finding empirical evidence
TRANSCRIPT
Finding Empirical Evidence
PUB5757 – Clinical Epidemiology
Research Workshop
Finding Empirical Evidence
PUB5757 – Clinical Epidemiology
Research Workshop
Lucia Ravi, LibrarianMedical and Dental LibraryLucia Ravi, LibrarianMedical and Dental Library
Workshop Purpose
•RCT Research Proposal
– Background research of the evidence
– Research methodology
•Journal Article Critique
– Study characteristics, critical analysis tools
PUBH5757 Assessment Summary:
Research Skills
– Construct an effective search strategy– Know what types of medical resources are
available and how to search them– Understand the different levels of hierarchies
of evidence; – Focus your search strategy on high level,
synthesised sources of evidence
Relevant Search Skills:
Search Strategy
What are the causes of poor diet in Australia?
Identifying key concepts, terms:
Unhealthy Eating Impact Australia
“poor diet” causesconsequences
reasons
Western AustraliaWA
Search Strategy
Your turn – activity 1
•Write out a broad research topic you are interested in researching
•Identify your key concepts and other similar terms that could be used to describe them
Use worksheet provided.
The Grey Literature
Finding grey sources: Guide link
Grey Literature Searching
Grey Literature sources:
•Australian Indigenous – Health InfoNet•AIHW – Australian Institute of Health & Welfare•WA Health Department – Health for…•wa.gov.au – global google search of WA Government•ABS – Australia Bureau of Statistics Topics @ Glance•WHO – World Health Organisation Heath Topics
•Jessica Tyndall’s “Databases for Research in Health”
Grey Literature Searching
Search Tips Grey Literature
Have a go:
Search one of the sources•AIHW •ABS•WHO
Identify one possible item, share with a neighbour
Grey Literature Searching
Your turn – activity 2
•Look at one of the suggested Grey Literature sources or identify a source from the database listing
•Browse the site to identify if they have broad topics of interest to you, or carry out a simple search (try boolean)
•Think about how you might join them together to form a search string
Use worksheet provided.
Hierarchy of Evidence
A key concept for your literature review.
The purpose of a literature review is to identify the existing body of research that has addressed a problem and clarify the gaps in knowledge that require further research. 1
The term levels of evidence refers to what degree that information can be trusted. 1
1 Buckingham JB Greenhalgh T. Searching the literature. In: Greenhalgh T. How to read a paper: the basics of evidence-based medicine.5th ed. Hoboken: John Wiley & Sons; 2014.
Levels of Evidence
The Hierarchy of EvidenceDecision support systemsProblem focused,
multiple questions
Simple, single questions
Hierarchy of Single StudiesRandomised controlled trials
A new proposed evidence-based medicine pyramid
M Hassan Murad et al. Evid Based Med doi:10.1136/ebmed-2016-110401
©2016 by BMJ Publishing Group Ltd
Hierarchy of Evidence
The hierarchy of evidence is:
•A hierarchy of the likely best evidence•Designed to be used as a shortcut by busy clinicians and researchers to find the best evidence•Assists researchers to conduct their own rapid appraisal
University of Oxford, Centre for Evidence Based Medicine. (2011). The 2011 Oxford CEBM levels of evidence: introductory document. Retrieved from: http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-Introduction-2.1.pdf
Systematic Reviews
http://guides.is.uwa.edu.au/systematic_reviews
Key Players: Australia
JBI Connect
Produce systematic reviews and best practice guidelines.
JBI COnNect+ Database
Key Players: International
Cochrane Collaboration
Systematic Reviews and
RCT’sCochrane Database
Evidence-based guidelines & summaries
• Developed by synthesising the highest level of evidence available on treatment choices
• Guidelines provide recommendations supported by that evidence
• May take into account resources and practices relevant to the organisation
• Concise and clinically relevant
Where do I find evidence?
• PubMed/MEDLINE• Embase/PsychInfo
• Cochrane/JBI • TRIP/OvidMD
• BMJ Best Practice
• ClinicalKey
• UpToDate
• ETG Complete
See: Resources for Answering Clinical Questions
ACQ Resources Guidehttp://guides.is.uwa.edu.au/acqresources
Guidelines and Protocols
Resources that aim to provide an overview of diagnosis, prevention and treatment of a specific conditions to be readily used by clinicians.
• Some claim to be evidence based (look for references)• Some are editorial based (professional backgrounds)
Guidelines: suggest current best practice but encourage further investigation by practioners of range of evidence given.
Protocols: Generally promoted as the core treatment method. Sometimes listed as Point of Care resource.
Searching Evidence in Practice
Your turn – activity 3•Select one of the resources that allow you to hone in on the synthesis of evidence for clinical practice
•Search for a topic of interest to you and evaluate its value (any ideas for additional concept terms?)
•See if the guidelines and references that underpin the decisions promoted are easy to find and follow
•Share your findings with a colleague.Use worksheet provided.
