Searching Effectively and Efficiently for Accurate Answers to Clinical Questions Andrew Schenkel DMD, MS New York University College of Dentistry Richard McGowan MLS New York University Health Sciences Library
Background Review Searching is one part of the evidence based decision making (EBDM) process used to answer clinical questions Searching is part of the second step in the process- finding the best available evidence to answer the question
EBP According to the ADA An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. American Dental Association (n.d.) Evidence-Based Dentistry: Glossary of Terms. Retrieved March 5, 2009 from the World Wide Web: http://ada.org/prof/ resources/ebd/glossary.asp#ebd
What Does That Mean? Best available evidence Practitioner s clinical expertise Patient s preference Decision Courtesy of Dr. Ivy Peltz
EBP According to NYUCD Our graduates must be able to ascertain the appropriate questions that they as clinicians need to answer in order to care for their patients; identify appropriate sources of information to answer these questions; assess the validity of the information obtained; and utilize the information in the care of their patients. We call this process Evidence-based Practice.
Why Bother? Provide the best possible treatment Based on the best evidence Objective & unbiased Systematic search and appraisal Acceptable level of uncertainty NYUCD Strategic Plan Develop men and women of science That is, sophisticated consumers of research able to appropriately treat patients
Before EBP? Who needs evidence? It works in my hands Going to the literature and finding an article that supports the position or treatment choice that you think is the best Random search (Google), limited appraisal Subjective & potentially biased (intentional or unintentional Inappropriate level of certainty
The Five A s of EBP Ask Determine the clinical question Acquire Systematically search the literature Appraise Critically appraise the literature Apply Make a decision Assess Evaluate the results Centre for Evidence-Based Dentistry (2007). Introduction to practising Evidence-based dentistry. Retrieved March 5, 2009 from the World Wide Web: http:// www.cebd.org/index.aspx?o=1007
A #1 Asking Focused PICO Format: Questions Population (Patient) or Problem Intervention Comparison Outcome Centre for Evidence-Based Medicine (2009). Asking Focused Questions. Retrieved March 5, 2009 from the World Wide Web: http://www.cebm.net/index.aspx? o=1036
PICO Example P Adult human patients I Chairside tooth whitening C At-home tooth whitening O Lighter teeth
Clinical Question In adult human patients, is chairside tooth whitening more effective than at-home tooth whitening in producing lighter teeth?
A #2 Acquire Appropriate Evidence EVIDENCE HIERARCHY
Systematic Reviews EVIDENCE HIERARCHY Strong RCT s Cohort study Case control study Case series Case report Expert opinion Animal research Bench-top research Weak Used by permission of the ADA. December, 2008
Why Systematic Reviews? Synthesizes results from multiple trials (studies) addressing the same question Provides a clear summary of the current best evidence on a specific topic Uses rigorous scientific methods to review original research in order to minimize bias Provides a way of managing large quantities of information and keeping current with new research When possible, allows statistical combination of data for a single estimate of effect- Meta Analysis
Why Systematic Reviews?- TMI MEDLINE: 4,000 journals 6 million references 400,000 new entries yearly American Dental Association (2009). Final_EBD_-_Intro_for_Champions_120909. The Evidence-Based Dentistry Champion Conference. ADA Headquarters, Chicago, IL.
Searching Beyond Google PubMed- Clinical Queries- Systematic Reviews See all (xx) Go to PubMed directly: http://www.pubmed.gov/clinical Or through your institution s link in order to get access to full text articles (subscription based)
Searching Beyond Systematic PubMed Medline Reviews Cochrane Library Google Scholar Web of Knowledge Web of Science Google
Searching Beyond Primary Sources EBD web site (ADA.org) EviDents Search Engine (UTHSCSA.edu) Evidence Based Dentistry (Nature.com) Journal of Evidence Based Dental Practice Google
Evidence Based Decision Ask answerable questions Acquire the best evidence Making Appraise the evidence Apply evidence to patient care Assess treatment outcomes Used by permission of the ADA. December, 2008
Additional training available SUNY DOWNSTATE MEDICAL CENTER EVIDENCE BASED MEDICINE TUTORIAL http://library.downstate.edu/ebm2/ contents.htm PubMed tutorial on online searches http://www.nlm.nih.gov/bsd/disted/ pubmed.html