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Evidence-Based Practice (EBP)

Resources and Information related to the field and practice of Evidence-Based Practice (EBP)

 

Now that you have formulated a specific and relevant clinical question, your focus will shift to finding the best evidence in the medical literature.  There is a lot of medical literature available that you must go through to determine what is best for your patient or problem. 
In this step, you will create a search strategy and 
select which database resources are best for your search. 

 

 

Click a heading to learn more about each element in the ACQUIRE process.
 

Breaking PICO Down

When you create a PICO question, you are actually thinking about how discrete topics relate to each other.  Each component: your P, your I, your C, and your O, comprises a portion of your search strategy, or what you will input into the database. 
You can utilize only your PICO components to execute a simple search, but each component will probably have different ways of being expressed when an author writes about them - i.e. synonyms. 
When you use databases or search engines, they only retrieve what you type in, nothing more and nothing related.  It is up to you to think of how an author might express your topic/concepts in their writing in order to expand the possibility of catching all relevant articles. 
It's helpful to create a chart to stay organized. Place your PICO components at the top of a column, then write possible synonyms in the row(s) below.

Clinical Question:

In infants, what is the effect of premature birth compared to full-term birth on sensory deafness over the lifespan?
P: Infant 
I: Premature
C: Full-Term
O: Deafness
Infants 
baby
babies
newborn
newborns
pre-mature
preerm
pre-term
preemie
fullterm
39 weeks
40 weeks 
sensory deafness
sensorial deafness
hearing loss
deaf

 

 

Now that you have created your synonym chart, you need to know a little bit about how databases and search engines work in order to ensure you create a search string that retrieves the types of results you want. 

Boolean Logic

  • Most databases and search engines understand at least three main operators: AND, OR, NOT
    • An operator is a word that is read as something the engine DOES, not as a word to search
    • Operators allow you to combine keywords or components in different ways

  • AND

    • Requires the results to contain both or all of the terms combined with AND
    • Narrows your search, the more ANDs you use the fewer results you'll retrieve
    • Cancer AND Aspartame

  • OR

    • Results contain either, both, or any combination of the terms combined with OR
    • Expands your search, use OR between synonyms
    • Cancer OR Neoplasms 

  • NOT

    • Results will not contain ANY articles that use the term(s) indicated after NOT
    • Narrows your search, use this carefully - it deletes any results that may also use a term you want to find.
    • Cancer NOT Colon

Phrases 

  • If you have 2 or more words that have to appear in a certain order, put them in quotation marks
  • "this is a phrase," the quotes tell the database to find the words in that specific order and not scattered throughout the text
  • This will occasionally bring back no results because the quoted phrase was not found, try again without quotes or use a synonym
    • "hearing loss"
    • "hospital-acquired infection"

Parentheses

  • Computers read search instructions from left to right and will follow the operators as they appear
  • Think of parentheses as creating a 'mathematical' search string for the database to follow: they tell the computer to do whatever is inside of them first
  • This is important because you will want to computer to find all the synonyms for one element of your search BEFORE combining the second, third, and/or fourth elements together
    • (infant OR infants OR baby OR newborn) AND (premature OR preemie OR pre-term) AND (full-term OR"39 weeks" OR "40 weeks") AND (sensory deafness OR deaf OR "hearing loss")

Guidelines

  • Follow this easy list of steps and rules to help you form your search string
    • Create a keyword/synonym chart for your PICO
    • Combine all synonyms within a column with OR
    • Place OR'd synonyms in parentheses 
    • Combine all individual columns with AND
      • (P OR P OR P) AND (I OR I OR I) AND (C OR C OR C) AND (O OR O OR O)

 
Once you have formulated a search strategy you will need to select a resource (or resources) to search.  To quickly find answers, you would usually first search filtered (pre-appraised) resources, beginning at the top of the evidence hierarchy, moving lower down the hierarchy is required.  If pre-appraised information is not available you will need to search unfiltered resources such as PubMed. 
This resources list aims to provide you with access or access information to EBM resources available to you through Rowland Medical Library & open-access sources. 
Resources are listed according to the hierarchy of evidence:

 

Filtered Resources: Meta-Search Engines:

Meta-Search Engines simultaneously search multiple evidence-based resources.

