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Transcript - Evidence Based Practice Library Lab - June 4 2018

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Librarian One: And welcome again to this webinar. This is for our Nursing 6052 students, or 5052. This webinar is intended to help you complete your Week 2 discussion because, for that discussion, you will need to do evidence-based practice research. And we're going to learn all about that tonight.

I'm Erin Guldbrandsen. I'm one of your health sciences librarians. And with me is the wonderful Julie James. She's your other health sciences and nursing liaison librarian. And with that, I'm going to hand things over to her to get us started. And I'm going to go ahead and turn off my webcam also.

Librarian Two: All right. Well, how's everybody doing tonight? Let's see. Let me get this up here. OK.

So we are doing evidence-based practice library lab. And we have a couple of objectives here to talk about. We want to help you pick relevant keywords, maybe brainstorm for some alternate keywords.

We're going to look at the evidence hierarchy pyramid, which you will probably use throughout this course. And we will identify and search both filtered and unfiltered resources. And we'll tell you what those are as we go along here.

So the Week 2 discussion for this class-- if you haven't looked at it yet, here it is. In Week 1, you develop the PICOT question. And for Week 2, we're going to take part of that PICOT question, and we are going to ask you to search six different levels of evidence.

So you'll do a search in each of the databases at each of the levels, and then you'll record the results you get at each of the six levels, and you'll select one article from each level. So we will show you all about that. But this is the text of the assignment.

And it's a little bit confusing. So Erin made this lovely slide for you all, where the top box-- you have to use a different database to find one systematic review, one critically-- whoops, I shouldn't click on it-- one critically appraised topic, and one critically appraised individual article. And then you can use CINAHL to find the other three-- randomized controlled trial, a cohort study, and a case study. And we will step you through finding all six of these, but you need six articles from four different databases-- three on the top and one on the bottom, OK?

All right. So when you are looking at your PICOT question, you want to divide up that topic back in the concepts. We had looked at the PICOT being the population and the intervention and all that. You want to take each of those back apart and separate your concepts up.

And think of synonyms, you know? What's another word for that population? What's another word for that type of intervention, things like that? And then you'll connect your terms using Boolean operators, and we'll talk to you about that, too.

OK. So translating your PICOT here, we're going to take the example of, in the NICU, what is the effect of handwashing on infection control compared with hand sanitizers? So the population are the NICU care providers, the visitors, the family members. The intervention is generally handwashing, in this list. And then the control is hand sanitizer, which is what everybody is using now, for the most part. And then the outcome-- we're looking for better infection control.

So if we break that down, we will go and try to come up with some other words. So for NICU, you may need to spell out neonatal intensive care. That's always a good idea if you have an acronym to try it spelled out and as an acronym. Because sometimes, you'll find something one way or the other. And then handwashing and hand sanitizers are pretty obvious.

But hand rubs? We don't hear that a lot here. But it is used in England and in other countries in Europe-- hand rubs, and then hand disinfection as a concept. And then for infection control, you can also consider cross infection or even just using the word infection by itself.

So this is the famous levels of evidence pyramid. And it's in a pyramid shape very purposefully. The top has the smallest mass available and the bottom layer has the largest mass available. That's kind of almost going in line with systematic reviews are going to be far fewer than the things below in the lower half of the pyramid.

Systematic reviews are kind of interesting because they take so many other articles. Yes?


Librarian Two: OK. So am I messed up here? How are we doing?

Librarian One: You're fine. I don't-- I'm not sure. I think maybe we didn't mute everyone. I'll just go ahead and check that.

Librarian Two: Oh, OK. Thank you. So systematic reviews take a bunch of other articles, usually randomized controlled trials. And they compare them against each other, and they look for the validity of the trials themselves.

They say, OK, well, this one had 1,000 participants, and it used these methods, and we consider it good. This one is not as great because it only has 18 participants, things like that. They compare them against each other and stack them up and provide an overall recommendation from looking at every research article published on a particular topic.

