Searching Effectively and Efficiently for Accurate Answers ......Searching Effectively and...

Searching Effectively

and Efficiently for

Accurate Answers to

Clinical Questions

Andrew Schenkel DMD, MS

New York University College of Dentistry

Richard McGowan MLS

New York University Health Sciences Library

Background Review

Searching is one part of the evidence based

decision making (EBDM) process used to

answer clinical questions

Searching is part of the second step in the

process- finding the best available

evidence to answer the question

EBP According to the ADA

“An approach to oral health care that

requires the judicious integration of

systematic assessments of clinically

relevant scientific evidence, relating to the

patient's oral and medical condition and

history, with the dentist's clinical expertise

and the patient's treatment needs and

preferences.”

American Dental Association (n.d.) Evidence-Based Dentistry: Glossary of Terms.

Retrieved March 5, 2009 from the World Wide Web:

http://ada.org/prof/resources/ebd/glossary.asp#ebd

What Does That Mean?

Decision

Patient’s preference

Best available evidence

Practitioner’s clinical

expertise

Courtesy of Dr. Ivy Peltz

EBP According to NYUCD

Our graduates must be able to ascertain the

appropriate questions that they as clinicians

need to answer in order to care for their

patients; identify appropriate sources of

information to answer these questions;

assess the validity of the information

obtained; and utilize the information in the

care of their patients. We call this process

“Evidence-based Practice.”

Why Bother?

Provide the best

possible treatment Based on the best evidence

Objective & unbiased

Systematic search and

appraisal

Acceptable level of

uncertainty

NYUCD

Strategic Plan Develop men and

women of science

That is, sophisticated

consumers of research

able to appropriately

treat patients

Before EBP?

Who needs evidence? “It works in my hands”

Going to the literature and finding an article that

supports the position or treatment choice that you

think is the best

Random search (Google), limited appraisal

Subjective & potentially biased (intentional or

unintentional

Inappropriate level of certainty

The Five “A”s of EBP

Ask – Determine the clinical question

Acquire – Systematically search the literature

Appraise – Critically appraise the literature

Apply – Make a decision

Assess – Evaluate the results

Centre for Evidence-Based Dentistry (2007). Introduction to practising Evidence-based

dentistry. Retrieved March 5, 2009 from the World Wide Web:

http://www.cebd.org/index.aspx?o=1007

A #1 – Asking Focused

Questions

PICO Format:

Population (Patient) or Problem

Intervention

Comparison

Outcome Centre for Evidence-Based Medicine (2009). Asking Focused Questions. Retrieved

March 5, 2009 from the World Wide Web:

http://www.cebm.net/index.aspx?o=1036

PICO Example

P – Adult human patients

I – Chairside tooth whitening

C – At-home tooth whitening

O – Lighter teeth

Clinical Question

In adult human patients, is chairside tooth

whitening more effective than at-home tooth

whitening in producing lighter teeth?

A #2 – Acquire Appropriate

Evidence

EVIDENCE HIERARCHY

Strong

Weak

Systematic Reviews

RCT’s

Cohort study

Case control study

Case series

Case report

Expert opinion

Animal research

Bench-top research

Used by permission of the ADA. December, 2008

EVIDENCE HIERARCHY

Why Systematic Reviews?

Synthesizes results from multiple trials (studies)

addressing the same question

Provides a clear summary of the current best

evidence on a specific topic

Uses rigorous scientific methods to review

original research in order to minimize bias

Provides a way of managing large quantities of

information and keeping current with new

research

When possible, allows statistical combination of

data for a single estimate of effect- Meta Analysis

Why Systematic Reviews?-

TMI

MEDLINE:

4,000 journals

6 million references

400,000 new entries yearly

American Dental Association (2009). Final_EBD_-_Intro_for_Champions_120909. The

Evidence-Based Dentistry Champion Conference. ADA Headquarters, Chicago, IL.

Searching Beyond Google

PubMed-

Clinical Queries-

Systematic Reviews

See all (xx)

Go to PubMed directly:

http://www.pubmed.gov/clinical

Or through your institution’s link in order to get

access to full text articles (subscription based)

Searching Beyond Systematic

Reviews

PubMed

Medline

Cochrane Library

Google Scholar

Web of Knowledge Web of Science

Google

Searching Beyond Primary

Sources EBD web site (ADA.org)

EviDents Search Engine

(UTHSCSA.edu)

Evidence Based Dentistry (Nature.com)

Journal of Evidence Based Dental

Practice

Google

Ask answerable

questions

Acquire the best

evidence

Appraise the

evidence

Apply evidence to

patient care

Assess treatment

outcomes

Used by permission of the ADA. December, 2008

Evidence Based Decision

Making

Additional training available

SUNY DOWNSTATE MEDICAL CENTER

EVIDENCE BASED MEDICINE TUTORIAL–

http://library.downstate.edu/EBM2/contents.ht

m

PubMed tutorial on online searches –

http://www.nlm.nih.gov/bsd/disted/pubmed.ht

ml

Thank you all for your

interest and attention!