1	Searching for Evidenced-Based Resources for Nursing Margaret (Peg) Allen, MLS-AHIP pegallen@tznet.com www.pegallen.net MLA Annual Meeting Symposium May 3, 2003
2	Learning Goals Participants will be able to: Identify the most useful types of information for evidence-based practice Search for evidence-based nursing resources via Internet, CINAHL and MEDLINE
3	Evidence Based Practice Star Model
4	Key information formats for EBN Discovery: Original Research Individual studies Abstracts and commentaries Need to synthesize findings Evidence Summaries – Synthesis Published as Systematic Reviews, Integrative Reviews, Meta-Analysis Translation Literature Practice Guidelines Standards Critical Paths Others?
5	Search Tools Librarians Internet World Wide Web Listservs Databases and indexes CINAHL MEDLINE Others
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7	Working with a Librarian Appointments Classroom instruction Team member “Teaching is not uncovering material for students, rather it is uncovering material with students.” For more information, see Pond, F. (1999). Searching for studies.
8	Search Strategy Planning Define question Select search tools Design search strategy that optimizes value of selected databases & their features Select subject headings Select limits Review results; modify Find and appraise literature
9	Bibliographic Databases: Value Added Resources Bibliographic databases include: Citation: author, title, source Indexing – the human factor Subject headings and subheadings Checktags Publication Types Subsets Language of publication (English or not) Abstract, when available
10	Health Sciences Databases NLM databases MEDLINE NLM Gateway Locator Plus CINAHL Handout: PubMed/MEDLINE & CINAHL indexing practices
11	National Library of Medicine (NLM) www.nlm.nih.gov/ The world’s largest biomedical library Federal agency - your tax $$$ at work! Organizer of the National Network of Libraries of Medicine (NN/LM) www.nnlm.gov/ DOCLINE & Loansome Doc Producer of: MEDLINE Many other databases PubMed MEDLINEplus NLM Gateway
12	MEDLINE: Database of citations and abstracts of journal articles from more than 4,600 medical, nursing, and dental journal titles Produced by NLM, 1966 to date Over 11 million references to the journal literature 88% English language 76% of articles have abstracts online Uses Medical Subject Headings (MeSH) for indexing Can be searched electronically with software from many vendors
13	Journal Subsets in PubMed MEDLINE
14	PubMed Search Options www.pubmed.gov/ See Related mapping Thesaurus – MeSH Browser Reviews – publication type Practice Guidelines – publication type Evidence based filters PubMed Clinical Queries Other evidence based filters
15	CINAHL® Produced by Cinahl Information Systems, Inc. www.cinahl.com/ Literature of nursing and allied health, 1982- Online counterpart to Cumulative Index to Nursing and Allied Health,1956- “The Red Books” Indexes all formats More than 1,500 journals, most in English CINAHL Subject headings Based on MeSH Adds many nursing & allied health terms, including nursing classifications
16	NLM Resources or CINAHL?
17	Nursing Journal Coverage Key Nursing and Electronic Journals http://nahrs.library.kent.edu/resource/reports/specrpts.htm CINAHL covers almost all MEDLINE covers most with high research % Other databases offer limited coverage for nursing Nurses use literature from many disciplines, so it’s important to use multiple databases for important searches!
18	Finding other databases References: Essential nursing references www.nln.org/nlnjournal/nursingreferences.htm Updated by Interagency Council on Information Resources for Nursing, http://icirn.org Library home pages
19	Evidence based practice searches Nursing vs. medical questions MEDLINE and CINAHL; others Web Resources
20	Medical vs. Nursing Concerns Medical Hip replacement Hip pinning Watchful waiting Nursing Pain Incontinence Immobility Confusion Skin breakdown Inadequate sleep
21	Subject search: clinical Nursing care of the patient with a broken hip to prevent pressure ulcers
22	Suggested search template for EBP: What is the effect of Nursing care Intervention (Predictor Variable) On Preventing pressure ulcers Given Characteristic (Outcome) For Aged with hip fractures Specific group of patients (Patient Characteristics)
23	Boolean = Combining Concepts AND narrows OR broadens Others: NOT NEAR Phrasing Truncation Wildcards
24	Explode - a Giant OR All MeSH Categories Diseases Category Neoplasms Neoplasms by Site Breast Neoplasms Breast Neoplasms, Male Mammary Neoplasms Mammary Neoplasms, Experimental
25	Searches for Evidence Based Practice Start with the quality-filtered products Translation Literature – Practice guidelines Are they evidence-based? Look for systematic reviews and meta-analysis What’s new? Primary Research Critical appraisal – abstract sources Research in progress Propose new research?