And then the critically appraised topics are less intensive than the systematic reviews. Systematic reviews could take like over [INAUDIBLE]. OK. So the critically appraised topics are just looking at an individual topic and synthesizing the evidence. And then an individual article-- or a critically appraised individual article is a critique of an article by another individual or group.

Those are all filtered. They go through another process before you get to see them. They don't come straight from the researcher to you. Randomized controlled trials are kind of a great granddaddy in the unfiltered section because the participants have to be selected randomly. Control-- they have to have a control group, as well, whether it be an existing type of medication or treatment for that particular ailment, or some other control group where they're not getting a drug at all, that kind of thing.

Cohort studies are observational studies, and they're longitudinal over time. By definition, they're not controlled. And for instance, you can follow smokers over time and compare them to nonsmokers over that same period of time. And we'll show you how to find those.

And then case controlled studies are a little bit more detailed investigations of an individual or a group of people or a particular phenomenon. And they can be prospective growing cohort of retrospective or backwards. And then background information are just the facts of the case. It may be an individual's opinion, things like that.

So Erin is going to talk to you about the filtered information and the three levels are on the top.

Librarian One: Lovely, wonderful, thank you so much. Let me just take over here and show my screen. Also, I'm going to start, actually, by showing you where you can get help for this discussion specifically. It's basically going to show you everything that we're going to cover in this webinar, anyway. And then I'm going to show you how to get to our guide that is a little bit more expansive about evidence-based research practice that you can also use to complete your discussion.

So let me start by going to your course guide. That is where we have assignment help specifically for this discussion. So I'm going to go to the library home page, which you can get to through your student portal. It's also linked, I think, in your classroom.

You can bookmark this page so that you don't have to go through your portal every time. And then, once you're here on the library home page, you will click on Course Guides, right here near the middle of the page. And then, we can just scroll through and either click on the letter N over here on the left for nursing.

And then, you would just go to the N-U-R-S 6052 or 5052, or you can just search for the course code with this box. I'm just going to type in N-U-R-S 6052. And it should come up-- yep, there it is. Here's our course guide.

So if you just start on the welcome page for your course guide, this is the page that has all of your required readings that have to come from the library. So if you didn't know that, this is a bonus tip that those are all linked here for you. And then, what I want to draw your attention to is over here on the left. You've got different weeks as buttons. And this will take you to specific help for an assignment or a discussion that you have to do for each of the corresponding weeks.

So I'm going to click on Week 2, which we're in right now, and show you this is everything, basically, that we are going over in this webinar. The link to that levels of evidence pyramid is here, a link to how you find filtered resources and how to find each of the unfiltered resource types are also here. There are also buttons over here on the left side of the page. So that's one way you can get help for this discussion.

And like I said, we also have a more comprehensive guide about evidence-based practice research. I'm going to show you how to get to that now. So I'm just going to close that one out. I'm back on the library home page now. And I'm going to go to Subject Resources. It's right next to Course Guides. They're neighbors.

I'm going to click on Select a subject. It gives me a whole list of subjects, then. And I'm going to choose Nursing. And now I'm on what we call the Nursing research home. It's just a page with all different kinds of nursing research resources.

And I'm going to scroll right down past a lot of things. I'm going to go down here where it says research help. And I'm going to click on evidence-based practice research. Gives us a little definition here first, which is nice.

And then we have our entire evidence-based practice research guide. And again, a link right to that levels of evidence pyramid that Julie just went over. So I'm going to open up that evidence-based practice research guide and just kind of show you how you would use this to help with this Discussion 2 that you have to do.

Over on the left, we have other buttons. Buttons are always on the left side, seems like. First, we are just on the introduction page.

And then, you can see again that clinical question anatomy, like we just went over. This goes into a few more examples that you might want to take a look at, of how we would get to our example question. It talks about what a PICOT is, if you need to remember that.

And then, I'm going to click on levels of evidence pyramid. And this is what mainly you can work off of to find each of these levels of evidence that you need to find for your discussion for Week 2. So we have, again, the pyramid. And I know that there are other pyramids out there. I do want to just briefly state that.

