Guide to Nursing Resources

EBN : Accessing the Research

 Learning Objectives

Introduce student to evidence-

based nursing literature and
effective strategies for searching
for and accessing evidence-
based research in nursing.
 What is EBM?

“Evidence based medicine is the

conscientious, explicit, and judicious
use of current best evidence in
making decisions about the care of
individual patients. The practice of
evidence based medicine means
integrating individual clinical
expertise with the best available
external clinical evidence from
systematic research.”
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB,
06/18/09 Richardson WS.IUON - Library Research 3
Evidence based medicine: what it is and what it isn't.
Evidence Based Medicine

EBM Decision Model:

"Evidence-based medicine (EBM) is
the integration of best research
evidence with clinical expertise
and patient values."

EBM Cycle:
Ask, Acquire, Appraise, Apply and
Act
 Primary Evidence

Primary evidence includes the

original reports of research
studies and are included in
journal citation databases:
 MEDLINE: randomized controlled
trials
 CINAHL: research
 EMBASE
 SCIRUS
 Secondary Evidence

Secondary evidence is the analysis

of research studies and is found
in:
 MEDLINE: meta-analysis, practice
guidelines, consensus development
conferences
 CINAHL: meta-analysis, practice guidelines,
research based nursing practice
 Cochrane Database of Systematic Reviews
 Database of Reviews of Effectiveness
(DARE)
 National Guidelines Clearinghouse
 Information ‘Pyramid’
EBM journals
Cochrane DB
Systemic reviews
Clinical Practice
Guidelines

primary research articles

CINAHL, Medline

Assoc. websites,
textbooks
Google
Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514

06/18/09 IUON - Library Research 7

 Evolution of Literature
Evidence Pyramid Type of Study
The base of the pyramid is where  Meta-
information usually starts with an idea
or laboratory research. As these ideas Analysis
turn into drugs and diagnostic tools
they are tested in laboratories models,
 Systematic
then in animals, and finally in humans. Review
The human testing may begin with
volunteers and go through several
 Randomized
phases of clinical trials before the drug Controlled Trial
or diagnostic tool can be authorized
for use within the general population.  Cohort studies
Randomized controlled trials are then
done to further test the effectiveness
 Case Control studies
and efficacy of a drug or therapy.  Case Series/Case Reports
As you move up the pyramid the
amount of available literature  Animal
decreases, but increases in its research/Laboratory
relevance to the clinical setting.
studies
 Medical Databases
 CINAHL  Medline
 EBSCOhost  EBSCOhost
http://  PubMed
support.epnet.com/training/tutorials.php
 Online training
 CINAHL.com http://
 Online training www.nlm.nih.gov/bsd
http://
www.cinahl.com/library/library.htm
 Evidence in MEDLINE

Searching for evidence in MEDLINE

includes several steps:
 formulate a clinical question
 run a subject search
 Ex. heart disease and aspirin
 select a strategy to retrieve
literature related to therapy,
diagnosis, prognosis,
harm/etiology.
 Evidence in CINAHL
 formulate a clinical
question
 run a subject
search
 use the Research
limit on the Main
Search Page.
 This is a very effective way to
limit retrieval to research
studies in CINAHL.
 Tutorial: http://
www.hscl.ufl.edu/help/CINAHL/index.htm
 Cochrane Database of Systemic
Reviews
 includes the full text of the
regularly updated
systematic reviews of the
effects of healthcare
 prepared by The Cochrane
Collaboration
 can be searched by
combing keywords or
phrases.
 The Browse Topics icon
retrieves a list of Cochrane
Groups who prepare and
maintain the reviews in
respective clinical areas,
such as nursing.
 http://
www.cochrane.org/index.htm
Database of Reviews of Effectiveness (DARE)
Database of Reviews of Effectiveness (DARE) a full text
database with critical structured abstracts of studies
reported in various medical journals.
 What is Systemic
Review?
 Systematic reviews are known as the
highest level of evidence in clinical
research.
 Developed countries are developing their
medical guidelines based on the information
provided by systematic reviews of
effectiveness.
 Therefore, it is mandatory for all
professionals involved in the delivery of
healthcare, to reach to a good
understanding about systematic reviews.
 This web site offers information about what
systematic reviews are, and how to conduct
The
National Guidelines Clearinghouse
includes evidence-based practice guidelines from various
health centers and organizations. It can be searched by
disease, treatment or organization. The Clearinghouse
includes a feature comparing attributes of two or more
guidelines.
 HealthWeb

The Evidence-Based Health Care

section of HealthWeb includes a
wealth of information about EB
organizations, databases and
publications.
The Tools and Tutorials has many
helpful links including the
EBM Tool Kit and EBM Toolbox.
 Other
Search Engines Databases
 Medstory  DynaMed
 Google Scholar  Up-to-Date
 MammaHealth  MDConsult
 MedlinePlus  NursingConsult
 Kosmix  InfoPOEMS
 ReleMed
 Steps to answering Clinical
Questions using the Medical
Literature
The Anatomy of the Clinical
Question:
1. Formulate a clinical question
("PICO" approach):
Patient characteristics
Intervention being considered
Comparison intervention (if any)
Outcome of clinical interest
 Clinical Question cont.

