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Evidence-Based Practice Journal Articles

How to Find Evidence-Based Journal Articles (Evidence-Based Practice)

A Librarian’s Advice

More and more students in the allied health, nursing, and medical fields are being asked to find evidence-based practice journal articles. The main term is “evidence-based.”

The Journal of the American Medical Association (JAMA) has an article that explains evidence-based medicine. “In the 1990s, evidence-based medicine emerged as a way to improve and evaluate patient care. It involves combining the best research evidence with the patient’s values to make decisions about medical care.” The key word is “evidence.”

As a librarian trying to find evidence-based articles for students, it appears to me that evidence-based information is kind of a “movement” that started in the 1990’s and has not really gone “mainstream,” at least not as much as many professionals would have liked, YET.  There are people pushing this in the medical and education professions, but it seems to me that there is NOT a lot of evidence-based information compared to ALL the scholarly research studies, clinical trials, and review articles that have been published over the past century. Let me put that another way. It is MUCH easier to find a regular peer-reviewed journal article on many topics than it is an evidence-based journal article on many topics.

Of what I understand, evidence-based articles are systematic reviews. The article is a REVIEW of the literature and the multiple research studies on a specific topic. Apparently, just one research study on the background of a disease and treatment is not evidence-based information.  In order for the article to be considered “evidence-based”, the authors of the article have to do some type of literature search. The authors have to compare the many research studies, REVIEW them, and provide information/summary/conclusion on the results of the REVIEW. I emphasize the word "review."  The authors provide the “evidence” of the results of many research studies.

From this “evidence,”  guidelines can be established to show healthcare workers how to treat a specific disease or condition.

Based on the research that I have done for a number of students, overall, there is NOT A LOT of evidence-based information out there. It really, really, depends on your specific topic on how much evidence-based information can be found. The best advice that I can give students to make it easier to find evidence-based journal articles is to pick a topic that is pretty popular and has a lot of articles written about that topic over time. MRSA and Diabetes are two good examples.


There appears to be ONLY four or five decent sources to help find evidence-based information.

 
Cochrane Library: is considered by many to be one of the BEST online resources for finding scholarly evidence-based practice information. The Cochrane Library contains long scholarly literature reviews on all kinds of medical subjects. It is a specialized, expensive resource. Usually, only the well-funded, academic universities will subscribe to this service. If you want to use this source, then please contact a local college library.


It appears that you can search the Cochrane Library from the Cochrane Library website to see what they have in their library. The citations presented will allow you to see if it is worthwhile for you to try to find a library that has this database containing the entire article. The link to the search box is http://www.thecochranelibrary.com/view/0/index.html



PubMed: I use PubMed A LOT to try to find “systematic reviews.” Often, these are reviews of the literature on a specific topic and provide evidence-based information.  However, not all systematic reviews can qualify as evidence-based material.  Examples of what we believe are evidence-based articles are provided much farther down this web page. PubMed has A LOT of different types of articles. You can program PubMed to find “systematic reviews.” You can program PubMed to find just “reviews” and some “reviews” will provide evidence-based information. Another possible choice is “meta-analysis.” “PubMed is a free service of the National Library of Medicine that provides access to over 11 million MEDLINE citations back to the mid-1960's and additional life science journals.” PubMed can provide some links to sites with free full-text articles and resources. PubMed allows you to select options to search “free full text available,”  “systematic reviews”, and more.

Please keep in mind that like most databases, NOT everything is FREE FULL-TEXT (entire article) within PubMed. However, as stated above, you can program PubMed to find only FREE full-text articles. If you find something that is not free, please ask a reference librarian if the library can interlibrary loan the article for free.


A very good step-by-step TUTORIAL on how to use PubMed to find evidence-based scholarly journal articles can be located at:
http://www.delta.edu/llic/libraryresearch/evidencebased.aspx



CINAHL Plus is regarded by many health-related instructors as a GREAT tool for finding health-related articles. CINAHL Plus allows the student to select (check the box) for “Evidence Based Practice.” HOWEVER, please be careful. We have noticed that some of the articles presented by CINAHL Plus as “evidence-based” ARE QUESTIONALBLE. For example, there are one or two-page “fact sheets” that are presented as evidence-based information, but it questionable if your teacher will accept this material as evidence-based. Please check with your teacher.

CINAHL is a fee-based database that many academic libraries have. Please check with a library.



Personally, I think after the Cochrane Library, PubMed, and CINAHL Plus, that the quality of the sources to find evidence-based information are either not as good OR you find the same information that you found in Cochrane Library, PubMed, and CINAHL Plus. However, the following sources are worth a try.


PEDro is the Physiotherapy Evidence Database. This database is more for physical therapists and physical therapy assistants. It is a "free database of over 16,000 randomized trials, systematic reviews, and clinical practice guidelines in physiotherapy." Basically, PEDro is a very good INDEX to "randomized trials, systematic reviews and clinical practice guidelines in physiotherapy." Whatever links to full-text articles that are presented, links to PubMed.  This resource has a tendency to provide, at least, a few more citations that you may not find in other databases. If you are a physical therapist student looking for evidence-based information, then you need to give this database a try.