You may see other pyramids in your textbook, I believe. It might look a little bit different. Don't worry about that for the purposes of this Week 2 discussion. This is the pyramid that you are asked to work off of and to refer to for your Week 2 discussion. So some of them are slightly different, but this is the one we want to use.

And now I'm just going to start showing you how to find each of these different filtered resources. And again, we need to use a different database for each of these three filtered resource types. That's not just to make things harder for you. It's not to make more work for you. But it's because, really, to find a systematic review, it does help to go to a specific database, or one of a few specific databases. And then, to find critically appraised topics, it really helps to go someplace else that just happens to have critically appraised topics in it.

And the same with the critically appraised individual articles-- they're just easier to find in certain places. So really, it would be pretty difficult to find each of these three in the same place, anyway. So that's why they want you to use a different database for each of the filtered resources. It actually does make it easier, believe it or not.

All right. So I'm going to scroll down to systematic reviews. And we have a few different places we can search for a systematic review. This is the tippy top, the very top, the highest quality of evidence on the pyramid.

And a systematic review, again, it usually is focused on a specific clinical question. And they actually take a really long time to do. I have a slide about it, and I'll talk about what makes all these filtered in just a moment. But they are really intense systematic reviews, actually.

And it takes a long time to do a systematic review. And usually what they're reviewing in a systematic review, what the authors are finding and reviewing, are usually randomized controlled trials. So if I was doing a systematic review, I would find all the randomized controlled trials I could that are answering a clinical query, like, what's the best treatment for this thing? And I'd find all the randomized control trials that are trying different experiments for different treatments.

And then I'm going to pull it all together in my systematic review. And based off of hundreds of randomized control trials, we can come to a really high level of evidence conclusion. Like, well, based off all these studies, it looks like this. And this is how I like to think-- well, this is a good way to remember what it means-- that these are filtered resources.

Because there's somebody in between you, the reader, and all of those randomized controlled trials. It's the systematic reviewer, or it's the person who writes a critically appraised topic, or the group of people who write a critically appraised individual article. So the person critically appraising, or the person doing all those reviews, they're like a filter in between you and that original research, telling you, look, these are really great studies, or here are the drawbacks, or maybe where the study was limited, or something like that. And then they're making recommendations for care or for treatment, or something, some kind of clinical recommendation based off of all that other research that other people have done. So there's a filter between you and the original research. That's what makes these filtered resources.

All right. So in the systematic reviews, they do make practice recommendations. And like we see here, and also, back on my levels of evidence page here, there are a couple different places where you can find systematic reviews easily. Cochrane database of systematic reviews-- I'm going to go ahead and open that one up. I'm going to demonstrate a search in there.

And it logged me out. I was logged in earlier. And this might happen to you, too. That it logs you out if you've been in there for too long. It just needs to know that I am from Walden and that I'm allowed to be in there. All right.

And Cochrane is really considered the gold standard. It's a little bit harder to get a systematic review done through this Cochrane database of systematic reviews. So if it's in here, it's like the gold standard of systematic reviews. That's not to say that other systematic reviews aren't worthwhile and aren't still high level evidence, but Cochrane is a really great place to go to find systematic reviews.

And then you can also find them in the Joanna Briggs Institute EBP database. This database looks different. So I am going to demonstrate it. I'm going to go ahead and open it up. But we'll start in Cochrane, and then we'll look at Joanna Briggs.

So the main thing to remember before you start doing your searches is that for this discussion, you need to find an article at each of those six levels of evidence that relates to part of your topic. And I'm going to say that again. You only need to find an article at each level of evidence for this discussion that just relates to part of your PICOT question. If you try to do this discussion post, and you try to find something at each level that answers your entire PICOT question, you're not going to be able to do the discussion. You're going to get really frustrated, and you're going to think this is impossible.

And you're right. That probably will be impossible. There won't be a systematic review out there for everyone's entire PICOT question. That's something that comes up a lot when we help students with this discussion later.

We get a lot of e-mails from students. And usually, what we have to tell them is the reminder, hey, your discussion says only pick part of your PICOT question to do this discussion. You probably won't find a systematic review to answer everyone's PICOT question.