2. Run your subject search.

3. Select the MEDLINE strategy to

answer the question:
Therapy, Diagnosis, Prognosis,
Harm/Etiology.
(including study design/article
type)
 For Quick Searches

A question of...
Therapy
Limit search to Publication
Type - Randomized Controlled
Trial pt
 In-depth EBM Searches:
Therapy
exp research design/ or exp clinical trials/ or
comparative study/ or placebos/ or
multicenter study.pt. or clinical trial$1.pt. Or
random$.ti,ab. or (single blind$ or double
blind$ or triple blind$3).ti,ab. or
placebo$1.ti,ab. or (clinical adjtrial$1).ti,ab.
or exp epidemiologic research design/ or
(controlled clinical trial or randomized
controlled trial).pt. or practice guideline.pt.
Or feasibility studies/ or clinical protocols/ or
exp treatment outcome/ or double blind
 For Quick Searches

A question of...
Diagnosis
Combine subject search with
search for exp "sensitivity and
specificity"
 In-depth EBM Searches:
Diagnosis
exp "sensitivity and specificity"/ or false
negative reactions/ or false positive
reactions/ or (sensitivity or specificity).ti,ab.
or (predictive adj value$1).ti,ab. or
(likelihood adj ratio$1).ti,ab. or (false adj
(negative$1 or positive$1)).ti,ab. or
(randomized controlled trial or controlled
clinical trial).pt. or double blind method/ or
single blind method/ or practice
guideline.pt. Or consensus development
conference$.pt. or random$.ti,ab. or random
allocation/ or (single blind$3 or double
blind$3 or triple blind$3).ti,ab.
 For Quick Searches

A question of...
Prognosis
Combine subject search with
search for exp cohort studies
or exp risk
 In-depth EBM Searches:
Prognosis
exp cohort studies/ or prognosis/ or exp
mortality/ or exp morbidity/ or
(natural adj history).ti,ab. or
prognos$.ti,ab. or course.ti,AB or
predict$.ti,ab. or exp "outcome
assessment (health care)"/ or
outcome$1.ti,ab. or (inception adj
cohort$1).ti,ab. or disease
progression/ or exp survival analysis/
 For Quick Searches

A question of...
Harm/Etiology
Combine subject search with
search for exp cohort studies
OR exp risk
 In-depth EBM Searches:
Harm/Etiology
random$.ti,ab. or exp epidemiological
studies/ or odds ratio/ or
cohort$.ti,ab. or (case$1 adj
control$).ti,ab. or risk$.ti,ab. or (odds
adj ratio$1).ti,ab. or causa$.ti,ab. or
(relative$1 adj risk$).ti,ab. or
predispos$.ti,ab. or (randomized
controlled trial or controlled clinical
trial).pt. or exp risk/ or practice
guideline.pt. or exp case-control
studies/ or exp cohort studies/
 For Quick Searches

4. Locate other sources of

evidence as necessary.
5. Examine the evidence, critically
appraise/evaluate the literature.
6. Apply the evidence + clinical
experience + the patient's
preferences.
7. Evaluate patient outcomes.
 In-depth EBM Searches

4. Once copied, paste it into the

search box in MEDLINE.
5. Click "Perform Search."
6. Combine this set with your
original search using AND (i.e. 1
AND 2).

(EBM filters developed by the Miner

Library at the
University of Rochester Medical Center
 Note
You can save each of these EBM filters as a separate
search in MEDLINE so that they can be run as
needed when searching MEDLINE
To do this:
 Authenticate to a new MEDLINE session with a
blank search history.
 Copy and paste one EBM filter.
 Click "Perform Search."
 After retrieving search results, click "Save Search
History."
 Select "Permanent," and name the search (ex.
EBM Therapy or Therapy Filter).
To use save searches:

 Run your subject search.

 Click "Run Saved Search."
 Select the EBM filter to run based
on the type of question being
asked (Therapy, Diagnosis,
Prognosis, or Harm/Etiology).
 Combine the two searches using
AND.
For further clarification and practice check out more online
training ‘EBM Toolkit’ based on the series in JAMA:
http://www.med.ualberta.ca/ebm/ebm.htm
OR
From Duke University Medical Center:
http://
www.hsl.unc.edu/services/tutorials/EBM/welcome.htm

EVIDENCE BASED
MEDICINE TOOLKITS &
TUTORIALS
EBM Jeopardy
 Thank you
Ann Celestine, BA MLS AHIP
Library Director