Evidence Based Surgical Nursing – Reviewing the Evidence
Carl Thompson
Dept of Health Sciences, University of York.
What is Evidence Based Health Care?
Evidence from research
Clinical experience
Patient preferences
Available resources
EVIDENCE BASED
DECISION
How do you focus your question?
Need to identify 3 things:
Who it is you are interested in - Population
What it is you are interested in - Intervention
What you are hoping for -
Outcome
An example….
In patients with opioid induced nausea and vomiting which is the most effective anti-emetic, metoclopramide or haloperidol
Population
Intervention
(Counter-intervention)
Outcome
Patients with opioid induced
nausea and vomiting
Metoclopramide
(Consider route of administration )
Haloperidol
(Consider route of administration )
Reduction in nausea/vomiting
(Consider how this might be monitored)
TYPE OFQUESTION
EXAMPLE BEST DESIGN
Effectiveness ofTreatment/Prevention;adverse effects oftreatments
Does compressionbandaging increase thehealing of venous leg ulcerscompared with nocompression?
Randomisedcontrolled trials(RCTs)
Causation Are people who have had adeep vein thrombosis morelikely to get a leg ulcer thanpeople who have not?
Cohort Study
Feelings;understanding;perceptions
How do people with venousleg ulcers feel about theirhealth and their lifestyle?
Qualitativetechniques
SEARCH EVIDENCE BASED JOURNALs FOR A PRE-APPRAISEDSYSTEMATIC REVIEW
SEARCH THE COCHRANE LIBRARY FOR A SYSTEMATIC REVIEW
SEARCH EVIDENCE BASED JOURNALs FOR APPRAISED PRIMARYRESEARCH eg. RCTs
SEARCH MEDLINE, CINAHL, COCHRANE LIBRARY (CochraneControlled Trials Register) FOR PRIMARY RESEARCH
No?
If you find one, rememberto appraise its quality
If you find some research,you need to appraise itsquality – use a checklist!
Finding good quality systematic reviews
The Cochrane Library Evidence based nursing Evidence based medicine Evidence based … ACP Journal Club Best Evidence (ACP
Journal Club and Evidence Based Medicine)
The Cochrane Library
completed reviews (CDSR) complete text of reviews,
updated as new research becomes available
reviews in progress (CDSR)Cochrane reviews in progress
quality assessed reviews (DARE)systematic reviews identified
by CRD and assessed according to quality criteria
Effectiveness information in accessible forms
Effective Healthcare Bulletins Effectiveness Matters Clinical Evidence Health Evidence Bulletins
Wales regional and national (e.g.
Bandolier http://www.jr2.ox.ac.uk:80/Bandolier/)
subject or special interest focused
Translating terms into a search
Need to know features of databases; indexes
Subject indexing - MeSH Truncation/wild cards Combination Sophisticated or basic
interfaces
Need to know features of databases; indexes
Subject indexing - MeSH Truncation/wild cards Combination Sophisticated or basic
interfaces
Example search, using MEDLINE subject headings
#1 substance use disorders/#2 exp substance dependence/#3 drug adj addiction#4 or/1-3#5 exp child/#6 teenager? or adolescent? or
young adj people#7 or/5-6#8 exp health promotion/#9 prevent? adj (campaign? or
program? or activit?)#10 or/8-9#11 4 and 7 and 10
What’s the effect of focussing?
Medline Cinahl Cochrane
Pressure sores and pressure relief
(1175)
28
(1211)
95
(9) 12
Diabetes and insulin injection
(147212)
447
(9493)
39
(6707) 281
Oxygen therapy and myocardial infarction
(8004) 193
(1033)
17
(3289) 281
Pre operative smoking cessation
Search on Cochrane library and find review of pre operative smoking cessation (no trials – check for updates in the future)
Find a review of nurse led smoking cessation (some based in hospital)
Rice VH, Stead LF. Nursing interventions for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.
Making sense of a review
Is it valid?
What do the results mean?
How (can?) I apply it to my patients?
Screening.
SCREENING QUESTIONS
Is there a clearly focused question?
Did the authors look for the appropriate sort of research?
Detailed questions
Do you think the important, relevant studies were included?
Did the review’s authors do enough to assess the quality of the included studies?
If the results of the review have been combined, was it reasonable to do so?
What are the results?
What is the overall result of the review?
How precise are the results?
Will the results help locally?
Can the results be applied to the local population?
Were all the important outcomes considered?
Are the benefits worth the harms and costs?