Centre for Reviews and Dissemination is a department of the University of York and is part of the National Institute for Health Research. CRD undertakes high quality systematic reviews that evaluate the effects of health and social care interventions and the delivery and organization of health care. This organization produces DARE, NHS EED, and HTA databases (look at the tabs near the top of the web page). DARE, NHS EED, and HTA databases are similar to PEDro.


Trip Database is a clinical search tool designed to allow health professionals to rapidly identify the highest quality clinical evidence for clinical practice. TRIP is a pretty straight-forward database. Basically, this is an index that leads to other indexes, like DARE and PubMed.



Examples of Evidence-Based Journal Articles


The Topic of MRSA

  Chen, W., Li S, Li L, Wu X, & Zhang, W. (2013). Effects of daily bathing with chlorhexidine

  and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycin-

  resistant Enterococcus: a meta-analysis. Journal of Thoracic Disease, 5(4): 518-24. Web.


“Chlorhexidine gluconate (CHG) is a common and safe antimicrobial agent and has been used widely in hand hygiene and skin disinfection; however, whether daily bathing with CHG results in the reduced acquired infection of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) remains inconclusive.”


“We did a meta-analysis searching PubMed, Embase and the Cochrane Central Register database for available studies. Primary outcomes were acquired infection of MRSA, VRE.”


“In all, twelve articles were available in this review. We found that daily application of chlorhexidine bathing would significantly low the acquired colonization of MRSA [incidence rate ratio (IRR) =0.58, 95% confidence interval (CI): 0.41-0.82] or VRE (IRR =0.51, 95% CI: 0.36-0.73).”


The authors searched a few databases and found “twelve articles” to review. They reviewed the literature and studies on this topic. The literature was analyzed by these authors and they gave their summary of the articles/studies. Their conclusion based on the “evidence” is that “the application of CHG bathing would significantly decrease acquired infection of MRSA or VRE, which may be an important complementary intervention to barrier precautions.” This conclusion is evidence-based.


If you would like to see the entire article, then please click on the following URL. This article can be found FREE, online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755671/. It is a good example of what a systematic review and evidence-based article looks like.


  Derde L.P., Dautzenberg, MJ, & Bonten MJ. (2012). Chlorhexidine body washing to control

  antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care

  Medicine, 38 (6), 931-9. Print.

“PubMed, Embase, CINAHL, and OpenSigle databases were searched using synonyms for "intensive care unit," "hospital," and "chlorhexidine." All potentially relevant articles were examined by two independent reviewers.” According to this statement, the authors searched literature for the evidence.


“Infections caused by antimicrobial-resistant bacteria (AMRB) are increasing worldwide, especially in intensive care units (ICUs). Chlorhexidine body washing (CHG-BW) has been proposed as a measure to limit the spread of AMRB. We have systematically assessed the evidence on the effectiveness of CHG-BW in reducing colonization and infection with AMRB in adult ICU patients.”


The authors/researchers concluded that “Based on this systematic review we conclude that there is evidence that CHG-BW is effective in preventing carriage, and possibly BSI, with MRSA and VRE in ICU patients, although this evidence is weakened by inter-study differences in intervention, co-interventions, and patient case mix. Overall, the quality of the studies was good, with low to medium risk of bias. There was no evidence (or lack of evidence) that CHG-BW reduces acquisition of carriage or infections with ARGNB.”


This peer-reviewed scholarly journal article shows what evidence-based information is all about. The authors searched the literature/research studies on this specific topic. They studied and discussed the evidence available from a variety of studies. The authors provided their interpretation of the studies by providing the evidence that was available on the specific subject. The authors’ conclusion was based on the “evidence.”


  Guilbeau, J., & Fordham, P. (2010). Evidence-based management and treatment of outpatient

  community-associated MRSA. Journal for Nurse Practitioners, 6(2), 140-145. Web.

This article is not obvious about listing all of the databases that the authors used, but according to the references and content, this is an evidence-based article. I admit, it DOES help that  “Evidence-based” is in the title.


“There is evidence of a growing incidence of resistant microorganisms in the United States, and nurse practitioners (NPs) are in a pivotal position to lead in the delivery of health care related to this problem. Recently, the incidence of community-associated methicillin-resistant Staphylococcus aureus has increased, which requires urgent attention to safe practice and prevention. Because this is a relatively new public health problem, the evidence to support management is evolving. NPs are positioned to examine the evidence and incorporate findings into practice.”  Within the content of the article, there are a number of prevention and treatment options listed based on evidence and many articles listed in the list of references.


The full-text of this article can be accessed for FREE, online at: http://www.medscape.com/viewarticle/717464. You may need to type the title of the article in Google in order to acces the FREE online article. Sometimes, the direct link does not work.


Cochrane Library Database Example

I know that it is helpful to provide examples to help explain what evidence-based practice information looks like, so here is an example from the famous Cochrane Library. It is one of the few Cochrane Library articles available on the Web that can be viewed for FREE. Most of these articles are contained within the fee-based database that can be found in some academic libraries. This particular article from the Cochrane Library Database is titled “Ultrasound and shockwave therapy for acute fractures in adults” and is 54 pages long. This particular article will be of interest to Physical Therapists and Physical Therapy Assistants. Please click on the following link to see what a typical evidence-based practice document within the Cochrane Library looks like:

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008579.pub2/pdf


 

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