  • TRIP Database (Turing Research into Practice) - Free Online
    • Simultaneously searches multiple evidence-based sources, including systematic reviews, meta-analyses, and critically-appraised topics and articles.  
    • Use the PICO search option and then filter by evidence type.
  • PEDro Physiotherapy Evidence Database - Free Online
    • Meta-search engine for randomized trials, systematic reviews, and clinical practice guidelines in physiotherapy.
    • Critically appraised randomized trials and awards PEDro Score.
  • Joanna Briggs Institute EBP Database
    • Simultaneously search summarized and appraised evidence including Evidence-Based Recommended Practices, Evidence Summaries, Best Practice Information Sheets, Systematic Reviews, Consumer Information Sheets, Systematic Review Protocols, and Technical Reports. 
  • OTSeeker - Free Online 
    • Meta-search engine containing abstracts of systematic reviews, randomized controlled trials, and other resources relevant to occupational therapy interventions. 
    • Most resources critically appraised for validity and interpretability. 
  • PDQ-Evidence - Free Online
    • "Pretty Darn Quick" -Evidence provides access to systematic reviews of health systems evidence.  Links together systematic reviews, overviews of reviews and primary studies. 

 

Filtered Resources: Systematic Reviews / Meta-Analyses

Filtered resources appraise the quality of studies and often make recommendations for practice. 

  • Cochrane Library 
    • Cochrane Library includes the Cochrane Database of Systematic Reviews (CDSR), which are the "Gold Standard" for high-quality systematic reviews, the Cochrane Central Register of Controlled Trials (CENTRAL) with multiple specialty groups, and Cochrane Clinical Answers.
  • PubMed Clinical Queries - Free Online
    • A special search interface of PubMed that allows you to find citations in the clinical study categories and systematic reviews.

 

Filtered Resources: Critically-Appraised Topics/Articles

Authors of critically-appraised topics evaluate and synthesize multiple research studies.

  • DynaMed 
    • Evidence-based critical review summaries
    • Narrative synopsis
    • Practice Guidelines
  • UpToDate 
    • Evidence-based critical review summaries
    • Narrative Synopsis
    • Practice Guidelines
  • VisualDX
    • Evidence-based differential diagnosis tool
    • Narrative synopsis
    • Practice Guidelines
    • Pictures and diagrams available to aid in the identification of visually identifiable diseases
  • Natural Medicine 
    • Graded evidence on complementary medicine
  • ACP Journal Club 
    • Journal screens the top 100+ clinical journals and identifies studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions, clearly stated, and a commentary are provided for each article. 
    • Internal Medicine focus​

 

Unfiltered Resources: Randomized Control Trials (RCTs), Cohort Studies, Case-Control Studies

Evidence is not always available from filtered resources and searching primary literature is sometimes required.  It is possible to use filters within these databases to identify studies appropriate to the clinical question. 

  • PubMed - Free Online/Go through Rowland Medical Library for Full-Text Access
    • PubMed is the largest biomedical/life sciences database in the world, it has over 28 million indexed citations and abstracts 
    • Use filters to limit your search results to particular types of articles, such as RCTs, Cohort Studies, Systematic Reviews, Meta-Analyses
    • Use the "clinical queries" searching feature to retrieve filtered results 
  • Ovid MedLine 
    • Subset of PubMed
    • All articles are indexed with MeSH terms (Medical Subject Headings) which produced more accurate search results
  • CINAHL Plus with Full Text 
    • Cumulative Index of Nursing and Allied Health
    • Use the "limits" icon to use "clinical queries" or limit to "research" or other publication types (i.e. systematic reviews)
  • PsycINFO 
    • Professional and academic research in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and more. 
    • Use the methodology limiter to choose desired evidence-based methodology type(s)
  • ScienceDirect 
    • Compilation of journals from Elsevier, one of the largest biomed publishers
    • Use the "Research Article" and/or "Review Article" limits to bring back primary literature.
  • Embase 
    • Biomedical database from Elsevier, emphasis on drug and drug-related research. 
    • Contains primary and grey literature.  
    • Use Emtree (Embase Controlled Vocabulary) for more precise searching.
  • Clinicaltrials.gov - Free Online
    • Registry database of publicly and privately supported clinical studies on human participants. 
  • Scopus 
    • One of the largest multidisciplinary abstract and citation databases of research literature and quality web sources
    • tracks cited and citing literature