So for our example, I'm just going to take two parts of it, the NICU and infection control. Let's try this first. I don't think this is even going to work. But let me explain what I'm doing.

I'm just taking two parts of my PICOT question, and I'm putting separate concepts in separate boxes. This helps the database understand that these are two different concepts.

And you'll notice the word and is in between the boxes already. So it would be the same thing if I typed "and" and then did infection control. Same thing-- database understands it the exact same way.

And some searches that we'll do will only have one search box-- absolutely fine. We just type the word "and" in between. This is a Boolean.

That's what that meant from an earlier slide, Boolean operators. You don't need to remember that. It's just how you connect words for the database to understand them.

I don't have to do anything special in Cochrane now. I just type in my keywords. I separate different concepts with the word "and," A-N-D, and I can just click Search. There's no special filters or anything I have to select.

And look at this. I'm not surprised. This seems like it should be a really huge topic, right? So many ways to do infection control in the NICU-- pretty important, too. But I only get two results.

I'm not surprised. Again, because there's not going to be a systematic review on every clinical question that we can think of. It may take a really long time to do, and they're very intense. And there's just not going to be one on every topic.

So I've got two here. They are both somewhat related to at least part of my PICOT question, at least one concept of my PICOT question. So I could choose either of these, and that's perfectly fine for the purposes of this discussion post.

I don't have to find something that answers my PICOT question for this discussion. I just need to find things that are related to part of my PICOT question. I could choose any one of these and there you go.

I'm done. I've got my systematic review. I can move on.

Maybe you'll use Cochrane, and you don't like what you see. And you're, like, well, I want to try that Joanna Briggs instead. So remember that's linked here on the evidence-based research guide. I've got Joanna Briggs EBP database already open.

It does look different. It's OK. We only have one search box, but we can just do what we did before with NICU. And you can see I've already done it.

It doesn't matter what order you put the terms in. I can do NICU and infection control. I do have to do something special here. I have to tell Joanna Briggs that I only want systematic reviews, because there are other things in here.

Cochrane Database of Systematic Reviews only has systematic reviews. It's nice. It's in the title, the name of the database.

But Joanna Briggs has other things in it. So I want to click on limits, right here under the search box. That gives me this light blue shaded area that opens up. And I just scroll down to systematic reviews and then click Search.

Now this is where this database confuses people a lot of the time. Because it looks like nothing's happened. It just keeps me on a search screen, and it doesn't look like it did anything except pick out my keywords. If you scroll down, you'll see, hey, look, it actually did do something.

It gave me four results. It says that over here, search returned four results. And sometimes people get confused, too, in here about how to get the full text. They don't have a fancy link underneath here. Instead, they hide the PDF link over here on the right.

So I would have to come over here and click on JBI database PDF. And I could open up this one. This one's about unplanned ICU admissions. If it has anything to do with part of my PICOT question, I can use it. And I could just click that, save it, there's my systematic review.

You only need one, though. You only need one systematic review for this discussion. You just need one of each of the six levels of evidence. So then I could just move on and use any of those. We're going to go back to Joanna Briggs to look at a different resource type in just a little bit.

That's how you find your systematic reviews. And before I take questions, I am going to move on, just for the sake of time, to critically appraised topics. So we've got a systematic review, great. Let's find a critically appraised topic.

There are, again, very special places to go to find a critically appraised topic. What these are-- like it says, it's a whole topic. So it's not an individual thing. It's a whole topic.

It's a lower quality of evidence than a systematic review, because they're not looking at just randomized controlled trials. They are evaluating and bringing together multiple research studies still, but it's not as rigorous as a systematic review. And they're also usually narrower in focus than a systematic review.

So instead of answering a clinical question that might have a control and a comparison, or an intervention and a comparison, they're probably going to be a little bit narrower than that. And it's like we're just looking at one treatment. We're not comparing it to anything, things like that.

So it's a little narrower, but they do look at very current evidence. So that's why they are a high level of evidence, because they're so timely. And places to go to find critically appraised topics-- one is the National Guideline Clearinghouse. I'll go ahead and open that up.

