1. Searching SohailBajammal October 9, 2011

2. Objectives Previous lecture Differences between primary & secondary sources of evidence Overview of popular secondary sources

3. Previous Lecture

6. Today’s Lecture

7. 5A

8. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 Computerized decision support system Evidence-Based Guidelines & Textbooks Secondary Critically-Appraised Journal Articles & Abstracts Systematic Reviews RCTs, Cohort, Case control, Case series Primary Expert Opinion: Classical Textbooks

9. Searching for evidence Case report, Case series, Case-Control, Cohort, Randomized Trial DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009

10. Studies(Primary Sources)

11. Primary Sources Original articles Through databases: MEDLINE, EMBASE Using: PubMed, OVID You have to retrieve and appraise the articles Strength (pyramid) of evidence

12. PubMed

14. MeSH(Medical Subject Headings)

15. It is a “strategy” Low Back Pain Treatment OR OR Low Back Ache Management Acute OR OR Low Backache Therapy AND AND OR OR "Low Back Pain"[Mesh] Surgery

19. We will talk more aboutSEARCH STRATEGYin the coming few weeks

20. PubMed Tutorials 20

23. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13

24. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13

25. Pyramid of Evidence http://library.downstate.edu/EBM2/2100.htm

29. This what we will be doing the coming few weeks

30. Tough Job If you have to do the critical appraisal for every single article you read  Tough BUT You need to learn about it in details for the sake of research

31. Don’t say there is “no evidence” Instead Weak evidence You might not have looked thorough enough

32. Absence of evidence is not the evidence of absence

33. Satisficing ‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience” Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.

34. Usefulness of information Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.

36. Secondary Sources

37. Syntheses(Systematic Reviews)

38. Syntheses The authors have done the work for you Hopefully: They asked a good question They searched the literature systematically (keywords & MeSH) They identified the studies and assessed their quality This is called Systematic Review If they did statistical combination of results, this is called Meta-analysis

39. How to search for “Syntheses”? Same databases: MEDLINE, EMBASE Cochrane Library

40. PubMed

42. Available at UQU

47. Are all syntheses good? You still have to appraise the quality of these systematic reviews and meta-analyses

49. Synopses(Critically Appraised Abstracts)

50. Synopses Physicians with training in research methodology: Read the articles Assess their quality Summarize them for you Many sources: Database of Abstracts of Reviews of Effects (DARE) Evidence-based Dentistry Journal of Evidence-Based Dental Practice Critically Appraised Topics (CATs) Evidence-based sections in many journals Others: DynaMed, EvidenceMatters, EssentialEvidence

52. DAREDatabase of Abstracts of Reviews of Effects Free

57. Evidence-Based Dentistry Journal Available at UQU

59. Journal of Evidence Based Dental Practice

61. Critically Appraised Topics (CATs)

64. SummariesEBM TextbooksEBM Guidelines

65. EBM Textbooks UpToDate

71. Guidelines

72. Guidelines Types of guidelines: Consensus Evidence-based Use the limiting features in the website

73. Guidelines NICE: National Institute for Health & Clinical Excellence SIGN: Scottish Intercollegiate Guidelines Network NGC: National Guideline Clearinghouse

83. Are all guidelines good quality?

92. Systems

93. Systems This is the ultimate goal Computerized decision support Too sophisticated for us to think about now

99. Paid Services DynaMed EvidenceMatters EssentialEvidence Plus

100. Available at UQU DynaMed

111. Evidence Matters

127. EssentialEvidencePlus

136. Meta Search (Many-in-one) NHS Evidence TripDatabase Google Scholar

137. NHS Evidence

142. TRIPDatabase

151. Google Scholar

153. Broad Term  Lots of irrelevant results

155. They will email you when new article cites this article

156. Searching for evidence DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009

157. The Remaining of the Course Primary Sources Critical Appraisal of: Therapy Systematic Review Diagnosis Prognosis

158. Assignment 3 What are the secondary sources available for dental students and dentists to practice evidence-based dentistry? Categorize them according to the 5S/6S model Visit these sites & describe in your words what are they & what do you think of them. If you find other sources, you can add them Type at least 2 lines describing each secondary source (size 12 font) Assignment due October 18 Send the assignment to my email (email subject & Word document: EBD3 your name)