c:\fakepath\exeter ppt ppt new
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Exeter Full 2509TRANSCRIPT
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Finding the Evidence
Pragmatic Information Retrieval in the of Context of Evidence-based Healthcare
Exeter
September 2010
Kate Boody
Reinhard Wentz
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“It’s publish or perish – and he didn’t publish!”
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Just One Definition of EBHC:
An approach to health care practice in which the clinician is aware of theevidence in support of his/herclinical practice, and the strength ofthat evidence
Postgraduate Medical Journal 1996;72:1
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Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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Unfocused (unanswerable) Questions
• Is health promotion a good thing?
• How to treat diabetes in pregnancy?
• Is physiotherapy useful?
• Why is Mrs. Gupta depressed?
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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Answerable question
Does the presence of a
Doula reduce caesarean
section rates?
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Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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Answerable question
What is the predictive value of
PCR compared to routine
blood culture in the
treatment of neonatal sepsis?
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Answerable question
How effective is
acupuncture in smoking
cessation programs?
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Aspects of the ‘Answerable Question’
• Patient or Problem• Intervention or
exposure• Comparison
• Outcome
= PICO
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Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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High-yield Databases Extracting · Evaluative · Synthesizing Databases
• PubMed (especially Clinical Queries Option)
• Cochrane Library
• Google Scholar
• NHS Evidence
• TRIP
• Quality Sites on the Web etc.
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Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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Suggested Search Strategy
Think ‘Telegram’
?
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
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The search-formulation ‘telegramme’ (here: on PubMed)
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Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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Archie Cochrane 1909-1988
Cochrane AL. Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972
All effective treatment mustbe free!
A. Cochrane circa 1935
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Archie Cochrane 1909-1988
All effective treatment mustbe free!
A. Cochrane circa 1935
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Answerable question
How effective is
acupuncture in smoking
cessation programs?
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To recap …
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Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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And finally ...
Start with a subject to which you know the answer: calibrate your skills (why?)
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The curtain closes, only questions remainBrecht: The good woman of Szechwan
The End
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And finally, again ...
Start with a subject to which you know the answer: calibrate your skills (why?)
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Calibrate your skills!How effective are stockings toprevent DVT in long-haul airline passengers?