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finding evidence

the research process

james lux

on 18 October 2012

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Transcript of finding evidence

Clinical observation ... what you see
in clinical practice as evidence Review MEDLINE Physiotherapy Evidence Database




Cumulative Index to Nursing and
Allied Health Literature At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analysis
which summarize and interpret the results of medical research.
The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine. Selecting search terms (summary) The world wide web , Search engines, and ... databases A regulated and controlled patient study Clinical Research such as
controlled trials
randomized trials
N-of-1 randomized trials This database systematically identifies economic evaluations from around the world, appraises their quality, and highlights their relative strengths and weaknesses.[3] NHS Economic Evaluation Database (NHS EED) Brings together details of
completed and ongoing health technology assessments
(studies of the medical, social, ethical and economic implications of healthcare interventions)
from around the world. Health Technology Assessment Database (HTA) Is a bibliography of publications that report on methods used in the conduct of controlled trials. The Cochrane Methodology Register (Methodology Register) Is a database that contains details of articles of Controlled trials and other studies of healthcare interventions from bibliographic databases (majorly MEDLINE and EMBASE), and other published and unpublished sources that are difficult to access.[2] The Cochrane Central Register of Controlled Trials (CENTRAL) Contains all the peer-reviewed systematic reviews and protocols prepared by the Cochrane Review Groups. The Cochrane Database of Systematic Reviews (Cochrane Reviews) The Cochrane Database of Systematic Reviews (Cochrane Reviews).
The Database of Abstracts of Reviews of Effects (DARE)..
The Cochrane Central Register of Controlled Trials (CENTRAL (majorly MEDLINE and EMBASE), and other published and unpublished sources that are difficult to access.
The Cochrane Methodology Register (Methodology Register
Health Technology Assessment Database (HTA).
NHS Economic Evaluation Database (NHS EED). The Cochrane Library consists of the following databases: The Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about groups in The Cochrane Collaboration. a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organizations. The Cochrane Library is… Archibald Leman Cochrane
was a Scottish doctor and pioneer of evidence based medicine. Cochrane Library “AND” is -
used to when there is more than one search term, so the search is for ALL the terms however this NARROWS the search. Search terms .. “AND & OR” Wild cards ...
identify word variants
act as a “proxy” or substitute for a string of characters (letters)
The * asterisk symbol is used to indicate this function.
E.g., "lumb" search would yield; lumbar, lumbosacral, and lumbo-sacral, etc.
is in most databases Wild Cards A function of PubMed , MeSH means Medical Subject Heading.
It’s a list of medical terms and their synonyms.
Each term has a list of synonyms and spelling variations that's listed in a hierarchical structure MeSH 3rd think of alternative terms or synonyms that could be used for the “key terms”.
E.g., shoulder pain upon awakening could be expressed as;
shoulder pain after sleeping,
shoulder discomfort upon awakening,
glenohumeral pain upon awakening,
Glenohumeral pain in the recumbent position
frozen shoulder after sleeping, Selecting search terms 2nd which key terms are going to be answered by the
studies of interest.
E.g., the query “shoulder pain upon awakening”
There are many studies on “the shoulder” and far more on the topic of “pain” BUT less on the term “shoulder-pain” which is more specific Selecting search terms 1st identify the key elements of your question
E.g., a question regarding “shoulder pain upon awakening” the key terms would be; should, pain, & awaken. Selecting search terms A type of longitudinal-study designed to determine the relationship between a condition and a characteristic shared by some members of the group, e.g., a group of people share the habit of “eating fast food” or “ thinking negatively” ; these people are studied for many years to see “who gets obese” or “who gets depressed” Cohort study (prospective study) Contains quality-assessed abstracts of systematic reviews, including a summary of the review and a critical commentary of its overally quality. The Database of Abstracts of Reviews of Effects (DARE) "I knew that there was no real evidence
that anything we had to offer
had any effect on tuberculosis,
and I was afraid that I shortened the lives
of some of my friends
by unnecessary intervention."

As a result, he spent his career urging the medical community to adopt the scientific method. He said, The Cochrane Library
is named after
Archie Cochrane Or
Becoming a better clinician ! Finding the EVIDENCE 1st identify the key elements of your question

2nd which key terms are going to be answered by the studies of interest.

3rd think of alternative terms or synonyms that could be used for the “key terms”. Hippocratic and Galenic theory-based practice was based on the notion of a balance of the fluids, or "humors". "OR !" is used to search for ANY of the terms, so it's used for synonyms which BROADENS the search. finding the evidence .............. interpreting clinical interventions as successful neglects extraneous factors that "confound" this approach in reasoning.
confounding factors, e.g.,
natural recovery
statistical regression
patient's self reports
clinician's recall bias contolled trails are where "outcomes" are compared; one group gets intervention and another group (with the same Dx) does not!

the bias of confounding factors is ELIMINATED because BOTH GROUPS have the same extraneous factors HOWEVER ! THIS IS ASSUMING THAT THE TWO GROUPS ARE COMPARABLE if they are not ... than this bias is referred to as "SELECTION BIAS" or to say
that the effects of intervention are confounded by the subject characteristics several CT & RCT are reviewed & investigated for the effects of the same intervention and provide date that support the same conclusion ( a "robust" review)

two types of reviews;

1. Narrative - subjective

2. systematic review - RCT reviews are the highest standard Systematic Review .. . in previous chapters we discussed,
asking clinical evidence -based PT questions, regarding;
effects of intervention (Tx outcomes)
pt's experiences
diagnosis ... so now we are SEARCHING for evidence regarding
"effects of intervention" and the best search engines for this are;
The Cochrane Library
PEDro Researching "Evidence of Patient's Experiences"
recommended databases are;
Social Sciences Citation Index HOWEVER ! there are some limitations to PEDro
and these are;
1. AND and OR search terms cannot be combined in a search
2. full text of Cochrane Systemic Reviews are not available
3. lacks randomized trials and systemic reviews in all areas of healthcare
.... Cochrane does all of the above! when searching for evidence-based physiology regarding Px & Dx, the following databases are recommended;
MEDLINE MEDLINE is the BEST choice because it's FREE! and
it has an excellent search engine (Clinical Queries)
that makes this type of search "straight forward"

at the present time, there are no databases dedicated to archiving studies of prognosis and diagnosis Clinical Queries database is accessed via PubMed Homepage under "PubMed Tools"

this homepage allows searches of studies in;

we will search the "Clincial Studies Category" Advance PubMed using MeSH & History features Longitudinal Studies
research that identifies a group with a common characteristic ( habit, disease, etc.) and observe how the group's characteristics change over time

Good evidence of Px are found in these types of studies Cross sectional studies
clinical studies of the accuracy of dx tests involves applying test to many people then determining how-well the test's findings correspond to the correct dx. there are two types;
cohort studies (?)
case studies (?) Ottawa Rules - the Knee
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