This presentation was designed for use in Library tutorials with Nursing & Paramedic Science students. The workshop introduces students to the basic concepts of evidence-based practice; asking answerable clinical questions using PICO; levels of evidence and how to search Library databases to find appropriate evidence.

1. EVIDENCE-BASED
HEALTH CARE:
SEARCHING THE
LITERATURE
Ishbel Leggat
Faculty Librarian
Health, Engineering & Science
Victoria University Library
WWW.VU.EDU.AU 1

2. Evidence-based practice:
Session outline
• Evidence-based practice
• 5 steps
• Step 1: Asking clinical questions
• Step 2: Finding evidence
• Levels of evidence
• Which databases to use
• Search process
• Peer-reviewed articles
• Hands-on search session
• How to find full text articles
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3. Evidence-based practice:
Definitions
"Evidence based medicine is the conscientious, explicit, and judicious
use of current best evidence in making decisions about the care of
individual patients. The practice of evidence based medicine means
integrating individual clinical expertise with the best available external
clinical evidence from systematic research" (Sackett et al 1996, p. 71).
"Even though this definition [by Sackett et al] was originally given with
respect to evidence-based medicine, it is often extended beyond the
medical profession and used to define evidence-based practice as
well" (Hoffmann, Bennett & Del Mar 2010, p. 2).
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4. Evidence-based practice:
5 steps
1
Ask
question
5 2
Evaluate Search
3
4
Critically
Implement
appraise
Adapted from: Purnell 2011
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5. Evidence-based practice:
Step 1 - Asking questions
PICO can be used to formulate a focused clinical research question.
P I C O
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6. Evidence-based practice:
Step 1 - Asking questions
PICO can be used to formulate a focused clinical research question.
P I C O
Population Intervention Comparison Outcome
Patient OR
Problem Exposure
Who are the What do we do What do we What
patients? to them? compare the happens?
What is the What are they intervention What is the
problem? exposed to? with? outcome?
Adapted from: Purnell 2011
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7. Evidence-based practice:
Step 1 - Asking questions
When you have formulated a focused clinical question, it can also be
useful to determine what type of question it is.
Diagnosis Prognosis Aetiology Effects Experiences
How can we find What happens Why does a How can we How does it feel
out whether or to a person with person get a prevent or treat to have a
not a person has a specific specific a specific specific
a specific condition or condition or condition, illness condition, illness
condition or illness? illness? or problem? or problem?
illness?
Adapted from: Purnell 2011
This will help you to decide what type of clinical studies to search for.
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8. Evidence-based practice:
Step 1 - Asking questions
Practice formulating a clinical question using PICO...
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9. Evidence-based practice:
Step 1 - Asking questions
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10. Evidence-based practice:
Step 1 - Asking questions
Now try writing a clinical question...
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11. Evidence-based practice:
Step 1 - Asking questions
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12. Evidence-based practice:
Step 1 - Asking questions
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13. Evidence-based practice:
Step 1 - Asking questions
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14. Evidence-based practice:
Step 2 – Finding evidence
• Levels of evidence
" Why you shouldn't just 'Google it'
Google is good for finding some information but evidence-based practice requires that
you find and use the best available evidence from systematic research. Google will
find you lots of information but it doesn't find everything and it won't help you filter the
good from the bad.
When looking for answers to clinical questions, you should start with resources
containing pre-appraised evidence. The information you find in these have already
undergone a filtering and critical appraisal process.
The 6s Model … may help you choose the right information resources … "
(Purnell 2011)
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15. Evidence-based practice:
Step 2 – Finding evidence
• Levels of evidence - the 6s Model
As explained by DiCenso et al … you should begin your search at the highest possible level in this
model. The type of question you have is also important to consider when choosing information
resources… (Purnell 2011) 15

16. Evidence-based practice:
Which databases to use?
Depends on your topic – be prepared to use several
databases...
• Biomed & health
Medline; PubMed; Informit Health Collection (Australian info);
Cinahl; Cochrane Library (EBM); PsychINFO (mental health)
• Multidisciplinary science
ScienceDirect; Web of Knowledge; Wiley Online Library;
SpringerLink
• General full-text
Academic Search Premier
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17. Evidence-based practice:
Search process
Peer-reviewed articles
•Some databases have options to search only for peer-reviewed articles
• Most databases don’t – that’s why you need to be aware of what peer
reviewed articles look like
Characteristics of peer-reviewed articles
 Formal language, technical vocabulary
 Charts, tables, statistical data (science literature)
 References to other scholarly literature
 Read and critiqued by anonymous reviewers who are scholars in the field
 Have a formal appearance (usually b&w, no pictures)
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18. Evidence-based practice:
Search process
• Before you start searching
Have a clear idea of what you are looking for and write it down
e.g. administration of epinephrine by paramedics during cardiac
arrest
• Identify the key words in your topic
e.g. epinephrine, paramedics, cardiac arrest
• Write down alternative words for the key words already
identified
e.g. adrenaline, allied health personnel, heart attack
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19. Evidence-based practice:
Search process
• Construct your search
Start out with a simple search
e.g. paramedics AND epinephrine
Link key words with the search operator AND to narrow down your
search
Add more key words if you get too many results
e.g. paramedics AND epinephrine AND “cardiac arrest”
Use double quotes to match phrases
e.g. “cardiac arrest”
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20. Evidence-based practice:
Search process
• Test drive your search in a database...
• Start out with a simple search
• Review your search results to determine what to do next...
Add more key words to narrow down your search
Use different key words if your results aren’t relevant
Use thesauri or subject lists (such as MeSH – Medical Subject Headings)
to find alternative key words
Incorporate alternative key words into your search if you are not getting
enough results
e.g. paramedics AND (epinephrine OR adrenaline)
Make use of database features to limit your search more effectively
e.g. limit to scholarly or peer reviewed articles; set specific date range...
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21. Evidence-based practice:
Finding full text articles
• Many databases have the full text or links to free full text
• If full text is not available, look out for button in
library databases
This will run a search in the library catalogue for the required journal
title – check ALL options...
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22. Evidence-based practice:
References
DiCenso, A, Bayley, L, & Haynes, RB 2009, 'Accessing preappraised evidence: fine-tuning the 5S
model into a 6S model', ACP Journal Club, vol. 151, no. 3, p. 1, viewed 4 August 2011, retrieved
from CINAHL with Full Text.
Hoffmann, T, Bennett, S & Del Mar, C 2010, Evidence-based practice across the health professions,
Elsevier Australia, Chatswood, NSW.
Purnell, M 2011, Evidence based practice: LibGuides at Northern Territory Department of Health,
Northern Territory Department of Health, viewed 4 August 2011,
< http://elibrarygroups.health.nt.gov.au/evidence >.
Sackett, D, Rosenberg, W, Gray, J, Haynes, R, & Richardson, W 1996, 'Evidence based medicine:
what it is and what it isn't', BMJ, vol. 312, no. 7023, pp. 71-2, viewed 3 August 2011,
<http://www.bmj.com/content/312/7023/71.full>.
University of Minnesota Libraries n.d., Evidence based practice, University of Minnesota,
Minneapolis, MN, viewed 4 August 2011, <http://hsl.lib.umn.edu/learn/ebp/mod01/index.html >.
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