Methods for searching the literature: why and how? Dr. Evi Nagler Ghent University Hospital

Transcription

1 Methods for searching the literature: why and how? Dr. Evi Nagler Ghent University Hospital

2 Conflict of interest No ties with industry No interest in systems discussed BUT Professional ties with guideline organisation

3 N Questions Q every 2 to 3 patients 10 questions every day! Green ML et al. AJM 2000; 109:

4 N Questions If it works, we're right If he dies, it was something else Ramsey PG et al. JAMA 1991; 266(8):

5 Board scores Experience = Knowledge? Board exam results for 300 internists Years since initial certification Ramsey PG et al. JAMA 1991; 266(8):

6 Experience = Knowledge? Studies (%) Systematic Review 59 studies Poorer No relation Better Knowledge Diagnosis Therapy Choudry NK et al. Ann Intern Med 2005; 142(4):

7 Experience = Knowledge? Studies (%) Systematic Review 59 studies Poorer No relation Better Knowledge Diagnosis Therapy Choudry NK et al. Ann Intern Med 2005; 142(4):

8 N Questions 10 questions? maybe more Ramsey PG et al. JAMA 1991; 26(8):

9 N Answers? In 4 /10 questions Time Inability to navigate available data Forget the question... Difference between physicians? Trainee Specialists Nephrologists Other internists Academic hospitals Community hospitals Ely J et al. J Am Med Inform Assoc 2005; 12(2): Shariff SZ et al. J Nephrol 2011; 24(6):

10 Where do we look? PD and peritonitis Search First 40 citations 2 minutes Shariff SZ et al. J Nephrol 2011; 24(6):

11 Evidence pyramid Unfiltered Studies Adapted from Haynes RB. EBM 2001; 6:

12 Evidence pyramid Systematic Reviews Unfiltered Studies Adapted from Haynes RB. EBM 2001; 6:

13 Systematic Review Methods Question definition Systematic search Study selection Data extraction Critical appraisal Data synthesis 6 months

14 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Higly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

15 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Higly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

16 Evidence pyramid Studies Adapted from Haynes RB. EBM 2001; 6:

17 Evidence pyramid Studies Adapted from Haynes RB. EBM 2001; 6:

18 Evidence pyramid Summaries Systematic Reviews Studies Adapted from Haynes RB. EBM 2001; 6:

19 Where do we look? PD and peritonitis Search

20 Where do we look? PD and peritonitis Search 15 seconds!

21 Where do we look? PD and peritonitis Search

22 Where do we look? PD and peritonitis Search 15 seconds!

23 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Highly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

24 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Highly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

25 Relevance - coverage Banzi 2010 Prorok ACP Pier Clinical Evidence Dynamed UpToDate Banzi R et al. J Med Int Res 2010; 12(3): e26. Prorok JC et al. J Clin Epi 2012; 65:

26 Relevance - coverage Banzi 2010 Prorok 2011 No tool covers every question ACP Pier Clinical Evidence Dynamed UpToDate Banzi R et al. J Med Int Res 2010; 12(3): e26. Prorok JC et al. J Clin Epi 2012; 65:

27 Relevance - Timeliness UpToDate Dynamed No tool is to the date Clinical Evidence ACP Pier Time (months) Prorok JC et al. J Clin Epi 2012; 65:

28 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Highly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

29 Usefulness equation Usefulness = Relevance Validity Work Little work Highly relevant Highly valid Shaughnessy AF et al. J Fam Pract 1994; 39:

30 Validity Banzi 2010 Prorok ACP Pier Clinical Evidence Dynamed UpToDate Banzi R et al. J Med Int Res 2010; 12(3): e26. Prorok JC et al. J Clin Epi 2012; 65:

31 Validity Banzi 2010 Prorok 2011 No tool has perfect validity ACP Pier Clinical Evidence Dynamed UpToDate Banzi R et al. J Med Int Res 2010; 12(3): e26. Prorok JC et al. J Clin Epi 2012; 65:

32 Evidence pyramid Summaries Less work Less detail Systematic Reviews More work More detail Studies Adapted from Haynes RB. EBM 2001; 6:

33 Evidence pyramid Summaries Systematic Reviews Studies Adapted from Haynes RB. EBM 2001; 6:

34 Where do we look? PD and peritonitis 15 seconds!

35 Evidence pyramid Summaries Systematic Reviews Randomised trials Adapted from Haynes RB. EBM 2001; 6:

36 Where do we look? PD and peritonitis 10 minutes

37 Evidence pyramid Summaries Systematic Reviews Randomised trials Cohort studies Case-control studies Case-series Case reports Adapted from Haynes RB. EBM 2001; 6:

38 Where do we look? PD and peritonitis Search Hours Shariff SZ et al. J Nephrol 2011; 24(6):

39 General advise Adapted from Haynes RB. EBM 2001; 6:

40 Criticims Some questions I KNOW are not covered! If you re right you ll lose 45 seconds If you re wrong you could spare yourself embarrasment

41 Criticims Usefulness = Not detailed enough! Relevance Validity Work

42 Criticims Dangerous if you ask me!!! Oh, and stupidity is always dangerous... For > 50% of questions, we don t look for an answer, but we ALWAYS take a decision

43 What to remember Search strategically: top-tobottom Don t be ashamed of using point-of-care tools Information you can search, but no-one can do the thinking for you!