Another is a special place called Annual Reviews. And then, we can also use Joanna Briggs, same database that we just saw for systematic reviews, we can also use that database to look up critically appraised topics. Now I used to get really confused myself, because none of these sites or databases call them critically appraised topics. But that's what they are.

So when we're in National Guideline Clearinghouse, anything you find there you can use. When we're in Annual Reviews, anything you find there you can use. And then in Joanna Briggs, they actually call them evidence summaries. So don't get concerned or stressed out because nothing on the page actually uses the phrase critically appraised topic. It's OK. You're still in the right place, and you're still doing it right.

So let me just show you National Guideline Clearinghouse. And you can take a moment on your own. I got a little riled up about this the last time we did this webinar-- that the agency that runs this website-- this is funded-- it comes from the Agency for Healthcare Research and Quality. And it is federally funded, and they're losing their federal funding, unfortunately, in July, unless something happens and the funding gets restored.

You can read more about that here on their website. So just be aware of that. But for this year, you have plenty of time to use this resource for your Week 2 discussion.

So I'm going to come down here underneath that notice and use the big huge search box that's just right here in the middle of the page. And I'm going to just type in some of my same keywords inside. Like, for instance, maybe we had more luck with neonatal and infection. I could try that instead of NICU.

This is, again, why we did that brainstorming for different keywords, in case some don't work. Like, if NICU didn't get me very many results, I could try neonatal and infection instead in all my searches.

And I get plenty of results. I do have one through 20 of 74 results up here is what it says. So I have plenty here. We have a lot more than we saw of the systematic reviews, which is not surprising. And I could just choose any of these.

Again, it just has to have something to do with part of my PICOT question. It does not have to answer my exact question. So I could just choose this first one.

And there is an area where you can download. And I would just go here and download the PDF. There, I've got my critically appraised topic.

In Annual Reviews, it's the same kind of-- they made it look pretty-- page. And we just have one search box. I can just do, again, neonatal and infection. Maybe I want a state control, action control, just go ahead and click Search.

And then I have my results. I could just choose any of these because they're all related to something, one part of my PICOT question. I would click on the Download PDF. You probably want the PDF. I would click on Download PDF. And then I will open it. And I can see that I actually don't want to do that. I'm afraid it will make my computer too slow. There we go, very simple search boxes and very easy to use websites with the PDFs there that you can save. Things--

Librarian Two: Don't forget to note--

Librarin One: Mhm?

Librarian Two: Don't forget to note how many results you got.

Librarian One: Oh, thank you. Yes, great reminder that your discussion does ask that you just take some note of how many results you get. Kind of to just show, again, that you get more of the lower levels of evidence sometimes.

So again, things do look different in Joanna Briggs. So if you don't like these two sites and you don't want to use them, you can use Joanna Briggs instead. And again, they're called evidence summaries in Joanna Briggs instead of them being specifically labeled as critically appraised topics.

So I could do my same keywords that I did before, neonatal and infection control. And this time select evidence summaries, and then click Search. Just like before, it's going to look like nothing happened.

I scroll down. I've got 22 results this time. And I would click on JBI database PDF over on the right for any of these that relate to part of my PICOT. And I've got my critically appraised topic.

All right. One less of the filtered resources, and then I'll see if you have questions. We're going to just move down to critically appraised individual articles. What is a critically appraised individual article? It's exactly what it sounds like.

It is an evaluation and synopsis of one individual research study. So instead of critically appraised topic, where we had people evaluating multiple research studies, this is where somebody is just evaluating one individual research study. And they're incredibly short, which is wonderful.

And I like to keep that in mind, actually. That's a good little side note. To remember that the whole point of evidence-based practices research is to make clinical decisions based on evidence. You know, it's supposed to be used in the real world when you're treating patients or diagnosing a patient or what have you.

So that's why I like to think of it as, like, well, in the real world, maybe a clinician doesn't have time to read through a whole systematic review, or maybe there is no systematic review for the clinical question they're facing in real life. And so they would move down the pyramid. And oh, well, I can find a critically appraised individual article on this, to find really, wonderful, still a high level of evidence, but it's super short. Because I'm a busy clinician, I don't have time to read something long.

