required elements, such as background, problem, purpose, methods, results, and discussion/conclusions; often available for free

WHO (World Health Organization)

A group within the United Nations responsible for human health, including combating the spread of infectious diseases and health issues related to natural disasters. aka the coordinating authority for health within the United Nations system

Meta-search Engine

A search engine capable of searching for information in multiple databases at the same time, resulting in one list of results ex. ACCESSSS and TRIP

Digital Object Identifier (DOI)

A unique number assigned by the publisher to identify each individual article in a journal; not all publishers assign doi's

Boolean Operator

A word that functions in a search engine as a command; 3 most common: AND, NOT, and OR; operators are used to focus search results *not all search engines utilize Boolean operators, nor do all engines utilize them in the same way

Cochrane Library

An online collection of databases that brings together in one place rigorous and up-to-date research on the effectiveness of healthcare treatments and interventions, as well as methodology and diagnostic tests

The only part of the PPAARE that is not required is...

A: alternative to the action

PubMed

An online database administered by the National Library of Medicine. It can be used to search millions of publications in biomedical literature, life science journals, and online books. *locating primary biomedical literature, although not all full-text publications are available online for free

Examples of Secondary sources

Cochrane ECRI Institute Trip Systematic Reviews Meta-Analyses Clinical Guidelines

CINAHL

Cumulative Index to Nursing and Allied Health Literature; an online index of literature about nursing, allied health, biomedicine, and other healthcare topics; provided by EBSCO Publishing and requires a license to access it, although some CINAHL resources are available for free to the public; many colleges purchase site licenses so all students can access full CINAHL *specialties: alternative medicine, gerontology, healthcare admin, oncology, and women's health

Citation

Details of the bibliographic information of a source, such as a book, website, or journal article; includes title of document; the name(s) of the author(s); title of its source; and other helpful details (volume/issue #, page #s)

Point-of-Care Resource

Health information search tools that contain synthesized evidence useful to the practitioner while treating the patient; ex UpToDate, MD Consult, Essential Evidence Plus, DynaMed, etc.

Clinical Queries

In PubMed, Clinical Queries are filtered sets of resources that have been grouped together into three major clinical research areas: clinical studies, systematic reviews, and medical genetics. Searches performed in the Clinical Queries section of PubMed produce only publications that fall into one of these three areas. The Clinical Queries tool shows the number of results that fall into each area and allows users to further reduce results by subcategories if any are applicable *located on PubMed home page under the heading PubMed Tools *place multiple MeSH combined with Boolean operators

Clipboard

In databases such as PubMed, the Clipboard is a place where selected search results can be retained; users have to create an NCBI account in order for the system to be able to retain Clipboard info after the window has been closed

When searching in PubMed, what controlled vocabulary is used to make the search results more focused on a topic?

Medical subject headings (MeSH)

The highest level of evidence on the evidence pyramid corresponds to...

Meta-analyses and systematic reviews

Within CINAHL, you can save evidence to a folder within...

My EBSCOhost

When using Boolean operators to combine two search words, what operator is used to exclude words from the search strategy?

NOT

PICO

P = description of the patient or the target disorder/problem of interest I = intervention (could be exposure, diagnostic test, prognostic factor, therapy) C = comparison intervention (relevant most often when looking at therapy questions) O = what are the relevant outcomes and how are they measured?

PPAARE

P = description of the problem related to the disease/condition P = description of the patient related to their demographics and risk factors A = description of the action related to the patient's diagnosis/diagnostic test/etiology/prognosis/treatment/therapy/harm/prevention/patient education, etc. A = description of the alternate to the action when there is one *not required* R = identify the patient's result of the action to produce, improve, or reduce the outcome of the patient E = identify the level of evidence available after searching

The first P in a PPAARE patient question relates to the...

Patient's disease or condition

Examples given of Primary sources

PubMed CINAHL Web of Science Clinical Trials Other Study types

The first A in a PPAARE community/public health question relates to the...

Public or community health program as the intervention

Examples of tertiary sources

UpToDate IBM Micromedex 5 Minute Consult Epocrates Chapman Libraries Google

MeSH Tree

a relational list of MeSHs that categorize MeSHs within one another, creating a branching structure (e.g. morbid obesity falls in the category of obesity which falls within category of overweight which falls within category of body weight) these branches show the hierarchies of each MeSH each level of the hierarchy represents a change in the generality of the topics contained *can help users expand or narrow searches to improve the relevance of results

PubMed Central Index Number (PMCID)

a unique number assigned to each citation contained in the PubMed Central database

PubMed Index Number (PMID)

a unique number assigned to each citation contained in the PubMed database

MeSH

an acronym stands for "Medical Subject Heading" used in PubMed and other indexing systems a type of controlled vocabulary that are used for categorizing and grouping publications *searching PubMed by MeSHs can significantly improve the accuracy of search results compared with performing key word searches

Filters

another term for limiters or limits; in PubMed, the filter options appear along the left column of the home search page; include text availability, publication data, species, article type, language, etc. *there is a link called "Show additional filters" that offers a pop-up menu with more filter options

Centers for Disease Control and Prevention (CDC)

part of the Department of Health and Human Services; its mission is to enhance health promotion; prevent disease, injury, and disability; and prepare for new health threats

Prevalence

proportion of the population who have a specific disorder at a given point or period in time

Algorithms

recommendations typically presented with a diagram, which can be used to supplement treatment decisions

Full-text

the complete version of a publication

In PPAARE, "E" should always be...

the highest level of evidence available! *from pyramids: synthesized summaries, meta-analyses, systematic reviews, evidence syntheses, confirmatory or transferability studies, etc.

Incidence

the number of new cases of a disease or condition during a specified time frame

Etiology

the science and study of causes; in healthcare, the term relates to the causes of illness, aka pathogenesis

In planning the search strategy, you should brainstorm...

words or phrases to use in searching for evidence relevant to PPAARE components; consists of: -search words -alternative words/synonyms -make sure to notice search words to exclude from your searches