EBMmalang_dokter

8/2/2019 EBMmalang_dokter

1/37

AUSTRALASIAN

COCHRANE CENTRE

Finding Current Best Evidence

(Penelusuran Bukti Ilmiah)

Nawang PurwantiMedical LibrarianPerpustakaan FK-UGM

[email protected]

Workshop Evidence-Based Practice for Doctors

SEA ORCHID Indonesia/HOGSI

Malang, 4 April 2008


2/37

AUSTRALASIAN

COCHRANE CENTRE

Background

Access

* Information overload - over 2 millions health

research papers published every year* MEDLINE indexes less than 25% of biomedicaljournals

*50% of health research is unpublished

*Best electronic searches identify less than 50%

RCTs Busy cliniciansproblems of keeping up-to-

date with current best evidence for the care ofpatients


3/37

AUSTRALASIAN

COCHRANE CENTRE

Objectives

To provide relevant information and tips informulating answerable clinical questions

To introduce the Cochrane database andPubMed as Evidence-Based Practiceresources

To show how to use the database to find

the best evidence


4/37

AUSTRALASIAN

COCHRANE CENTRE

Elements of EBP

Your

ClinicalExpertise

EachIndividual

Patient

The BestAvailableEvidence


5/37

AUSTRALASIAN

COCHRANE CENTRE

The 5 steps of EBP

Ask a clear clinical question

Search for the evidence

Appraise the evidence

Apply the results to clinical practice

Evaluate the impact on practice


6/37

AUSTRALASIAN

COCHRANE CENTRE

Stages in searching best evidence

1. Identify types of clinical questions

2. Formulate an answerable clinical question

PICO method3. Choose search terms

4. Develop a search strategyuse of searchingtools

5. Where to search

6. Find research evidence


7/37AUSTRALASIAN

COCHRANE CENTRE

Clinical questionscentral issues in clinical work

Therapy orInterventiontreatments to patients that

- do more good than harm

- are worth the efforts and costs of using them

Prognosispatients likely clinical course over atime and complications of the disorder

Etiologycauses or risk factors of disease

Diagnosis - possible causes of patients clinicalproblems


8/37AUSTRALASIAN

COCHRANE CENTRE

FROM QUESTION TO SEARCH STRATEGY

Describe each PICO element, using synonymswhere appropriate

Begin with the central element/concept Define the type of question

Use the tools of each particular databaseeg descriptors/subject headings/MeSH, filters

Add other elements of the question to limit

retrieval Examine relevant records for additional terms


9/37AUSTRALASIAN

COCHRANE CENTRE

Ask a clinical question

Is ibuprofen or paracetamol betterat reducing pain and fever inchildren?


10/37AUSTRALASIAN

COCHRANE CENTRE

PICO method

P : Children with pain and fever

I : Ibuprofen

C : Paracetamol

O : Reduction in pain and/or fever


11/37

AUSTRALASIAN

COCHRANE CENTRE

Reformatted clinical question

P: In children with pain and fever

I: is ibuprofen

C: compared with paracetamol

O: more effective at reducing pain or fever?


12/37

AUSTRALASIAN

COCHRANE CENTRE

From Question to Search Terms

Search Terms Alternatives

Patient

Intervention

Comparison

Outcomes

ChildPainFever

Ibuprofen

Children, infant, infants

Febrile

Paracetamol AcetaminophenPainFever Febrile


13/37

AUSTRALASIAN

COCHRANE CENTRE

Points to remember when choosing searchterms

Search terms are specific

They belong to a controlled language, as

found in MeSH (medical subject heading orthesaurus)

MeSH available in both the Cochranedatabase and PubMed

Always consult MeSH or thesaurus to identifyappropriate search terms


14/37

AUSTRALASIAN

COCHRANE CENTRE

Searching tools

Boolean operators

AND, OR and NOT

Truncation

Grouping/Nesting


15/37

AUSTRALASIAN

COCHRANE CENTRE

Searching tools - Boolean Operators AND -narrowing

warna

A AND B


16/37

AUSTRALASIAN

COCHRANE CENTRE

Searching tools - Boolean Operators OR -broadening

AOR B


17/37

AUSTRALASIAN

COCHRANE CENTRE

Searching tools - Boolean Operators NOT -excluding

A NOT B


18/37

AUSTRALASIAN

COCHRANE CENTRE

Searching tools - Truncation

Symbol of truncation *

Exampleschild* = child, or

children

childcare

childhood


19/37

AUSTRALASIAN

COCHRANE CENTRE

Searching toolsGrouping/nesting

Symbol of grouping ( )

Examples

(fever OR febrile)

(paracetamol OR acetaminophen)


20/37

AUSTRALASIAN

COCHRANE CENTRE

Bringing them together

Children with

pain and fever

Paracetamol Ibuprofen

The answer


21/37

AUSTRALASIAN

COCHRANE CENTRE

Search Phrase

Search Terms

Patient (child* OR infant*) AND (pain OR(fever* OR febrile))

Intervention ibuprofen

Comparison (paracetamol OR acetaminophen)

(child* OR infant*) AND (pain OR (fever* OR febrile))AND ibuprofen AND (paracetamol OR acetaminophen)


22/37

AUSTRALASIAN

COCHRANE CENTRE

Why bother?

