2010 e-library resources gr june 29 2010

• As a member of the CME

Committee I recuse myself

from voting on this activity.

• I have no relevant or

financial conflict of interest to

disclose concerning this

presentation and have

received no honorarium or

payment in kind, above and

beyond my normal salary.

DISCLOSURE STATEMENT

At the conclusion of this activity participant’s

performance should be enhanced regarding:

● effectively accessing the e-library

resources;

● navigating the research databases

to ‘search smarter, not harder’

for clinical information;

● appreciating the “What’s in

it for me” moment.

“Knowledge is of two kinds. We

know a subject ourselves, or we

know where we can find

information upon it.”

-Samuel Johnson, 1775

The 9th standard of the Medical Library Association’s

Standards for Hospital Libraries 2002 with 2004

Revisions states that:

“Knowledge-Based Information

resources containing evidence

based cl inical information

resources be avai lable to

cl inical staff 24 hours a day,

7 days a week .”

Ideal 21st Century E-Library Resource:

• Evidence-Based

• Point-of-Care / Bedside Access

• Easy to use

• Fast /efficient

• Comprehensive

• Current

• If possible, provide full-text

E-Library Selection CriteriaMust Evaluate/trial multiple KB databases

No one database offers access to all available electronic journals and books (very little overlap between vendors)

• Provide best evidence to support clinical decision making

• Excellence/reputation of resource

• Multi-discipline resources

• Added value clinical tools/features/CME-CE hours

• Validate expected end-user experience

• Contract negotiations

– Cost (actual + hidden = $ + employee productivity)

– Concurrency of users

– 24/7 access portals

– E-access license for all

Return on Investment

The literature has shown that physician’s and

hospital staff who utilize EBM enhance the

quality of patient care and value of service

through:

• Improved Outcomes

• Cost Savings

• Improved Patient Safety

(Fischer 2005;93(4):347-352. King 1987; 75(4):291-301. Marshall 1992;80(2):169-178)

Added Value of E-Library

• Align with changing education structure of NEPA

• Sharpen competitive edge

– Recruitment/retention tool

– Enhance IM & Podiatry programs

– Attract student programs as clinical training site

• Sustain reputation of providing clinical excellence

• Support Magnet Recognition Requirements

• Research best practice information

• Retrieve benchmark data/support

– QI decision-making

– Management decision-making

• Maintain accreditation standards

– ACCESS MEDICINE

– DYNAMED

– EBSCO RESOURCE DATABASES

– MDCONSULT

– NURSING REFERENCE CENTER

– PERC

– STAT!REF

EBSCO Basic Search Screen lets you create

a search with

•Limiters

•Expanders

•Boolean operators

Boolean Search Operators

• And (results contain all search terms)

• Or (results contains at least one search term)

• Not (results do not contain the specified

terms)

You can use these operators to

create a very broad or very

narrow search.

EBSCO Advanced Search Options

• Search modes• “Find all of my search terms,”

• “SmartText Searching,”

• “Apply related words.”

• Limit your results• Full Text

• Publication type

• Time Frame

• Special Limiters • Apply limiters specific to a database. If you select

a special limiter, it is applied only to the database

under which it appears

• Click the Search button

• The Result List displays

(Searching…)

• SmartText Searching– You can copy and paste chunks of text (up

to 5000 characters including spaces) to

search for results.

– SmartText Searching leverages a technology

that summarizes text entered to the most

relevant search terms then conducts search. (This search mode is not available for all databases).

• Quotations– Typically, when a phrase is enclosed by

double quotations marks, the exact phrase is

searched.

– Stop words are always ignored, even if they

are enclosed in quotation marks.

• Parenthesis– Use parentheses to nest query terms within

other query terms using Boolean operators.

Stop Words Are always ignored, even if they are enclosed in quotation

marks.

This allows the search engine to retrieve a more precise

Result List, especially for a natural language (relevancy

ranked) search.

Stop words vary by database. A sample list of common

stop words appears below.

a

an

are

as

at

be

because

been

but

by

for

however

if

in

is

of

on

so

the

there

to

was

were

whatever

whether

would

Wildcard

The wildcard is represented by a question

mark ? or a pound sign #.

• To use the ? wildcard, enter your search

terms and replace each unknown character

with a ?.

(For example, type ne?t to find all citations containing

neat, nest or next.)

• To use the # wildcard, enter your search

terms, adding the # in places where an

alternate spelling may contain an extra

character.

(For example, type colo#r to find all citations

containing color or colour.)

Truncation

Truncation is represented by an asterisk (*).

To use truncation,

• enter the root of a search term and replace

the ending with an *.

(For example, type comput* to find the words

computer or computing.)

• may be used between words to match any

word.

(For example, a midsummer * dream will return

results that contain the exact phrase, a midsummer

night’s dream.)

click the Search Options link to use Limiters or Expanders.

A result list will be displayed that matches the information you

provided.

