World Health Organization



. HINARI Access to Research in Health Programme

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1 Module 7.2 EVIDENCE-BASED PRACTICE RESOURCES

2 FOR HINARI USERS

Table of Contents:

Evidence-based Practice definition, background and resources

Clinical Evidence

Cochrane Library

EBM Guidelines

HINARI EBM Journals

Searching for EBM articles in a specific journal (Science Direct)

HINARI/PubMed’s Clinical Queries

Summary

Module Objectives:

11 The objectives of this module are to briefly summarize the concept of Evidence-based Medicine and give an overview of some of the Evidence-based health care resources in HINARI particularly those accessible via the Reference Sources drop down menu – Clinical Evidence, Cochrane Library and EBM Guidelines. The module also outlines how to locate Evidence-based health care information using the PubMed’s Clinical Queries features including ‘Search by Clinical Study Category’ and ‘Find Systematic Reviews’. The use of evidence-based information will assist clinicians and health workers in making informed decisions in the care of patients and communities.

You will need access to the HINARI to complete a series of exercises.

1. Finding the HINARI website and registering to access the resources

➢ Open the HINARI website at who.int/hinari

➢ From the initial page, select the LOGIN hyperlink which will take you to the HINARI login page.

➢ When the login page opens, enter your institutional HINARI User Name and Password into the login boxes and then select the Login button to access the HINARI site.

➢ Logging in to HINARI will provide authentication to access full-text articles and other resources via the project’s website. If you do not register using your institutional User Name and Password, you will not have access to the full-text articles, only the citations.

➢ Note the Reference Sources drop down menu in the right column.

2. Accessing article that discusses Evidence-based Medicine

14 The PowerPoint presentation includes a definition of Evidence-based Medicine by D. Sackett. You will access/read this article from HINARI so that you can better understand Evidence-based Medicine.

Exercise 1

➢ From the HINARI login page, enter your institutional HINARI User Name and Password into the login boxes and then select the Login button to access the HINARI site.

➢ After entering the Full-text journals, databases and other resources page, go to Find journals by title.

➢ Find the BMJ: British Medical Journal by clicking on B from the A-Z title list.

➢ Select it from the list by clicking on the title.

➢ The BMJ will open on the publisher’s website.

➢ Scroll down the page until you locate full text archives and the hypertext link to the 1996 issues. Click on this link.

➢ Go to the volume 312 (13 Jan) and then scroll to pages 71-72 for the editorial titled Evidence based medicine: what it is and what it isn’t? (Sackett, et al.)

➢ Open the full-text of the document and read the brief editorial.

➢ Does the practice of Evidence-based Medicine combine ‘clinical expertise’ with ‘best evidence’ research?

➢ How could you or individuals in your institution use Evidence-based Medicine in the clinical setting?

3. Using Evidence-based Healthcare resources available from HINARI/Reference Sources

3.1 Finding resources in Clinical Evidence

15 Clinical Evidence is one of the Evidence-based Medicine resources available from HINARI. Go to the Reference Sources drop down menu and click on the link to Clinical Evidence. You will be re-directed toward this resource. This is a resource for informing treatment decisions and improving patient care. It is published by the BMJ Publishing group.

Exercise 2

➢ From the Full-text journals, databases and other resources page, go to the Reference Sources drop down menu and click on Clinical Evidence.

➢ In this resource, open the Sections drop down menu and click on the HIV/AIDS category.

➢ What is the number of Systematic reviews topics in this section?

➢ Go back to the initial page of Clinical Evidence and enter infant diarrhea in the Search this site box and click on the magnifying glass.

➢ What is the number of Results from this keyword search?

➢ Complete one keyword search using a topic of interest to you in Search this site and note the number of Results.

3.2 Finding resources in Cochrane Library

16 Cochrane Library is a second of the Evidence-based Medicine resources available from HINARI. Go to the Reference Sources drop down menu and click on the link to Cochrane Library. This resource contains high-quality, independent evidence including reliable evidence from Cochrane and other systematic reviews and clinical trials. It is published by John Wiley.

Exercise 3

➢ From the Full-text journals, databases and other resources page, go to the Reference Sources drop down menu and click on Cochrane Library.

➢ In the Title, Abstract or Keywords search box, enter pneumonia and click on Go.

➢ What is the number of records found in the Cochrane Database of Systematic Reviews?

➢ Go back to the Title, Abstract or Keywords search box, enter pneumonia AND developing countries and click on Go

➢ What is the number of records for this more precise keyword search?

➢ View the abstracts of the articles of interest to you.

➢ How many of these studies from the Cochrane Database of Systematic Reviews would be of use at your institution or a hospital in your country?

➢ Complete one keyword search using a topic of interest to you in the Title, Abstract or Keywords search box and note the number of Results.