26	Translation Literature Practice guidelines Care Plans Critical paths Protocols Standards Clinical Innovations Others in your organization?
27	EBP Scenario 1: Preventing pressure ulcers in the elderly Finding translation literature SUMsearch http://sumsearch.uthscsa.edu/ CINAHL Internet Nursing Organizations
28	Systematic Reviews CINAHL Publication Type (98-) Subject scope note: A specific type of literature review in which a concept is identified and the research which has studied it is analyzed and evaluated. The results of this research are synthesized to present the current state of knowledge regarding the concept. For articles that are systematic reviews or contain systematic reviews, search for document type systematic review.
29	Meta-Analysis MEDLINE: Publication Type CINAHL: Subject heading – search minor Scope note: The quantitative analysis of two or more independent studies to integrate and synthesize the findings and describe the features of the studies that contribute to variation in their results. History Note: Before 1988 see under RESEARCH METHODOLOGY; RESEARCH, NURSING/methods
30	Searching for Systematic Reviews Internet search sites: TRIP database http://www.tripdatabase.com/ DARE – Database of Reviews of Effectiveness http://www.york.ac.uk/inst/crd/ CINAHL Systematic Review publication type MEDLINE (Systematic [sb] AND Review [PT]) OR Meta-Analysis [PT]
31	Searching for Original Research MEDLINE Limit topic search to Clinical Trials Publication Topic search AND (Explode Research OR Explode Nursing Research) Limit to “Has abstract” PubMed clinical query or SUMsearch query http://sumsearch.uthscsa.edu/ CINAHL Research publication type Search for critical abstracts in Evidence Based Nursing & other journals Internet searches
32	Critical appraisal CINAHL search: Abstract publication type For critical abstracts, add Commentary PT Evidence-Based Nursing http://ebn.bmjjournals.com/ Critical appraisal Medical and nursing literature
33	EBP Clinical Scenario 2 What is the best evidence on the methods used to confirm the placement of NGT (nasogastric tubes)? Intervention? Desired outcome? Population? Search strategy:
34	EBP Clinical Scenario 2 What is the best evidence on the methods used to confirm the placement of NGT (nasogastric tubes)? Intervention? NGT tube insertion Desired outcome? Appropriate placement Population? Human Search strategy:
35	EBP Search strategy 2
36	EBP Clinical Scenario 3 Do HbA1c levels decrease in diabetic patients following the implementation of a formal multidisciplinary diabetic education and management program? Intervention? Desired outcome? Population? Search strategy:
37	EBP Clinical Scenario 3 Do HbA1c levels decrease in diabetic patients following the implementation of a formal multidisciplinary diabetic education and management program? Intervention: diabetes education program Desired outcome: improved glycemic control and quality of life Population: patients 1-99 years of age, male & female, varied cultural and ethnic backgrounds Search strategy:
38	EBP Search strategy 3
39	EBP Clinical Scenario 4 What is the evidence on assessment of pain in cognitively impaired elderly? Intervention? Desired outcome? Population? Search strategy:
40	EBP Clinical Scenario 4 What is the evidence on assessment of pain in cognitively impaired elderly? Intervention? Pain assessment Desired outcome? Appropriate pain control Population? Cognitively impaired elderly Search strategy:
41	EBP Search strategy 4
42	Searching for qualitative research CINAHL research indexing practices Research methods subject headings assigned to describe methods used Combine with Research publication type Consider other databases Search question: How do I find qualitative studies dealing adult survivors of childhood sexual abuse?
