1. Managing the information infrastructure
Wendy McDonald RN MPH&TM

2. Searching for External Evidence
 The best evidence to answer the PICOT question.
 Time is important
 Evidence that has already been appraised for the
quality of study methodology & reliability is desirable.
 Preappraised literature can range from
Meta-analytic systemic reviews to synopsis of a single
study.

3. Determine Your Resources
Know the databases that are available to you to
collect the best evidence to answer the PICOT
question.
The PICOT question will determine which
databases you will need to search.

4. PICOT
 Carefully formulate the PICOT question.
 Using unambiguous, nonjargon terms to
describe the PICOT question components will
assist in obtaining the best search in the
shortest time.

5. Keyword Searching KW
 Keyword searching is searching using basic language.
 Must include all synonyms such as research,
evidence, studies, study, Investigation, or items will
be missed.

6. Keyword Search continued
 In data bases - yields evidence if there is a match
between the keyword entered and what is found in
the title and/or abstract.
 Evidence may be missed, if a different term is
entered.
 you get only articles that match terms you put in the
search.
 may include unrelated articles due the word searched
(many words have more than one meaning).

7. Controlled Vocabulary
 A Controlled vocabulary is Medical Subject Headings
(MeSH) - the content of articles indexed in MEDLINE.
If a MeSH term is searched all the articles would contain
information about the term searched.

8. Combining & Limiting Searches
 AND and OR are used when combining keyword or
controlled vocabulary
 AND to combined terms to appear in the final record.
 AND is a restrictive word so both words must appear in
the article – reduces the number of studies retrieved
 OR - keyword searching of synonyms

9. Resources for Searching

10. The Cochrane Library
To scan many types of information pre-filtered for quality
 Includes the Cochrane Database of Systematice Reviews
(Cochrane Reviews), Database of Abstracts of Reviews of
Effectiveness (DARE), Cochrane Controlled Trials Register
(Clinical Trials) &others
 Systematic reviews aggregate randomized controlled trials
 Review process is labor intensive, so not all topics are
covered
 Small database
 Cochrane library http://www.cochrane.co.uk

11. CINANL
 Dates back to 1981
 Contains more than a million records
 Indexes almost 3,000 journals
 Searchable cited references for more than 1,200 journals
 Full text for 71 journals
 Covers nursing, biomedicine, health science librarianship,
alternative/complementary medicine, consumer health
and 17 allied health disciplines
 Now features Clinical Query Functionality

12. PubMed/MEDLINE
 Citations and Abstracts
 Includes over 4600 journals worldwide
 More than 17 million citations
 Approximately 1/3 full text articles available
 Uses MeSH controlled vocabulary
 Updated daily
 Available anywhere, anytime
 Searching help available
 Must do one’s own quality filtering
 Must learn how to search the database
 www.pubmed.gov

13. Check the question
type
Check the emphasis
AND means both
terms required
* Means any other
letters

14. Critical Appraisal
Critical reviews of published studies
 ACP Journal Club
 InfoPOEMS
 Clinical Inquiries
 High quality evidence with commentary
 High specificity
 Abstracts accompanied by commentary
 Incomplete coverage of literature
 Small databases

15. Trip Data Base
 Turning Research Into Practice Data Base Plus (TRIP)
 Simultaneously searches evidence-based sources of
systematic reviews, practice guidelines, and critically-
appraised topics and articles
 Searches MEDLINE’s Clinical Queries, medical image
databases, e-textbooks, and patient information
leaflets.
 TRIP Database allows a limited number of free
searches.

16.  Specialized Journals
 ACP Journal Club
 Evidence Based Medicine
 Evidence Based Nursing

17. For more Information
 Centre for Evidence-Based Medicine
 http://cebm.jr2.ox.ac.uk/
 Health Information Research Unit Evidence-Based Health
Informatics
 http://hiru.mcmaster.ca/
 Exploring the evidence base
 http://clinicallibraian.wordpress.com/2008/08
 Evidence-based nursing resources
 http:muhc.ebn.mcgill.ca/EBN_tools.htm

18. Managing citations of interest
 Once a search is completed each data base will
provide options for dealing with the citations you
are interested in.

19. Saving Searches
 Saving the method of searching – how you went about
the search - is imperative to repeat the search or
communicate the search to someone else.
 Save the search details when you conduct the initial
search so it can be replicated.
 Each search engine offers different ways for saving the
search.

20. Organizing Searches
 Organize the evidence found.
 Teams can use bibliographic management software
(BMS) – web-base password protected folders.
 Allows all team members quick access to the
resources.

21. Other Resources That Support EBP
 Clinical Practice Guidelines National Guideline
Clearinghouse
 http://www.guidelines.gov
Health Services/Technology Assessment Text
(HSTAT)
 http://text.nlm.nih.gov
The Best Evidence Database
http://evidence-basedmedicine.com

22. Searching made easy 

23. Conduct rapid critical appraisal of studies found
in the search
 - keep the valid and reliable studies
 -Evaluate the keeper studies
 -synthesis the evidence from the keeper studies

24. Skills Required for EBP
 Clearly identify practice problem or new
knowledge (innovation)
 Find research literature
 Critically evaluate research findings
 Apply to practice through change process

25. Things that help EBP
 development of strategies for efficiently tracking down
and appraising evidence
 creation of systematic reviews of the effects of health
care
 creation of evidence-based journals of secondary
publications
 creation of information systems/decision
 support systems/answering services
 application of effective strategies for lifelong learning and
for improving clinical performance

26.  McNabb C., Descriptive Research Methodologies.
(power point)
Pangea.tec.selu.edu/~cmcnabb/philosop/power.ppt
 Institute of Medicine, (US)Greiner, A. & Knebel, E.,
(Eds.) (2003) Health Professions Education: A bridge
to quality, The National Academies Press, 45-74
 Ireland M. C.(2010) Evidence -Based Practice What
does it mean? Innovations and Perspectives Virginia
Department of Education. 1,2

27.  Bio medical library University of Minnesota, Evidence
Practice (power point)
http://hsl.lib.umn.edu/learn/ebp/modo1/pico.html
 Beyea S.C. , Slattery M.J.(2006)Evidence-Based
Practice in Nursing a guide to successful
implementation Marblehead MA: HCPro ,Inc
 Royle J., Blythe J.(1998) Promoting research
utilisation in nursing: the role of the individual,
organisation, and environment Evidence-Based
Nursing,1:71-72

28.  Malloch, K., Poter-OGrady, T., (2006)Introduction to
Evidence -Based Practice in Nursing and Healthcare .
Sudbury, MA, .Jones and Bartlet
 Glasziou P. Introduction to EBM 2010(power point)
www.cebm.net/index.aspx?0=1382