Nursing Research Resources

Guide to Nursing ResourcesEBN : 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.

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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, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2.

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’

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EBM journals Cochrane DB systemic reviews

Clinical Practice Guidelines

primary research articles

CINAHL, MedlineAssoc. websites,

textbooksGoogle

Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514

Evolution of LiteratureEvidence PyramidThe base of the pyramid is where

information usually starts with an idea or laboratory research. As these ideas turn into drugs and diagnostic tools they are tested in laboratories models, then in animals, and finally in humans. The human testing may begin with volunteers and go through several phases of clinical trials before the drug or diagnostic tool can be authorized for use within the general population. Randomized controlled trials are then done to further test the effectiveness and efficacy of a drug or therapy.

As you move up the pyramid the amount of available literature decreases, but increases in its relevance to the clinical setting.

Type of Study Meta-

Analysis Systematic

Review Randomized

Controlled Trial Cohort studies Case Control studies Case Series/Case Reports Animal

research/Laboratory studies

Evolution of EB Information

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Systems [computerized decision support]& Summaries [EB textbooks]

Synopses [EB journal abstracts]

Syntheses [systematic reviews]

Studies [original journal articles]

Based on: Haynes, Brian. “Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information

services for evidence-based healthcare decisions”/ Evidence based medicine. 2006 Dec. 11(6):162-4.

Medical Databases CINAHL

EBSCOhosthttp://support.epnet.com/training/tutorials.php CINAHL.com

Online traininghttp://www.cinahl.com/library/library.htm

Medline EBSCOhost PubMed

Online traininghttp://www.nlm.nih.gov/bsd/disted/pubmed.html

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 them.http://ssrc.tums.ac.ir/SystematicReview/

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.

OtherSearch Engines Medstory SearchMedica Google Scholar MammaHealth MedlinePlus OminiMedicalSearch

Databases Nursing Reference

Center DynaMed Up-to-Date MosbyNursingIndex NurseConsult InfoPOEMS

Steps to answering Clinical Questions using the Medical

LiteratureThe Anatomy of the Clinical

Question:1. Formulate a clinical question

("PICOT" approach):Patient characteristicsIntervention being consideredComparison intervention (if any)Outcome of clinical interestTimeframe

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 method/

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)

http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf

NoteYou 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.

Evidence Based Medicine Toolkits & Tutorials

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.htmOR

From Duke University Medical Center:http://www.hsl.unc.edu/services/tutorials/EBM/welcome.htm

EBM Jeopardy

Thank you Ann Celestine, BA MLS AHIP

Library Director