43	EBP Clinical Scenario 5 How do I find qualitative studies dealing adult survivors of childhood sexual abuse? Intervention? Desired outcome? Population? Search strategy:
44	EBP Clinical Scenario 5 How do I find qualitative studies dealing adult survivors of childhood sexual abuse? Intervention? Not applicable Desired outcome? Qualitative research Population? adult survivors of childhood sexual abuse Search strategy:
45	EBP Search strategy 5
46	EBP Clinical Scenario 6 What is the effect on frequency of occurrence of asthma asthmaticus exacerbations of daily email communication between children ages 8-12 and a health care provider to report PERF readings and to adjust daily medication in response? Intervention? Expected outcome? Population? Search strategy:
47	Useful Limits for Evidence-Based Searching
48	Internet Research Resources Conference abstracts Medscape Nursing http://www.medscape.com/nurseshome Nursing Organizations HealthWeb Nursing http://healthweb.org/browse.cfm?subjectid=60 CINAHLsources web index www.cinahl.com/csources/csources.htm Research in progress STTI Registry of Nursing Research - http://www.stti.iupui.edu/library Canadian-International Nurse Researcher Database - http://nurseresearcher.com/ World Wide Web Research centers & funding organizations (NINR) Clinical trials http://clinicaltrials.gov/
49	Additional abstract sources CINAHL search: Abstract publication type For critical abstracts, add Commentary PT Medscape – Nurses http://www.medscape.com/nurseshome NurseLinx Newsletter - www.nurselinx.com Publisher abstracts For current awareness
50	Continuing Education Method for diffusion of innovation Licensure requirement – varies by locale Certification requirement CEU Articles often free on the web Searching for CEU opportunities: CINAHL CEU publication type Organization & journal websites
51	Evidence-Based Patient Education Nurse’s role Evidence-based website examples PDQ Cancer information summaries http://www.nci.nih.gov/cancer_information/pdq/ National Electronic Library for Mental Health http://www.nelmh.org/ MEL Evaluation links http://mel.lib.mi.us/health/health-evaluating.html Searching CINAHL Consumer/Patient Teaching Materials (publication type) Searching MEDLINE Patient Education Handout (publication type)
52	Searching for research instruments Typical questions: We have a nurse looking for information on the Schmid Scale….I have a feeling it has to do with fall risk & safety. I have been reviewing the literature and find the Health Promotion Lifestyle Profile (HPLP) scale very interesting. Does anyone know how I can obtain that instrument?
53	Searching CINAHL for Research Instruments Research Instruments – title and/or subject; limit to Pub Type. Instrumentation field References Recent articles by author of research instrument
54	Additional Tests & Measurements Resources HAPI (Health and Psychosocial Instruments) database Taubman Medical Library Guide to Tests and Measurement Instruments http://www.lib.umich.edu/taubman/info/testsandmeasurement.htm Tests and Measures in the Social Sciences: Tests available in compilation volumes. May 2002 ed. Helen Hough, University of Texas in Arlington http://libraries.uta.edu/helen/test&meas/testmainframe.htm
55	Evidence Based Nursing Resources Evidence Based Nursing journal http://ebn.bmjjournals.com/ Online Journal of Clinical Innovations www.cinahl.com Centre for Evidence-Based Nursing, University of York http://www.york.ac.uk/healthsciences/centres/evidence/cebn.htm
56	Additional Evidence Based Practice Resources SUMsearch, San Antonio Cochrane Center http://sumsearch.uthscsa.edu/ TRIP database TRIP database http://www.tripdatabase.com/ Cochrane Reviews & Evidence-based collections NHS Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effectiveness (DARE) http://www.york.ac.uk/inst/crd/ Centre for Nursing Research http://www.jgh.ca/research/nursing/index.html Guidelines resources Reference: CINAHLsources Link Index: Evidence Based Practice section www.cinahl.com/csources/csources.htm
57	Search Strategy Review Define your search question Select the appropriate database(s) for your question: PubMed (or MEDLINE) & CINAHL; Internet; others as needed Use thesaurus terms whenever possible Limit retrieval to “focus” (major subject heading) for your main concept Understand and use “Explode” feature Consider database indexing practices: Use check tags (human, age group) whenever possible Use publication/document types to help limit retrieval Limit to English and/or Journal subsets
58	Questions? Thanks for coming!