NMETH403: Research to Practice

Sample Question:

What are effective interventions used to prevent falls in the elderly?

Searching the Literature

Researchers perform comprehensive literature reviews as a preliminary step in research studies. Clinicians perform more focused searches of the literature to discover information that is useful for patient care. Clinical information is developed gradually through research studies and individual interactions between clinicians and patients. Different types of publications summarize information from both these sources.

This outline highlights the major resources a clinician might consult to answer a clinical question. Not every question requires consulting the full range of resources.

Textbooks

Core textbooks summarize current standards of care, based on the experiences of expert clinicians and the results of research studies.
Textbooks are concise and easy to scan for relevant information, but ...
Textbooks are expensive and take several years to publish, so information in them may be incomplete or inaccurate if new knowledge has been developed, which is especially likely regarding therapies.
Begin by looking in UpToDate
The most current, extensive electronic textbook for medicine. Recommendations are based on the available evidence and the author's clinical experience. Continuously updated.

HINT: Type falls in the search box. One of your choices will be "Overview of falls in the elderly."
Locate additional textbooks using:
- HealthLinks: Textbooks for electronic textbooks. There are no electronic textbooks on falls but you may want to look at:
  - Harrison's
    HINT: Type falls in the search box and the first result is "Chapter 9: Falls in Geriatric Medicine."
  - MD Consult | Search Tips
    HINT: Click on "Open Generic Account" then click on "Books." Click on "Advanced Search" to search within textbooks. Type falls and elderly in the search box.
- UW Libraries Catalog for print textbooks
  
  HINT: Type falls and elderly or falls and prevent in the keywords search box.

Review Articles

Review articles summarize a number of studies on the same topic.
Reviews can lead you to extensive lists of research articles on a similar topic, but ...
It may not be possible to tell what criteria the author used in selecting the studies to be included or excluded.
Locate review articles using:
- PubMed | Search Tips
Check availability of journals using:
- HealthLinks: Journals for electronic journals
- UW Libraries Catalog for print journals

Research Articles

Research articles are published results of research studies.
Research studies are the primary means of developing new clinical knowledge, but ...
Research articles vary in the level of detail given about the study. You may need to do your own evaluation.
Locate research articles using:
- PubMed | Search Tips
  Hint: you can limit Publication Type, such as randomized controlled trial or clinical trial
- PubMed Clinical Queries | Search Tips | Video
- CINAHL | Search Tips
  HINT: Type falls and prevent$ and aged in search box. You can limit with Publication Type, such as Clinical Trial or Research
- More databases ...

Clinical Practice Guidelines

Guidelines are systematically developed statements of appropriate care designed to assist the practitioner and patient make decisions about appropriate health care for specific clinical circumstances.
Guidelines from reputable, authoritative organizations are usually based on the most current, relevant research, but ...
Guidelines are developed using widely varying standards. Cost may be considered as well as health outcomes.
Locate clinical practice guidelines using:
- National Guideline Clearinghouse
  The National Guideline Clearinghouse (NGC) is a comprehensive database of evidence-based clinical practice guidelines sponsored by the Agency for Healthcare Research and Quality, the American Medical Association, and the American Association of Health Plans. The database includes structured abstracts, links to full-text guidelines (where available), and ordering information for print copies.
  
  HINT: Type falls and prevention in search box.
- CINAHL | Search Tips
  HINT: Type falls and aged in search box. Limit to Practice Guidelines publication type.
- MD Consult | Search Tips
  MD Consult Clinical Guidelines section contains over 600 peer-reviewed clinical practice guidelines. MD Consult is an online medical information service containing full-text reference books, guidelines, full-text journals, patient information, and drug information.
  HINT: Click on "Open Generic Account" then click on "Current Practice" then "Practice Guidelines." Click on Topics and look under "F" for Fall Prevention.
- Web search engines or subject directories
  - Google
    HINT: Type falls prevention elderly guidelines in the search box.
- Remember to evaluate anything you locate on the web using the Criteria for Evaluating Web Sites on the Navigating the Web: Using Search Tools and Evaluating Resources tutorial.

Summaries

It is difficult for a clinician to analyze all the information in a field.
Some resources, such as UpToDate and Clinical Evidence, offer summaries of evidence-based information on a topic.
Locate summaries using:
- UpToDate
  The most current, extensive electronic textbook for medicine. Pediatric, Neurology and Allergy/Immunology sections in development. Recommendations are based on the available evidence and the author's clinical experience. Continuously updated, not by any specific time schedule.
  HING: Type falls in search box.
- Clinical Evidence
  Updated compendium of evidence on the effects of clinical interventions. Summarizes the best available evidence and the current state of knowledge, including knowns and unknowns, based on thorough searches. Covers more than 145 conditions and more than 350 clinical questions.
  HINT: Type falls in the search box.

MetaSearch Engines

A metasearch engine is a search engine that searches multiple other search engines simultaneously and combines the results.

Locate evidence-based sources using a metasearch engine:

TRIP Database
TRIP (Turning Research Into Practice) database performs a simple search of more than 75 databases, including CDSR Abstracts, NGC, Bandolier, Evidence-Based Medicine, DARE, POEMs, etc. for access to evidence-based material as well as articles from peer-reviewed journals. Only free online documents are linked on the free access site.
HINT: Type falls in the search box.

Search PrimeEvidence

PrimeEvidence searches selected evidence-based documents in the PrimeAnswers database

Search PrimeEvidence: (selected evidence-based documents in the PrimeAnswers database)
HINT: Type falls in the search box.

Systematic Reviews

Systematic reviews use explicit methods to identify, select, and critically evaluate relevant research. Meta-analyses are systematic reviews that combine the results of several studies using quantitative statistics.
Systematic reviews minimize the possibility of bias by using explicit criteria, and expand the relevance of individual studies with limited scope, but ...
Only a small number of clinical topics are covered by systematic reviews, because they require years of effort to develop.
Locate systematic reviews using:
- Cochrane Database of Systematic Reviews (CDSR)
  The CDSR is a full-text database containing systematic reviews of the effects of health care interventions; mainly randomized controlled trials.
  HINT: Type accidents and falls and elderly in the search box.
- PubMed Systematic Reviews | Video
  PubMed Systematic Reviews combines your search term(s) with citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines.
  HINT: Click on systematic REviews. Type falls prevention aged in search box.

For More Information

Evidence-Based Practice Tools Summary
http://healthlinks.washington.edu/ebp/ebptools.html
Find the Evidence, in the Care Provider Toolkit
http://healthlinks.washington.edu/care_provider/
Evidence-Based Practice
http://healthlinks.washington.edu/ebp/
Basic Introduction to Evidence-Based Practice
http://healthlinks.washington.edu/hsl/classes/evidence/

Janet G. Schnall, MS, AHIP
Information Management Librarian
Library Liaison to the University of Washington School of Nursing, Department of Pediatrics, Department of Ophthalmology and Multicultural Affairs
schnall@u.washington.edu
http://healthlinks.washington.edu/hsl/liaisons/schnall/

Joanne Rich, MLIS, BScPharm
Information Management Librarian
Library Liaison to the University of Washington School of Nursing, and Departments of Anesthesiology and Physiology and Biophysics
jrich@u.washington.edu
http://healthlinks.washington.edu/hsl/liaisons/rich/

Created March 31, 1999.
Revised October 23, 2003.

This page may be reprinted or adapted for academic nonprofit purposes, providing the source is accurately quoted and credited.