Week 2: EIDM - Finding the Best Available Evidence

Single Studies (Dicenso 100)

6th level of the 6s pyramid

Pre-appraised articles that can be found in journals containing unique research information and addressing a specific clinical questions. Includes entire process for collecting data and published in reputable journals

Characteristics (Dueck)

-Primary, original research studies

-Includes introduction, methods, results, conclsuions

-Methods key terms: RCT, case study, survey, cohort study, interview

-Contains a list of references

What are examples of resources on the "Single Studies" level of the 6s pyramid?

PubMed

Ovid Databases

HSR Queries

CINAHL

Synopses of Single Studies (Dicenso 101)

5th level of the 6s pyramid

Provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice

Characteristics (Dueck)

-Provide abstracts/summaries (one page) of individual single studies

-May include commentary providing clinical relevance of the findings of the study

-Method key terms: RCT, case study, survey, cohort study, interview

-Includes a reference for the original study being summarized

What are the three advantages of finding evidence with a "synopsis of single studies" resource? (Dicenso 101)

-Assurance that the study is of sufficiently high quality and clinical relevance

-Brevity of the summary

-Value of commentary in the synopsis

Syntheses (Dicenso 100)

4th level of the 6s pyramid

Comprehensive summary (secondary research) of all the research evidence related to a focused clinical question using a rigorous selection criteria, more applicable to the entire population

Characteristics (Dueck)

-Research process involves using existing studies rather than conducting original research

-Methods includes list of databases or other sources used to find relevant research studies

-Selection criteria explains why studies were included or excluded

-Long reference list

-Includes appendices

What are example of resources on the "synthesis" level of the 6s pyramid? (Dicenso 100)

-ACPJC Plus

-EvidenceUpdates

-Nursing+

-Cochrane Library (Cochrane Database of Systematic Reviews)

Synopses of Syntheses (Dicenso 100)

3rd level of the 6s pyramid

Comprehensive summary of all the research evidence related to a focus clinical question, often provide sufficient information to support clinical action

Characteristics (Dueck)

-Provides abstracts/summaries (one page) of individual systematic reviews

-May include commentary about clinical relevance

-Methods includes list of databases or other sources used to find relevant research studies

-Includes reference for original study being summarized

What are the two advantages of finding evidence within a "synposes of syntheses" resource? (Dicenso 100)

-Provides convenient summary of the corresponding synthesis

-Often accompanied by a commentary that addresses the methodological quality of the synthesis and the clinical applicability of its findings

What is a disadvantage of finding evidence within a "synposes of syntheses" resource? (Dicenso 100)

It takes time to prepare a systematic review after the publication of original studies

Summaries (DiCenso 100)

2nd level of the 6s pyramid

Clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating

Characteristics (Dueck)

-Provide practice recommendations based on evidence from lower levels of pyramid

-Each recommendation is discussed with evidence provided

-Reference list is long

-Numerous appendicees

What are examples of resources on the summaries level of the 6s pyramid? (DiCenso 100)

Clinical Evidence

Dynamed

Best Practice Guidelines (RNAO BPGs)

Overton

Systems (DiCenso 99)

1st level of the 6s pyramid

Evidence-based clinical information system (CDSS), which integrates and concisely summaries all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links a specific patient's circumstances to the relevant information, generating patient-specific assessments or recommendations for clinicians

Characteristics (Dueck)

-CDSS

-Bring together all of patient's data and links it to the evidence so that treatment recommendation can be made for a specific patient

Where should you begin research for an EIDM question on the 6s pyramid? (NCCMT)

Start from top (often at Summaries), the most synthesized evidence and keep moving down until you find the best available quality evidence to answer your question

Background question

Filling in gaps of knowledge, looking for symptoms, treatments, prognosis, information usually derived from textbooks, eBooks, general websites

Foreground question

Answers a more specific clinical patient-centered PICO/PS question

PICO Question

Structure of a quantitative foreground question

P-Population

I-Intervention

C-Comparison of Intervention

O-Outcomes

PS Question

Structure of a qualitative foreground question

P-Population

S-Situation