EBM Literature

Searching

Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBSChairman, Knowledge Translation Committee

Department of Medicine, KAMC,KSA

What is Best Evidence? Hierarchy of Levels of Evidence

Acquire the Best Evidence:Finding the Best Evidence First

Hierarchy of Sources of Evidence Pyramid

Pre-appraised, systematic reviews: Cochrane

Databases with EBM background: CKS, Essential Evidence Plus ®, DynaMed®, ACP’s PIER, BMJ Best Treatment, Guidelines Clearinghouse, Guidelines Finder Highly referenced, current e-

textbook: Up-to-Date

Standard e-textbooks (emedicine)

Primary Resources: PubMed (Clinical Queries), Medline

Pre-appraised, individual studies: ACP Journal Club, BestBets

*Adapted from Shaughnessy and Slawson

Self-Education & Training in EBM

EBM Resources:  http://guides.mclibrary.duke.edu/content.php?pid=274

373&sid=2262393 http://www.med.yale.edu/library/education/guides/feat

ure/finditfast

 CEBM Website:  http://www.youtube.com/user/cebmed, http://www.cebm.net/index.aspx?o=1965

YouTube: http://www.youtube.com/watch?v=odfo9CQGi0c

The 6 Prerequisites for successful Literature Searching

1

•Know how to use a computer/electronic device.

2

•Know the Internet Jargon of Terms.

3

•Know the EBM Jargon of Terms.

4

•Know how to formulate your question.

5

•Know where to go.

6

•Know what to do when you get there: the site’s technical language/know-how.

Learn how to navigate your resource: Website Tutorial

Resources For EBM Knowledge Translation

EBM Resources

Point of Care Clinical

Resources

Updates

New Evidence

Decision Support Systems

Critical Appraisal

Tools

Evidence-Based Quality

Improvement

Evidence-Based

Guidelines & Policies

• DynaMed• Essential

Evidence Plus

• First Consult

• UpToDate• Clinical

Evidence• ACP

PIERS 

• Mc Master Plus: STAT REF

• BMJ Evidence Updates/Alerts

• ACP Journal Club

• Open Clinical

• Dxplain• Emergenc

y Medicine on the Web

• Clinical Decision Making Calculators

• EBM toolbox

• CATmaker• Evidence

based medicine toolkit

• EBM Calculator

• National Guideline Clearinghouse

•  NHS Evidence

•  ICSI Institute for Clinical Systems Improvements

• AHRQ• Institute

for Healthcare Improvement

• Knowledge Translation Clearinghouse

• NICE

Advanced EBM SkillsEBM Hunting Tools

Hunting for Evidence

Please use in conjunction with the Hyperlinked Page.

1

•Decide if the question is a Foreground or Background Question

2

•Convert clinical Foreground question to searchable question (e.g. PICO)

3

•Choose the database you want to search: Primary (e.g. Pubmed), Secondary (e.g. Cochrane)or Tertiary (e.g. Trip Database)

4

•Apply filters to restrict your search (e.g. PubMed limits linked to PICO such as gender, age, study type limits)

“Finding Evidence”: Searching Strategy

5

•Appraise your Primary studies: Critical Appraisal Tools

6

•Assess result (e.g. using systematic review worksheet)

7

•Decide if you have enough information to make a decision

8

•If not then refine steps 2-4 until you either have an answer or decide there isn’t enough evidence to make an evidence based decision

“Finding Evidence”: Searching Strategy

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 1:

Background Knowledge: Textbooks/eTextbooks e.g. emedicine

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 2:

Foreground Knowledge: Primary Literature/Original Studies= Pubmed, Embase, Cinahl etc

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 3:

Foreground Knowledge: Secondary Literature/Pre-appraised Literature

Focused/Specific Broad/General Topic

Diagnosis e.g.Troponin in ACS Uric acid in Pre-eclampsia

Therapy e.g.– Misoprostol for PPH– Statins for hypercholesterolemia– Specific procedure

Focused/SpecificSystematic

Review Sites e.g. Cochrane

Technology Assessment

Sites e.g. Cochrane

Guidelines e.g.

Guideline Clearinghouse

Evidence Based eTextbooks e.g. Dynamed

Broad/General Topic

Management of Postpartum Hemorrhage

Management of hypertensionManagement of Fetal Respiratory

Distress SyndromeManagement of cancer pain

Guidelines

e.g.Guideline

Clearinghouse

Evidence Based eTextbooks e.g.