And so then that will give me just some very good evidence without-- maybe I can't find a systematic review. So I would look for the highest level of evidence that I can, and that might be the highest level I could get. So just something to make it practical of why we are learning about this.

All right. So there are two places to go that I'm going to show you to find these critically appraised individual articles. One is a website called EvidenceAlerts. And another is actually just a specific journal, one single journal, that publishes these.

So back at our guide, I'm going to just click the links here to get EvidenceAlerts. And then I'll also go ahead and open up ACP Journal Club. I'm going to show you EvidenceAlerts first. This also logged me out. Let's hope it's remembering the right username and password.

You do have to create an account to use EvidenceAlerts. Some of you might already have an account. Some of you might need to register for free before you can use it. But you do have to have a log in and be signed in to use EvidenceAlerts.

That's why we show you also how to use ACP Journal Club. I know some people really don't like registering for things online. You don't get any spam from them, though. I never get any e-mails from them. Maybe I don't see them, but I really don't think I do.

So if you've never used it and you don't have a log in, you would click where it says free registration here. It's a very short form. You fill it out. And then you can sign in, like I'm just about to do.

Once I'm signed in, I get, again, just a simple search box in the middle of the page here, and I can go ahead and type in my same topic, neonatal and infection control. All of these are going to understand me putting the word "and" in between separate concepts. I really wouldn't do more than two concepts from your PICOT question. Some of you might only be able to do one main concept for each of your searches from your PICOT question.

And that's totally fine. You're going to be fine. It will all still work out for you. So I'm going to click Search now.

I get quite a few results. I have 22 matches here. And I could just click on any of these. And this, actually, is the whole thing on this page. What you see is what you get. Again, they're very concise.

And then I see these comments down here. A question came up the last time we did this webinar of are critically appraised articles-- are they ever critically appraising the article and saying that the study was no good? It does happen, but not very often.

Usually they're critically appraising and evaluating a study because it was a good study. Some of the comments might point out, like, what it could not be applied to. Sometimes you'll see things like this is only-- they're focused on a very specific population, so these things can't be generalized to other populations or what have you. But usually, they're talking about what was good about the study.

Of course, every study has those kinds of limitations, though. Because they focus on, usually, a specific thing, a specific population, and a specific disease or treatment or whatever. But that's what you'll find. So you can just save this. And then you have your critically appraised individual article.

The Save article is kind of hiding. So I should point that out. It's underneath this box that will be at the top before the abstract, the appraisal of it. You just click Save article. All right, so that was EvidenceAlerts.

And now I'm going to show you that ACP Journal Club. Again, that's just the name of one specific journal. So we're not going to get a very big number of results because this is just one journal that publishes these critically appraised individual articles. And this is what will bring you to. When you click on ACP Journal Club from our levels of evidence pyramid page, it brings you to this page that confuses people a little bit at first.

It's because we are just wanting to search inside this one publication, this one journal. So I want to click here where it says search within this publication so I can actually put in my keywords. Some people want to try browsing through the issues. That's going to take you forever. Don't do that.

Just click Search within this publication. And now it brings me to a search screen. I want to leave the top box alone. This is the database talking to itself, telling itself just search inside this one journal. Don't forget that.

And then I can type in neonatal and infection control. I could separate them out if I wanted to, same thing. You don't need to put all caps. You can if it helps you remember that you type the word A-N-D, "and" in between your words. I just do it so it's a little bit more visible, same thing if it's in lowercase.

And then just click Search. You don't want to do anything else to the page. Oh, hey, I got nothing. So if that happens, I would just start chopping off things. Let's try neonatal and infection, instead of infection control. Hey, look, now I've got one result.

Again, it's only searching inside this one journal that happens to have critically praised individual articles. EvidenceAlerts also has critically praised individual articles, and it's searching outside of just that one journal. So you're not going to get very many results if you use ACP Journal Club. It's just one journal.

