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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
“It’s publish or perish – and he didn’t publish!”
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
Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
Unfocused (unanswerable) Questions
• Is health promotion a good thing?
• How to treat diabetes in pregnancy?
• Is physiotherapy useful?
• Why is Mrs. Gupta depressed?
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
Answerable question
Does the presence of a
Doula reduce caesarean
section rates?
Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
Answerable question
What is the predictive value of
PCR compared to routine
blood culture in the
treatment of neonatal sepsis?
Answerable question
How effective is
acupuncture in smoking
cessation programs?
Aspects of the ‘Answerable Question’
• Patient or Problem• Intervention or
exposure• Comparison
• Outcome
= PICO
Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
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.
Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
Suggested Search Strategy
Think ‘Telegram’
?
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
Answerable question
How effective is a single dose
of dexamethasone in
outpatient croup?
The search-formulation ‘telegramme’ (here: on PubMed)
Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
Answerable question
How effective is aspirin in
preventing DVT in patients
following hip-replacement?
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
Archie Cochrane 1909-1988
All effective treatment mustbe free!
A. Cochrane circa 1935
Answerable question
How effective is
acupuncture in smoking
cessation programs?
To recap …
Preconditions for Successful EBHC
• Start with a focused, answerable question
• Select a high-yield database
• Formulate a simple search
And finally ...
Start with a subject to which you know the answer: calibrate your skills (why?)
The curtain closes, only questions remainBrecht: The good woman of Szechwan
The End
And finally, again ...
Start with a subject to which you know the answer: calibrate your skills (why?)
Calibrate your skills!How effective are stockings toprevent DVT in long-haul airline passengers?