The Result List Screen has three columns ● Narrow your results

● All Results

● Limit your results

You can hide or show the different areas by clicking the control arrows

near the top of your results

Citation View

PrintE-mail

SaveCite

Export

Folder

(EBSCOhost User Guide - Searching April 2010 support.ebsco.com)

On the Citation Matcher search screen, enter as much information as you

have into the fields provided (Publication, Volume, Author, Title, etc.) and

click Search.

• SmartLinks– A hyperlink within the citation when the article is

available as full text or a page image (PDF)

within another EBSCOhost database.

• Create a new Account

• My Folder

• Sharing a Folder

• Un-sharing a Folder

• HELP Link

• CME/CE

Additional Features

My Folder

There are three folder areas for use:

– My Folder – this area holds the items that you have

collected during your current session. This folder

cannot be shared.

– My Custom – custom folders you create, and then

move result items into. You can share custom folders

with other EBSCOhost users, if desired.

– Shared by – custom folders that another user

creates and then shares with you.

You must be signed into My EBSCOhost to access custom

or shared folders.

In order to share a folder, it must be at the “top level” of the

folders.

If you have multiple levels of folders, the sub-folders cannot

be shared.

Sharing a Folder

Sharing Options

EBSCO Help Link

DynaMed

Nursing Reference Center

Patient Education Reference Center

MDConsult

Access Medicine

STAT!Ref

Additional Open Access Links

PubMed

PubMed Central

Centre for Evidence-Based Medicine

Founder of the

Oxford Centre for Evidence-Based Medicine

• pioneered and considered to

be the “Father of Evidence-

Based Medicine”

• is a Canadian medical

doctor

• founded the first department

of clinical epidemiology at

McMaster University,

Canada

• well known for his textbooks

Clinical Epidemiology and

Evidence-Based Medicine

David Lawrence Sackett

What is EBM?

Evidence-based medicine (EBM) is the integration of best

research evidence with clinical expertise and patient values.

•BEST RESEARCH evidence we mean clinically relevant research, often

from the basic sciences of medicine, but especially from patient centered

clinical research into the accuracy and precision of diagnostic tests (including

the clinical examination), the power of prognostic markers, and the efficacy

and safety of therapeutic, rehabilitative, and preventive regimens. New

evidence from clinical research both invalidates previously accepted

diagnostic tests and treatments and replaces them with new ones that are

more powerful, more accurate, more efficacious, and safer.

•CLINICAL EXPERTISE we mean the ability to use our clinical skills and past

experience to rapidly identify each patient's unique health state and diagnosis,

their individual risks and benefits of potential interventions, and their personal

values and expectations.

•PATIENT VALUES we mean the unique preferences, concerns and

expectations each patient brings to a clinical encounter and which must be

integrated into clinical decisions if they are to serve the patient.

Level of Evidence

Level A

– Cochrane Reviews of randomized controlled trials (RCTs) where adequate

data are found for analysis

– Other good quality systematic reviews or meta-analyses of RCTs where

adequate data are found for analysis

– Good-quality RCTs

Level B

– Other RCTs not included in Level A

– Other systematic reviews or meta-analyses not included in Level A

– Rarely, good-quality nonrandomized clinical trials, and very occasionally

other types of study such as case-control studies, clinical cohort studies,

cross-sectional studies, retrospective studies, or uncontrolled studies

Level C

– Evidence-based consensus statements and expert guidelines

The U.S. Preventive Services Task Force (USPSTF) Another grading system for EBM

Quality of Evidence The USPSTF grades its recommendations according to one of five classifications

(A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit

(benefits minus harms).

The overall evidence for a service is graded on a 3-point scale (good, fair, poor):

• Good: Evidence includes consistent results from well-designed, well-

conducted studies in representative populations that directly assess effects on

health outcomes.

• Fair: Evidence is sufficient to determine effects on health outcomes, but the

strength of the evidence is limited by the number, quality, or consistency of the

individual studies, generalizability to routine practice, or indirect nature of the

evidence on health outcomes.

• Poor: Evidence is insufficient to assess the effects on health outcomes

because of limited number or power of studies, important flaws in their design

or conduct, gaps in the chain of evidence, or lack of information on important

health outcomes.

(U.S. Preventive Services Task Force Ratings: Grade Definitions. Guide to Clinical Preventive Services, Third Edition:

Periodic Updates, 2000-2003. Agency for Healthcare Research and Quality, Rockville, MD.

http://www.ahrq.gov/clinic/3rduspstf/ratings.htm )

Evidence-Based Process

The evidence-based practice process involves the following steps:

1. Problem Identification: Converting information needs into

an answerable question

2. Finding the Evidence: Finding, with maximum efficiency,

the best evidence with which to answer the question

3. Critique: Determining the merit, feasibility and utility of

evidence

4. Summarize the Evidence: Combining findings from all

evidence to make a practice recommendation

5. Application to Practice: Incorporating the recommendation

into a clinical setting or organization

6. Evaluation: Determining the effectiveness of the practice

change over time

EBM is patient centric, beginning & ending with the patient.

Thank you for supporting today’s CME Program & utilizing the E-Library Databases at CMC!

“The Desk Set” (1957) Emmerac is introduced to assist the

researchers…(Emmerac can make a mistake, but only if the human

element made the mistake first upon entering the data)