UpToDate

On-line

eTextbooks

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 4:

Foreground Knowledge: Evidence-based Quality Improvement: Policies, Pathways, Order Sets etc

NICE Pathways: guidance at your fingertips- www.nice.org.uk Society of Hospital Medicine: http://www.hospitalmedicine.org/ AHRQ Agency for Healthcare Research and Quality   http://www.ahrq.gov/ Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/ ICSI Institute for Clinical Systems Improvements  http://www.icsi.org/index.aspx

Secrets of Literature Searching

Strategies for Literature Searching: Strategy 1:

Background Knowledge: Textbooks/eTextbooks e.g. emedicine

e.g. Pancreatitis, Appendicitis

How to access emedicine: Three ways! (applies to all EBM Websites)

1: Google it: pancreatitis emedicine

2. Click on the www address from the hyperlinked page

3: Saved address from your favorites links menu.

Topic Headings

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 2:

Foreground Knowledge: Primary Literature/Original Studies= Pubmed, Embase, Cinahl etc

A PICO for Appendicitis

P Acute Appendicitis

I Ultrasound

C Computerized Tomography

O Diagnostic Accuracy

Option 1: Use Pubmed via pico

(for both Primary and Secondary Literature)

Click on PICO

Select Publication Type from drop-down menu

TBL The Bottom Line

Increase your hits by using the Related option if this hit is the closest to your PICO

http://pubmedhh.nlm.nih.gov/nlm/

PubMed for Handhelds (PubMed4Hh): Download to your device from Play Store

MEDLINE/PubMed     Search MEDLINE/PubMed     Read Journal Abstracts

PICO search     Patient, Intervention, Comparison, Outcome

askMEDLINE     free-text, natural language search

Option 2: Use Pubmed search box

(for both Primary and Secondary Literature)

The Limits options

The Limits options

Option 3: Use the “Clinical Queries” option in Pubmed.(for both Primary and Secondary Literature)

Clinical Queries Option

Filters/LimitsFor Primary Literature

Systematic Reviews

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 3:

Foreground Knowledge: Secondary Literature/Pre-appraised Literature

Focused/Specific Broad/General Topic

Looking for EBM information in Guideline Clearinghouse directly from Google

Looking for EBM information in UpToDate directly from Google

Looking for Calculators for Decision Making e.g. Pancreatitis

Looking for Calculators for Decision Making

Looking for Calculators for Decision Making e.g. Pancreatitis

Looking for EBM Calculator in UpToDate

Technology Assessment Database in the COCHRANE LIBRARY

Critical Appraisal Checklists http://www.gla.ac.uk/departments/generalpracticeprimarycare/ebp/

checklists/#d.en.19536

§         Checklist for an article on treatment or prevention §         Checklist for an article on qualitative research §         Checklist for an article on decision analysis §         Checklist for an article on an educational intervention §         Checklist for an article on prognosis §         Checklist for an article on harm or causation §         Checklist for an article on guidelines §         Checklist for an article on diagnosis or screening §         Checklist for a systematic review §         Checklist for economic evaluations

Looking for EBM Critical Appraisal Tools

Critical Appraisal Calculators

Oxford Centre for EBM: http://www.cebm.net/?o=1023

Secrets of Literature Searching

Strategies for Literature Searching:

Strategy 4:

Foreground Knowledge: Evidence-based Quality Improvement: Policies, Pathways etc

NICE Pathways: guidance at your fingertips- www.nice.org.uk Society of Hospital Medicine: http://www.hospitalmedicine.org/ AHRQ Agency for Healthcare Research and Quality   http://www.ahrq.gov/ Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/ ICSI Institute for Clinical Systems Improvements  http://www.icsi.org/index.aspx

For a Clinical Pathway

For a bad incident: An evidence-based M&M Report ready

for use.

  WebM&M  Morbidity & Mortality Rounds:  http://www.webmm.ahrq.gov/

With its PowerPoint presentation

For high re-admission rates

For delayed discharge

Boolean operator ‘OR’

After its creator George Boole

Akobeng AK. Arch Dis Child 2005 ; 90 : 837 – 840.

The Boolean Operators

Akobeng AK. Arch Dis Child 2005 ; 90 : 837 – 840.

Boolean operator ‘AND’

After its creator George Boole

Akobeng AK. Arch Dis Child 2005 ; 90 : 837 – 840.

Boolean operator ‘NOT’

After its creator George Boole

Boolean search After its creator George Boole

Boolean operators Meaning

Peptic ulcerOR Hemorrhage

Peptic ulcer AND Hemorrhage

Peptic ulcerNOT Hemorrhage

Summary

Competency in Literature Searching is a must for an effective healthcare force.

Thanks and Good Luck