Clinical Practice Resources
Have a go:
Search one of the sources•BMJ Best Practice•UpToDate•eTG Complete•ClinicalKey
Share with a neighbourResources for Answering Clinical Questions
Search Tips Clinical Practice, Guidelines, Protocols
Have a go:
Search one of the sources•AIHW •ABS•WHO
Identify one possible item, share with a neighbour
Search Strategy
Risk Factor: impact, causes, context in Australia
Identifying key concepts, terms:
Unhealthy EatingOR
ImpactOR
AustraliaOR
“poor diet”
NutritionObesity
causesconsequences
ReasonsEpidemiology
Aetiology
Western AustraliaWA
• Use AND to combine concepts and identify results that include both
Boolean Logic
AND retrieves all the articles with both ‘Diabetes’ and ‘Indigenous’
OR retrieves all the articles containing either ‘Aboriginal’ or ‘Indigenous’ or both
NOT retrieves all the articles containing ‘Indigenous’ but not those about
‘Canada’
Search Tips
Phrases and Truncation:
smok* = smoke, smoker, smoking
Austral* = Australia, Australian, Australians, Australasian
4. Use Quotation Marks for Phrases
“cigarette smoking”
Search Strategy
Risk Factor: impact, causes, context in Australia
Adding Boolean logic, truncation and phrases:
“Unhealthy Eating”OR
ImpactOR
AustraliaOR
“poor diet”NutritionObesity
Obes*e/ity
causesconsequences
Reason*sepidemiology
Etiology
Western AustraliaWA
Austral* ia, ian, s
• Use quotations “…….” to search for a phrase• Use asterix * to find all term derivatives• Use OR to search for/identify all similar concepts• Use AND to combine concepts and identify results that include both
AND
AND
Search Strategy
Constructing a search string(“unhealthy eating” OR “poor diet” OR obes*)AND (“austral*)AND(impact OR cause* OR epidemiology OR etiology OR aetiology)
In most databases enclosing terms in brackets will help order how concepts will be searched.
Study Type Search Tips
Randomised Control Trial Questions:Patient/population/problem = who or what is of
interest
Intervention = what intervention is being investigated
Comparison group = what alternatives can be compared to the intervention group
Outcome of interest = what should the intervention achieve, what improvements?
Useful References: CEBM Study Design and PHCRIS Formulating a Question
http://guides.library.uwa.edu.au/systematic_reviews
Search Strategy
Population/Problem
Intervention Comparison Outcome
Body mass indexIn Children 0-4
Physical Activity in Nurseries
No exercise Reduction in BMI
Weight Exercise Not in nurseries
Physical activity to prevent obesity in young children, cluster randomised controlled trial. DOI
Search Strategy
Your turn – activity 1b
•See if you can build on your search strategy concepts.
• Think about how you might join your concepts with AND, OR operators to refine your search to build a search string.
•Are there any particular interventions or comparators you want to focus your search to at this stage.
Use worksheet provided.
Searching for Evidence Research
Cochrane Library
• Search Trials Central - largest collection of RCT’s• Cochrane Database of Systematic Reviews (CDSR)
Can browse by topic or carry out an advanced search
Developed by US National Library of Medicine (NLM) this life sciences and biomedicine database uses specialist Medical Subject Headings (MeSH) to index highly reputed medical journals.
Ability to map to MeSH search terms and to build up your search strategy with inbuilt Boolean operators.
A range of ways to refine and limit search results based on types of studies, cohort study groups and more.
MeSH topics and sub-topics provide a range of ways to focus in on very specific medical areas of research.
Developed by Elsevier, Embase aims to provide the widest possible coverage of biomedical literature incorporating many conferences and journal titles not covered by MEDLINE.
Ability to map to Emtree search index providing a comprehensive vocabulary to describe biomedical data.
Use of Ovid interface to build up your search strategy with inbuilt Boolean operators.
A range of ways to refine and limit search results based on types of studies, cohort study groups and more.
Search Systematic Review Databases for Interventions
Have a go:
Search one of the sources•Cochrane•Medline •Embase•PsychInfo
Save searches and itemsShare with a neighbour
Your Search in OVID
Your turn – activity 4•View one of the short videos or guides about constructing a search in Medline, Embase or PsychInfo
• Build your search in Ovid for one of these databases, mapping to search terms and join concepts with AND,OR.
•Use the additional limits to limit your dates and select a specific type research evidence.
•Create a Ovid log-in and save your search and some of your search results to a personal folder.
DoPHER – Health Promotion ReviewsTRoPHI – Trials for Health Promotion Interventions
Evidence for policy and practice information centre.
Search Databases Australian Context
Have a go:
Search one of the sources•AUSTHealth•Heath & Medical Complete•CINAHL Plus
Are they of relevance to your topic?Are any of the articles unique to Medline/Embase.
YouTube Link
Critical Analysis
–CASP – Critical Appraisal Tools Checklists –JBI – Critical Appraisal ToolsUse to evaluate different types of studies; RCT’s, Case control, cohort, diagnostic, systematic reviews etc.
–Cochrane Methodologies RegisterResearch focussed on an analysis of methodologies.
(Last update 2012)
CAT’s - Critical Analysis Tools
Contact the University Library
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