Evidence Based Practice Resources

• The 5 step process
  1. Constructing the Question
  2. Searching
     • Hierarchy of Pre-Processed Evidence
       • Systems
         • Clinical Practice Guidelines
         • Evidence-Based Texts
       • Synopses
         • Of Syntheses
         • Of Studies
       • Syntheses (Systematic Reviews)
       • Studies
         • Meta Searches
         • Consumer Resources
  3. Critical Appraisal
• Other resources
  • Tutorials
  • Directories

Evidence-Based Practice is a five-step process:

1. Construct a relevant, answerable question from a clinical case.
2. Plan and carry out a search of the literature for the best external evidence.
3. Critically appraise the literature for validity and applicability.
4. Apply the evidence to your clinical practice.
5. Evaluate your performance.

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Step 1: Construct a relevant, answerable question from a clinical case.

• Flemming K. EBN notebook. Asking answerable questions. Evidence-Based Nursing 1998;1:36-37.
• Formulating Answerable Clinical Questions (Centre for Evidence-Based Medicine, Mount Sinai Hospital)
• The Well-Built Clinical Question (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill)
• Formulating Patient Centered Questions (University Library, University of Illinois at Chicago)
• Asking Focused Questions (Centre for Evidence-Based Medicine, Oxford)

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Step 2: Plan and carry out a search of the literature for the best external evidence.

NOTE: To use the resources identified by , you will need to login to LibAccess

Hierarchy of pre-processed evidence

[Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 12,99-101]

Tips for Searching for the Evidence

Systems

“An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

Summaries

"These include clinical pathways or textbook summaries that
integrate evidence-based information about specific clinical
problems and provide regular updating."

Clinical Practice Guidelines:

• Best Practice Guidelines (Registered Nurses Association of Ontario)
• AGREE (Appraisal of Guidelines Research & Evaluation)
• Endorsed Guideline Summaries (Guideline Advisory Committee (GAC))
• CMA Infobase: clinical practice guidelines -- Canadian Medical Association
• National Guideline Clearinghouse (United States)

Evidence-Based Texts

• Clinical Evidence
• PIER:The Physicians' Information and Education Resource (adult and internal medicine) [Available through STAT!Ref]
• FIRSTConsult

Syntheses: Systematic Reviews

"A synthesis or systematic review is a comprehensive summary of all the research evidence related to a focused clinical question."

Cochrane Database:

• Cochrane Library
• Cochrane Reviews (Abstracts)
• Cochrane Neonatal Reviews from the National Institute of Child Health & Human Development

Agency for Healthcare Research and Quality (AHRQ)

• EPC Evidence Reports

Synopses

“...a synopsis that summarizes the findings of a high-quality systematic review can often provide sufficient information to support clinical action... the synopsis of a single study provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice."

Of Syntheses:

• NHS Centre for Reviews and Dissemination (CRD) Databases, including:
  • Database of Abstracts of Reviews of Effects (DARE)
  • NHS Economic Evaluation Database (NHS EED)
  • Health Technology Assessment (HTA) Database
• health-evidence.ca "Promoting evidence based decision making"
• Evidence-Based Abstract Journals

Of Studies:

Evidence-Based Abstract Journals

• Evidence-Based Nursing
• ACP Journal Club
• Cancer Treatment Reviews (formerly Evidence-Based Oncology)
• Evidence-Based Healthcare and Public Health (ceased publication December 2005)
• Evidence-Based Medicine
• Evidence-Based Mental Health
• Evidence-Based Midwifery
• Evidence-Based Obstetrics & Gynecology
• Evidence-Based Oncology

Studies:

Databases:

• MEDLINE:
  • PubMed
    • Clinical Queries
    • Health Services Research (HSR) Queries
  • Ovid MEDLINE Use the "Limit" feature to add Clinical Queries
  • Using Medical Subject Headings: MeSH (Medical Subject Headings) Browser
• CINAHL:
  • CINAHL Use the Clinical Queries limits
• Cochrane Controlled Clinical Trials Register: through Cochrane Library
• Public Health +

Meta Searches

• Essential Evidence Plus
• Primary Care Electronic Library
• SUMSearch
• TRIP Database (Turning Research Into Practice)

Consumer Resources

• MEDLINEplus
• Informed Health Online
• Bandolier Healthy living

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Step 3: Critically appraise the literature for validity and applicability.

• Users' Guides to the Medical Literature (1st ed.) Click on Access UGI
• EBM Tools

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Other Resources:

• ClinicalTrials.gov
• Bandolier "Evidence based thinking about health care"
• Health and Psychosocial Instruments (HaPI)
• Tutorials:
  • Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, University of North Carolina at Chapel Hill)
• Directories:
  • Netting the Evidence: : A ScHARR Introduction to Evidence Based Practice on the Internet
  • Evidence Based Medicine (EBM) Toolkit (New York University School of Medicine. The Frederick L. Ehrman Medical Library)
  • Nesbit guide to evidence based resources (University of Rochester, Edward G. Miner library)
  • Resource Guide for Evidence-Based Practice (University of Alberta Libraries
• Web of Science (to link articles by citation)

Need some help? Contact: Laura Banfield
Health Sciences Library, HSC-2B33
Tel: (905)525-9140, ext. 20239
Email: banfie@mcmaster.ca