Search Phrase

Pubmed

3/27/08

(child* OR infant*) AND pain OR (fever* OR febrile) ANDibuprofen AND (paracetamol OR acetaminophen)

(child* OR infant*) AND pain OR (fever* OR febrile)

AND ibuprofen

(child* OR infant*)

(child* OR infant*) AND pain OR (fever* OR febrile)

PubMed Clinical Queries Systematic Reviews

1884467

166801

457

225

13


23/37

AUSTRALASIAN

COCHRANE CENTRE

What to look for?

The paper where someone trustworthy

has already answered yourquestion


24/37

AUSTRALASIAN

COCHRANE CENTRE

Primary & Secondary Research

Primary research research undertakento address a question

Secondary research researchundertaken to find the existing primaryresearch that addresses a question

reviews (systematic, narrative) and meta-analyses


25/37

AUSTRALASIAN

COCHRANE CENTRE

Narrative vs Systematic Reviews

Narrative review

Opinion with illustrations from the literature

Cannot appraise Not trustworthybecause potential sources of bias

cannot be assessed

Systematic review

Rigorous research methodology

Objective review of all the evidence

Can be appraised like other research

Trustworthy because potential sources of biascan be assessed


26/37

AUSTRALASIAN

COCHRANE CENTRE

What type of research to look for?

If your question is about: Look for a systematic review

or

Intervention / Therapy Randomised Controlled Trial(RCT)

Diagnosis / Screening:

- Accuracy Cohort studies

- Health outcomes RCT

Prognosis Longitudinal cohort studies

Aetiology / Risk factors RCT, cohort or case-controlstudies


27/37

AUSTRALASIAN

COCHRANE CENTRE

Where to search?

The Cochrane Library(www.thecochranelibrary.com)

collection of databases of high quality information

about healthcare interventions, includingsystematic reviews.

PubMed Clinical Queries (www.pubmed.gov)

specialised MEDLINE search engine with built-insearch filters designed to find high quality studies in

four study categories: therapy, diagnosis, aetiology and prognosis

systematic reviews
http://www.thecochranelibrary.com/http://www.pubmed.gov/http://www.pubmed.gov/http://www.thecochranelibrary.com/


28/37

AUSTRALASIAN

COCHRANE CENTRE

www.thecochranelibrary.com


29/37

AUSTRALASIAN

COCHRANE CENTRE

www.pubmed.gov


30/37

AUSTRALASIAN

COCHRANE CENTRE

Other sources

National Guideline Clearinghouse (NGC) - apublic resource for evidence-based clinicalpractice guidelines

(www.guideline.gov)

Canadian Medical Association - voluntaryassociation of physicians that advocates onbehalf of its members and the public for accessto high quality health care, and provides

leadership and guidance to physicians.)(www.cma.ca)

BMJ Clinical Evidence(http://clinicalevidence.bmj.com)

ACP Journal Club (www.acpjc.org)
http://www.guideline.gov/http://www.cma.ca/http://clinicalevidence.bmj.com/http://www.acpjc.org/http://www.acpjc.org/http://clinicalevidence.bmj.com/http://www.cma.ca/http://www.guideline.gov/


31/37

AUSTRALASIAN

COCHRANE CENTRE

www.guideline.gov


32/37

AUSTRALASIAN

COCHRANE CENTRE

www.cma.ca


33/37

AUSTRALASIAN

COCHRANE CENTRE

cma clinical practice guidelines


34/37

AUSTRALASIAN

COCHRANE CENTRE

BMJ Clinical Evidence


35/37

AUSTRALASIAN

COCHRANE CENTRE

ACP Journal Club


36/37

AUSTRALASIAN

COCHRANE CENTRE

Conclusion

Use PICO method to formulate clinicalquestions

Consult and use terms available in MeSH to getthe appropriate search terms

Develop search strategy using search toolsprovided

Activate search history (if available) to helprevise search

Practice makes perfect. Asah ketrampilandengan banyak berlatih. Selamat mencoba.


37/37

Searching practice

Go to www.thecochranelibrary.comand www.pubmed.gov

Use the sample search phrase (child* ORinfant*) AND (pain OR (fever* OR febrile)) ANDibuprofen AND (paracetamol OR

acetaminophen) and find out the result

How do they differ?
http://www.thecochranelibrary.com/http://www.pubmed.gov/http://www.pubmed.gov/http://www.thecochranelibrary.com/

EBMmalang_dokter

Documents

Transcript of EBMmalang_dokter