Searching Effectively
and Efficiently for
Accurate Answers to
Clinical Questions
Andrew Schenkel DMD, MS
New York University College of Dentistry
Richard McGowan MLS
New York University Health Sciences Library
Background Review
Searching is one part of the evidence based
decision making (EBDM) process used to
answer clinical questions
Searching is part of the second step in the
process- finding the best available
evidence to answer the question
EBP According to the ADA
“An approach to oral health care that
requires the judicious integration of
systematic assessments of clinically
relevant scientific evidence, relating to the
patient's oral and medical condition and
history, with the dentist's clinical expertise
and the patient's treatment needs and
preferences.”
American Dental Association (n.d.) Evidence-Based Dentistry: Glossary of Terms.
Retrieved March 5, 2009 from the World Wide Web:
http://ada.org/prof/resources/ebd/glossary.asp#ebd
What Does That Mean?
Decision
Patient’s preference
Best available evidence
Practitioner’s clinical
expertise
Courtesy of Dr. Ivy Peltz
EBP According to NYUCD
Our graduates must be able to ascertain the
appropriate questions that they as clinicians
need to answer in order to care for their
patients; identify appropriate sources of
information to answer these questions;
assess the validity of the information
obtained; and utilize the information in the
care of their patients. We call this process
“Evidence-based Practice.”
Why Bother?
Provide the best
possible treatment Based on the best evidence
Objective & unbiased
Systematic search and
appraisal
Acceptable level of
uncertainty
NYUCD
Strategic Plan Develop men and
women of science
That is, sophisticated
consumers of research
able to appropriately
treat patients
Before EBP?
Who needs evidence? “It works in my hands”
Going to the literature and finding an article that
supports the position or treatment choice that you
think is the best
Random search (Google), limited appraisal
Subjective & potentially biased (intentional or
unintentional
Inappropriate level of certainty
The Five “A”s of EBP
Ask – Determine the clinical question
Acquire – Systematically search the literature
Appraise – Critically appraise the literature
Apply – Make a decision
Assess – Evaluate the results
Centre for Evidence-Based Dentistry (2007). Introduction to practising Evidence-based
dentistry. Retrieved March 5, 2009 from the World Wide Web:
http://www.cebd.org/index.aspx?o=1007
A #1 – Asking Focused
Questions
PICO Format:
Population (Patient) or Problem
Intervention
Comparison
Outcome Centre for Evidence-Based Medicine (2009). Asking Focused Questions. Retrieved
March 5, 2009 from the World Wide Web:
http://www.cebm.net/index.aspx?o=1036
PICO Example
P – Adult human patients
I – Chairside tooth whitening
C – At-home tooth whitening
O – Lighter teeth
Clinical Question
In adult human patients, is chairside tooth
whitening more effective than at-home tooth
whitening in producing lighter teeth?
A #2 – Acquire Appropriate
Evidence
EVIDENCE HIERARCHY
Strong
Weak
Systematic Reviews
RCT’s
Cohort study
Case control study
Case series
Case report
Expert opinion
Animal research
Bench-top research
Used by permission of the ADA. December, 2008
EVIDENCE HIERARCHY
Why Systematic Reviews?
Synthesizes results from multiple trials (studies)
addressing the same question
Provides a clear summary of the current best
evidence on a specific topic
Uses rigorous scientific methods to review
original research in order to minimize bias
Provides a way of managing large quantities of
information and keeping current with new
research
When possible, allows statistical combination of
data for a single estimate of effect- Meta Analysis
Why Systematic Reviews?-
TMI
MEDLINE:
4,000 journals
6 million references
400,000 new entries yearly
American Dental Association (2009). Final_EBD_-_Intro_for_Champions_120909. The
Evidence-Based Dentistry Champion Conference. ADA Headquarters, Chicago, IL.
Searching Beyond Google
PubMed-
Clinical Queries-
Systematic Reviews
See all (xx)
Go to PubMed directly:
http://www.pubmed.gov/clinical
Or through your institution’s link in order to get
access to full text articles (subscription based)
Searching Beyond Systematic
Reviews
PubMed
Medline
Cochrane Library
Google Scholar
Web of Knowledge Web of Science
Searching Beyond Primary
Sources EBD web site (ADA.org)
EviDents Search Engine
(UTHSCSA.edu)
Evidence Based Dentistry (Nature.com)
Journal of Evidence Based Dental
Practice
Ask answerable
questions
Acquire the best
evidence
Appraise the
evidence
Apply evidence to
patient care
Assess treatment
outcomes
Used by permission of the ADA. December, 2008
Evidence Based Decision
Making
Additional training available
SUNY DOWNSTATE MEDICAL CENTER
EVIDENCE BASED MEDICINE TUTORIAL–
http://library.downstate.edu/EBM2/contents.ht
m
PubMed tutorial on online searches –
http://www.nlm.nih.gov/bsd/disted/pubmed.ht
ml
Thank you all for your
interest and attention!
