Transcript Evidence on the run

When evidence is needed quickly
Terence M Harrison
Clinical Librarian
Royal Melbourne Hospital
The six steps
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6.
Formulate your query (PICO)
Check your terms (Mesh?)
Select sources (by type of evidence needed)
Carry out searches
Evaluate results (appraise?)
Turn evidence into practice
1. Formulate your query
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Patient
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Intervention
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Comparisons
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Outcomes
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adult with occult
pneumothorax
chest tubes/catheters
for 24 hours
conservative
management or
observation
reduced morbidity after
positive pressure
ventilation
2. Check your terms (via MeSH)
3. Select sources*
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Top-level evidence sources (e.g. Cochrane,
PubMed Clinical queries, etc) for a
comprehensive search
Evidence Summaries (for quick search)
Guidelines (local, national, international)
Drugs info speciality sites
* Note: for more extensive searching, see longer list of sources listed
on Evidence Direct website.
Examples of Evidence Summaries
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Cochrane* (free)
Clinical Evidence (via CHC)
ACP Journal Club
Up-to-Date (via Library on RMH machines)
Dynamed (via CHC)
Bandolier (free)
BMJ+Updates (free)
BMJ Best Practice (via CHC)
Also: try Trip, a search engine that searches over 100 evidence
sources (free)
* Summaries in Database of Abstracts of Reviews of Effects, Central Register of
Controlled Trials, HTA Database, Economic Evaluation Database
Quick searching tips
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Learn boolean searching
If ready-made filters available on search
source, then use them if needed
Use Limits as needed (if available)
Some sources provide for combining searches
Truncation symbols vary from source to source
Refer to Help pages on source if you get stuck
5a. Evaluate results
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Cochrane concluded that patients
with occult pneumothorax who
require positive pressure ventilation
should undergo tube thoracostomy.
Clinical Evidence found no RCTs
comparing chest tube drainage
versus observation.
Best Bets found no harm in
observation only.
Trip came up with a handful of
results, the most relevant being the
one from Best Bets
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Evidence level: 1b
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Evidence level: 1a*
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Evidence level: 1a*
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Evidence level: 1a*
* Evidence levels for Evidence Summaries are assessed individually
and depend on extent of research involved and sources quoted.
5b. Summarise results
The evidence demonstrated that while there is
no harm in observation, if a patient does
require positive pressure ventilation then a
tube thoracostomy will be needed.
6. Turn evidence into practice
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Apply results to practice
Order via Inter-Library Loan the full-text
versions of search results
Add results to a local (departmental) database
of searches
Contribute results to RMH Guidelines