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“Expert searching for health librarians: in the evidence-based era…” Dean Giustini, UBC librarian / October 2015 Expert searching to support user groups in medicine

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Page 1: LIBR 534 Expert searching for health librarians

“Expert searching for health librarians: in the evidence-based era…”

Dean Giustini, UBC librarian / October 2015

Expert searching to support user groups in medicine

Page 2: LIBR 534 Expert searching for health librarians

What is evidence-based medicine?

“…evidence-based medicine (EBM) is the conscientious, explicit & judicious use of current best evidence in making decisions

about the care of individual patients”

Sackett, et al. BMJ 1996;312:71-72

Dr. David Sackett

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Landmark article in 1992 JAMAGuyatt G, Cairns J, et al (McMaster University)

JAMA 1993 – 2000 series of articles◦ Then: “Users' Guides to the Medical Literature” (2008 ed.)

Last 15 - 20 years, three (3) major trends◦ Explosion of systematic reviews◦ Rise of search engines e.g., Google Scholar◦ Knowledge tools (“point of care”) & mobiles/social

EBM – a glance back 20 years

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EBM integrates evidence with care

…evidence should always integrate with clinical expertise & preferences, values & circumstances of patients & families

Patient Values/Local Conditions

Best Evidence

Clinical Expertise

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• Background questions require use of background information

• Foreground questions are asked by experts

• Answers are found by searching the biomedical databases

Is it background …or foreground?

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Five Steps of EBM

The five steps:

• Step 1 — Frame your clinical question• Step 2 — Find the “best evidence”• Step 3 — Critically appraise that evidence• Step 4 — Integrate best evidence into practice• Step 5 — Evaluate steps 1-4

Ask

Access

Appraise

Assess

Apply

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Use PICO to frame foreground Qs

P = Patient Can you describe the patient or problem? Can you describe the population?

I = Intervention What main intervention (or treatment) will be considered?

C = Comparison Do you want a placebo comparison /or drug comparison?

O = Outcome What is the desired outcome or effect for patient?

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Is equal to:

Relevance of information X validity Effort/work required

Health librarians have two (2) options: Find relevant information for physician (they determine its value) Find authoritative sources that do the finding /validating for clinician

Usefulness of medical information

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MOST clinically relevant (at the top) Least clinically relevant (at the bottom)

Hierarchy of Evidence Tr

acki

ng D

own

Filtered & Critically Appraised

Expert Opinion / Not Filtered

Background info

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Validity/Strength of Inference

Time Spent in Critical Appraisal

Hierarchy of Evidence find evidence at level for clinician

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Where is ALL the evidence?SYSTEMATIC REVIEWS

• Cochrane Library via OvidSP • PubMed Clinical Queries / Haynes filters

CLINICAL PRACTICE GUIDELINES

• National Guideline Clearinghouse (US)• Canadian Medical Association Infobase

RESEARCH CRITIQUES

• ACP Journal Club 1996- • Bandolier 1994- & BestBETs

EVIDENCE SUMMARIES

• BMJ Clinical Evidence & FirstConsult• UpToDate

META-SEARCH ENGINES• TRIP+ & SUMSearch

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P = Patient, population or problem (Who is the patient or population of patients? What is the disease?)

I = Intervention (What do you want to do with this patient e.g. treat, diagnose, observe?)

C = Comparison intervention (What is the alternative to intervention e.g. placebo, different drug, nothing?)

O = Outcome (What are the relevant outcomes (e.g. morbidity, mortality, death, complications)?

PICO frames the information need

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• Defines a clinical scenario• Prepare you to search• Places focus on patient-centered questions• Developing a clinical question using PICO requires:

• some background about the condition• some understanding the patient • outcomes & beliefs important to the patient• Prognosis

– Disability? Quality of life? Cost? Improvement of symptoms?

Why use PICO?

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• Search via OvidSP• Includes all Cochrane topic reviews “Cochrane Library”• Includes clinical trials register• Articles reviewed in ACP Journal Club or BMJ Evidence-Based Medicine• Papers in Database of Abstracts of Reviews of Effectiveness (DARE)• Studies in DARE meet strict EBM scoring criteria

Uses “Keywords” to search OvidSP’s EBMRUBC library access: http://resources.library.ubc.ca/644

EBM Reviews (meta-search)

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Cochrane Database of Systematic Reviews

• Search via OvidSP• Independent non-for-profit international collaboration• Reviews are among studies of highest scientific evidence• Minimal bias: evidence included/excluded on basis of explicit criteria• Reviews involve exhaustive searching for studies & clinical trials, both published

and unpublished• Abstracts are available for free; consumer summaries are free also

UBC library access: http://resources.library.ubc.ca/231/

Uses “Keywords” to search Cochrane …

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Database of Abstracts of Reviews of Effects (DARE)

• Search via OvidSP• Produced by the National Health Services' Centre for Reviews and

Dissemination (NHS CRD) at the University of York, England• DARE is a full text database containing critical assessments of systematic

reviews from a variety of medical journals • DARE contains structured abstracts of systematic reviews• Its records cover topics such as diagnosis, prevention, rehabilitation,

screening, and treatment

UBC library access: http://resources.library.ubc.ca/489

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ACP Journal Club• Search via OvidSP• Consists of two journals, ACP Journal Club (American College of Physicians) and

Evidence-Based Medicine, by ACP & British Medical Journal• Editors select studies (includes reviews) that are methodologically sound and

clinically relevant (high-quality) • Some topics may not be found• Review top clinical journals; top therapy, diagnosis, harm &prognosis Qs• Commentaries on each study's value• Helps physicians understand and apply evidence• Reveals changes in medical knowledge

UBC library access: http://resources.library.ubc.ca/230