Exercise 4

➢ For institutions without full access to Cochrane Library, enter the Cochrane Reviews directly using the website address.

➢ Click on the Cochrane Library button.

➢ In the Title, Abstract or Keywords search box, enter diarrhea child* and click Go.

➢ What is the number of records found in the Cochrane Database of Systematic Reviews?

➢ How many of these studies from the Cochrane Database of Systematic Reviews would be of use at your institution or a health facility in your country?

➢ Remember that you cannot access the full-text reviews, only the abstracts.

3.3 Finding resources in EBM Guidelines

17 EBM Guidelines is the third of the Evidence-based Medicine resources available through HINARI. Go to the Reference Sources drop down menu and click on the link to EBM Guidelines. Also published by John Wiley, this resource is a collection of clinical guidelines for primary care combined with evidence-based research.

Exercise 5

➢ Return to HINARI and make sure you are properly logged in. From the Full-text journals, databases and other resources page, go to the Reference Sources drop down menu and click on EBM Guidelines.

➢ In the Search box, enter infection control and click on Search.

➢ What is the number of Evidence summaries?

➢ How many of these summaries would be of use at your institution or a health facility in your country?

➢ Complete one keyword search of interest to you in the Search box and note the number of Results.

Exercise 6

➢ Return to the initial page of EBM Guidelines.

➢ Above Search Box, click on Browse Database Contents, then click on the +EBM Guidelines.

➢ View the various subject categories (e.g. Cardiology, Infectious diseases).

➢ Name three subjects that would be of interest to you.

➢ View the contents of one of these subjects.

➢ How many EBM Guidelines are in this specific category?.

4. Searching in an Evidence-based Health care journal.

18 There are several HINARI journals that are devoted to Evidence-based health care. By going to the Find journals by title A-Z list, clicking on E and scrolling down to Evidence, you can locate several journals. Remember that other journals also contain evidence-based health care articles.

Exercise 7

➢ From the HINARI Full-text journals, databases and other resources page, go to the Find journals by title A-Z list and click on E.

➢ Scroll down the E list until you locate titles beginning with Evidence.

➢ How many journal titles starting with the word Evidence are listed?

➢ Click on the link to Evidence-based Child Health: a Cochrane Review Journal and go to the current issue.

➢ List the citation of one article that is of interest to you or an individual at your institution.

➢ Enter diarrhea in the SEARCH IN THIS JOURNAL box with the All Fields option and click Go.

➢ How many articles are listed for this search?

5. Locating Evidence-based Medicine information using HINARI/PubMed’s Clinical Queries

19 PubMed’s Clinical Queries is another option for locating evidence-based health care information. From this option, you can Search by Clinical Study and Find Systematic Reviews to find citations for systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Remember that you must use HINARI/PubMed to have access to the HINARI’s full-text articles.

Exercise 8

➢ From the Full-text journals, databases and other resources page, click on the Search HINARI journal articles through PubMed hyperlink.

➢ After entering PubMed, click on the link to Clinical Queries that is located under the PubMed Tools heading.

➢ In the Search box, enter hypertension AND developing countries. In the Clinical Study Category drop down menus, also click on the diagnosis Category and the broad in the Scope. Click on Search.

➢ How many citations are listed for the Clinical Study Categories filter? How many citations are listed for the Systematic Reviews filter?

➢ Click on See all for the Clinical Study Categories. In the Search Results display, what are the numbers of articles listed under the Free full text and HINARI filters?

Exercise 9

➢ Return to Clinical Queries from the initial HINARI/PubMed page.

➢ In the Find Systematic Reviews Search box, enter smoking cessation AND behavioral interventions (or a search of interest to you) and click Go.

➢ What is the number of Systematic reviews in the Results of this search?

➢ Go back to the initial page of Clinical Queries and complete one keyword search of interest to you in Find Systematic Reviews and note the number of Results.

Exercise 10

Complete the Evidence-based Medicine Module Review. Answer the following true/false questions:

1. Evidence-based practice mandates the application of evidence in clinical decision-making.

____true false____

2. HINARI resources include evidence-based guidelines, articles, summaries, and systematic reviews.

____true false____

3. Evidence-based practice requires continuous updating of one’s knowledge base.

____true false____

4. Searching in Clinical Queries/PubMed is one of the key ways to find evaluated evidence-based summaries.

____true false____

5. A well-done systematic review usually provides stronger evidence than a single clinical trial.

____true false____

Assignment

You have completed ten exercises about evidence-based health care. You have read an overview article and learned how to locate information in three HINARI Reference Source, the HINARI journal A-Z list and via HINARI/PubMed Clinical Queries. The final exercise was a true/false quiz about evidence-based health care. These skills will be useful to obtain evidence-based medical information and will assist clinicians and health workers in making decisions in the care of patients.

Updated 2011 08

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