PICO Searching @ Heritage University Library Video

Step 1 in  EBP is to develop an answerable clinical question.

Review the section on PICO questions in this LIbGuide
 

PICO Searching @ Heritage University Library Video

• PICO Pointers

  A worksheet to help conduct a PICO search.

• PICO Searches in HU Library Databases

  Step-by-step guide in for doing PICO searches in:
  • Chochrane
  • PubMed
  • ProQuest
  • EbscoHost

• PICO Basic

  A quick review of the mnemonic PICO and what each category includes.

• PICO Populations

  A guide to selecting specific populations in PICO searching

Lagnado, & Kohll, S. (2003). Seven steps to evidence based general practice. BMJ, 326(7395), 933–933. https://doi.org/10.1136/bmj.326.7395.933/a

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. AJN, American Journal of Nursing, 110, 51-53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2

Pipe TB, Wellik KE, Buchda VL, Hansen CM, Martyn DR. Implementing evidence-based nursing practice. Urol Nurs. 2005 Oct;25(5):365-70. PMID: 16294614.

Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ 312. pp. 71-72.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice. AJN: The American Journal of Nursing, 110(3), 58-61

 Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLoS ONE, 14(12), N.PAG.

• Access Science 

• CINAHL Complete 

• Cochrane Clinical Answers 

• Cochrane Library 

• Health Source: Nursing/Academic 

• MEDLINE 

• Nursing and Allied Health Science 

• PubMed 

Alternative EBP Resources
Agency for Healthcare Research and Quality
As an agency within the Department of Health and Human Services, AHRQ supports research that helps people make more informed decisions and improve the quality, safety, efficiency, and effectiveness of healthcare services. 

 American Association of Critical Care Nurses Levels of Evidence
In the AACN hierarchy, the highest forms of evidence are ranked as A and include meta-analyses and meta-syntheses. Evidence from controlled trials is rated B. Level C, the highest level for nonexperimental studies such as systematic reviews of qualitative, descriptive, or correlational studies. The lowest levels of D, E, and M are considered recommendations drawn from articles, theories, or manufacturers’ recommendations.

Bandolier
First published in 1994, Bandolier is an independent evidence-based healthcare eJournal.  Based at Oxford University, it is a leading source  of evidence based healthcare in the UK .

BestBETS (Best Evidence Topics)
The Emergency Department of Manchester Royal Infirmary, UK, developed  BETSs to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature.
 

Clinical Trials.gov:
Provides regularly updated information about federally and privately supported clinical research in human volunteers. Includes statements of a trial's purpose, participation guidelines, locations, and phone numbers for more details.

Johns Hopkins Evidence-Based Practice (JHEBP) model
Designed for Nurses and Healthcare Professionals as a problem-solving approach to clinical decision-making and is accompanied by  tools to guide users or through the EBP process.

6S Search Pyramid Tool 
The 6S pyramid is a guide to help find the best available research evidence quickly and efficiently. The higher levels of the pyramid represent more synthesized evidence.

Levels of Evidence for Cancer Screening and Prevention Studies (PDQ®)–Health Professional Version
Includes reviews of human studies and summarizes the level of the evidence for the magnitude of the effect (including absolute and relative risks) for both the benefits and the harms of implementing cancer screening and prevention interventions. The term Level of Evidence refers to the certainty of its estimate of the health effects of implementing the intervention in question.

Application evidence examines the integration of relevant evidence with clinical experience. The effectiveness of a therapeutic intervention is based on evidence determined by assessing the internal validity and external validity of a given study.

     -       Internal validity:  Is it a high quality study in terms of its methods (does it measure what it was intended to measure)?

     -       External validity:  Is the population and setting of the study similar to that of the one evaluated in the clinical question?

When these questions are answered, the evidence is applied by making a practice decision that integrates evidence, clinical expertise, and patient factors and preferences.  Usually a model of evidence based practice is used to apply research findings in nursing practice.

(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.)

Integrating the Evidence Tools
Applying the Evidence Worksheet
From Dartmouth Biomedical Libraries

Number Needed to Treat Calculator
Tool to calculate the number needed to treat (NNT) between two independent groups.

How to Calculate Relative Risk (RR)
Relative risk is calculated by dividing the death or disease risk in a specific population group (Group A) by the risk of people from all other groups.

The Intention-to-Treat Principle
The ITT principle defines both the study population included in the primary efficacy analysis and how the outcomes are analyzed.

Tutorial: How to read a forest plot 
The forest plot is a key way researchers can summarize data from multiple papers in a single image

Understanding confidence intervals helps you make better clinical decisions
The CI allows clinicians to determine if they can realistically expect results similar to those in research studies 

Understanding and using sensitivity, specificity and predictive values
Sensitivity and specificity are inversely proportional, meaning that as the sensitivity increases, the specificity decreases and vice versa.

Assessing or outcome evaluation seeks to interpret the results and evaluate the outcomes evidence of the intervention.  Outcome measures may be psychosocial (quality of life, improved patient perception of care, reduction in depressive and anxiety symptoms), physiologic (improved health, reduced complications), or functional improvement.  Evaluation of the process and the results may occur through peer assessment, audit, or even self-reflection.  Depending on the type of outcomes achieved, it may be possible to compare the outcomes of a study with similar outcomes on a local, or broader level.

(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.)
 

Assessment Tools

• General Appraisal Overview for All Studies

• Rapid Clinical Appraisal Checklist for Randomized Controlled Trials (RCTs)

• Rapid Critical Appraisal Checklist for Cohort Studies

• Rapid Critical Appraisal for Descriptive Studies

• Rapid Critical Appraisal of Evidence-based Guidelines

• Rapid Critical Appraisal of Evidence-based Practice Implementation or Quality Improvement Projects

• Rapid Critical Appraisal of Systematic Reviews of Clinical Interventions/Treatments

• Rapid Critical Appraisal of Qualitative Evidence

• Johns Hopkins Evidence Level and Quality Guide

• Johns Hopkins Synthesis Process and Recommendations Tool

Templates

• Evaluation Table Template

• Evidence Synthesis Table Templates

Standards
 Agency for Healthcare Research and Quality (AHRQ),Research Findings & Reports
The Agency for Healthcare Research and Quality (AHRQ), through its EPCs, sponsors the development of various reports to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reports provide comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies

Center for Nursing Classification and Clinical Effectiveness (CNC)
​​​​​​​An Iowa Board of Regents-approved Center, was established in 1995 to facilitate the ongoing research and development of the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). NIC and NOC are standardized nursing terminologies focused on nursing treatments and patient outcomes for use across settings and specialties.

Performance Measures 
The Joint Commission has successfully developed and nationally implemented many standardized core performance measures for hospitals.