Trainer: Isatou N’jie

Knowledge and Library Services

Barts Health NHS Trust

Introduction to Evidence Based

Practice for NMAHP EBP Fellows

12th January 2015

Objectives

• Identify the type(s) of information you might need for Evidence

Based practice

• What is the purpose of evidence-based practice, the hierarchy of

evidence and the key steps of evidence based practice?

• Be aware of the coverage and content of the health databases

• Understand how to search the key databases electronically

• Plan a search strategy using the PICO formula

• Run a search query on one of the EBP resources

The Purpose of Evidence-Based Practice • Aim: To deliver high-quality care to an individual patient.

• Means integrating clinical expertise with up-to-date information

from clinically relevant research in making decisions about the

care of individual patients.

• To achieve this, health care professionals must therefore keep up

to date with new perspectives on care and they must learn to adopt

a process of evidence-based practice that is open to scrutiny by

their peers and the public

• They need to be able to critically evaluate ideas and experiences

and apply what they have learnt to their practice

Hierarchy of Evidence

Filtered

Information

Unfiltered

Information Qu

ali

ty o

f th

e E

vid

en

ce

• Systematic reviews and meta-analyses constitute a comparative analysis

of research and are at the apex of the pyramid.

• The systematic review of several randomized trials has become the “gold

standard” for judging whether a treatment does more good than harm.

1. Ask a searchable clinical question;

2. Find the best evidence to answer the question;

3. Critically Appraise the evidence;

4. Apply the evidence with clinical expertise, taking the patient's

wants/needs into consideration;

5. Evaluate the effectiveness and efficiency of the

process.

The 5 steps of EBP

PICO

Population

(Patient/Problem)

What are the most important characteristics of the patient? This may include

the primary problem, disease, or co-existing conditions. Identify the main

concepts and alternative terms

- Deep vein thrombosis, DVT, Venous thrombosis, prophylaxis

Intervention

(drug, procedure,

diagnostic test,

exposure)

Which main intervention are you considering?

- Compression stockings, pressure stockings

What factor/s may influence the prognosis of the patient? - Sex, Age, Co-

existing problems? What was the patient exposed to?

Comparison

What are the main alternatives to compare with the intervention?

Are you trying to decide between two diagnostic tests or no medication?

Outcome

What can you hope to accomplish, improve or affect?

What are you trying to do for the patient? Relieve, eliminate the symptoms,

Prevent or reduce the risk?

Scenario: Are compression stockings effective in preventing deep vein thrombosis?

Developing a Search Strategy

Take your PICO and find keywords:

• Synonyms/ Spelling variations

e.g. Deep vein thrombosis, DVT, Venous thrombosis

Compression stockings, pressure stockings

• Boolean logic i.e. AND , OR , NOT

e.g. Venous thrombosis AND Compression stockings (will find

documents containing both of your terms) OR will find documents with

either one term or the other term

• Phrase searching use "inverted commas" to search for phrases

e.g. “Deep vein thrombosis”

• Truncation * (asterisk) use to search for word stems, e.g. compres*

- compression, compress, compressing

Resources to find ‘Best Evidence’

Knowledge and Library Services

http://bartshealth.nhslibraries.com

You will need an NHS Athens

Username and Password to use

the databases. You can self-register

for an Athens account online

Click on the “Athens Registration”

and follow the link to register online.

If you already have an Athens account

start your search by clicking on

NHS Evidence.

NHS Evidence - Advanced Search NHS Evidence - http://www.evidence.nhs.uk/ Click on the link to

“Journals and Databases”

Healthcare Database Advanced Search (HDAS) provides access to an

extensive set of journals and bibliographic databases via Athens.

Login via Athens and search one database at a time for the best results – tick

to select a database then click on ‘Search’.

Cochrane Database of Systematic Reviews

Cochrane Library - http://www.thecochranelibrary.com

The Cochrane Database of Systematic Reviews (CDSR) is the

leading resource for systematic reviews in health care. The

Clinical Answers tool offers practical evidence for healthcare

decision-making.

Each clinical answer is

linked to a clinical question

and you can ‘drill down’ to

the evidence from relevant

Cochrane reviews.

TRIP Database

TRIP Database - http://www.tripdatabase.com/search

Trip is a clinical search engine which allows users to conduct a PICO

search. It simultaneously searches evidence-based sources of

systematic reviews, practice guidelines, and also searches

MEDLINE’s Clinical Queries,

medical image databases, videos

and patient information leaflets.

Search Results:

Systematic reviews

Guidelines

Evidence Based Synopsis

Controlled Trials

Countries

Critical Appraisal Is the process of carefully examining research to judge its trustworthiness, value and

relevance in a particular context (Burls, 2009)

Clinical Define the Search Appraise Decide Evaluate

Problem Question

PICO Tool Finding the Evidence Critical Appraisal

• Who is the Author?

Often we come across news articles that make unjustified scientific/ medical claims.

• Is the study valid? The first step is to decide whether the study was unbiased by evaluating its methodological

quality.

• What are the results? Are the study’s results clinically important. e.g. did the experimental group show a significantly

better outcome compared with the control group?

• Are the results useful? How does the evidence apply to your question? e.g. Is it likely that your patient or population

may have different characteristics to those in the study?

Check lists are commonly used for the critical appraisal of different study designs:

http://www.sign.ac.uk/methodology/checklists.html#

http://cebmh.warne.ox.ac.uk/cebmh/education_critical_appraisal.htm

Practical Exercise

Thank you for your attention!