If I wanted to see more, I would, again, just take off more keywords and maybe just go with the concept of anything really [INAUDIBLE] neonatal. And now I have six results. And it makes it real easy. They're all mostly going to have the PDF full text.

If you do see a Find at Walden, you can click on it. And it's going to say, hey, maybe the library has this in another place. It thinks we might have it in Medline. I know we're not actually going to have it, because we only have this journal in the one place.

But for other situations, you might see Find at Walden. And you should definitely click on it. Because in other cases, it might bring you to the full text. It just [INAUDIBLE] someplace else.

For this discussion, and specifically when just searching in ACP Journal Club, just find one that has the PDF. Just look for one that has this PDF full text. You've got one that's related to at least one concept of your PICOT question.

There you go. You're done. You've got your individually appraised individual article.

All right. I will stop now and see if there are questions. And then I have some questions for all of you.

Librarian Two: Well, we had a couple of hands raised. But I asked them to type a question in the question box, and I don't see any. We have too many people in the room really to turn on everybody's microphones. So if you wouldn't mind typing it, we appreciate it.

Librarian One: Yeah. I think sometimes people accidentally click the hand raising, too. I know it's easy to do by accident because I've done it myself. [LAUGHING] Well, while you're thinking of your questions, I will ask you some questions, just to see what you have remembered from what we've said so far.

So I'm going to actually launch a question for you all, and you can click on your answer. The first question, just a little quiz, what is the highest level of filtered evidence? So I'm launching that question right now, and you can click right on the screen on your answer. What is the highest level of filtered evidence that we have talked about?

I'm going to give it a few more seconds to get more people the answer. I'd like at least half of you to participate. All right, this is good. I'm going to close it in three, two, one. All right.

And I'm going to share the results. 87% of you got it correct. The systematic review is the highest level of evidence. It is at the very top of that pyramid.

It is considered the highest level of evidence because it is an entire review of a lot of individual randomized controlled trials, usually, or some other kind of experiment. A lot-- and they would get a whole bunch of experiments. And then they make recommendations based off of all of that evidence. Great job!

I've got another question for you right now. And it's which of the following are those filtered information sources? And you can choose all that apply. So go ahead and click on your answers. And again, this is which of the following are considered filtered?

So there would be something in between you and the person who did the original research. There's somebody else telling you some kind of evaluation of that evidence. Maybe they're, I don't know, critically appraising it, would be another way of saying it. And I'm going to give it a few more seconds to get at least half of you participating. Great! And closing-- all right.

So a lot of you got this right. Systematic reviews are filtered, very much so. Critically appraised individual articles are filtered, and critically appraised topics are also filtered. Because there's somebody in between the original researcher-- who's saying what they did-- and you as the reader. Somebody else is coming along, evaluating it, being critical about it, telling you what was good about it, what recommendations can we come up with based off it, filtering that information.

All right. And with that, I'm going to turn it over to Julie.

Librarian Two: Before we go, we do have one really interesting question.

Librarian One: Sure.

Librarian Two: We have a student that had already started on their Week 2 research. And they found a systematic review, but it was inconclusive.

Librarian One: Oh, wow.

Librarian Two: [INAUDIBLE]

Librarian One: Well, I really try to stay away from words like good or bad. I would say that means a couple of things. And I mean, I'm not sure I can say much without having read that systematic review myself. But it means more research is obviously needed on whatever question they were trying to answer, based off that systematic review. I'll keep this short and say, you could still use it for this discussion.



Librarian One: And then, I mean, it's hard to say more without knowing what it was about. So you can contact one of us after this webinar if you want to, you know, maybe have some e-mailing back and forth about that. We could tell you more. But you could still definitely use that for this discussion.

Librarian Two: Great. Well, we have another one asking if they can change their PICOT question after doing the review. And yes, we do see that almost every quarter. But you do have to talk to your instructor about changing your PICOT question.

Librarian One: Yeah. Yep. And really, I think, by Week 2-- I know in Week 1 you were developing your PICOT question. And then in Week 2, again, you just choose part of it to do this Week 2 discussion post.

And then I believe there is still time, and it even comes up, I think, in Week 3 or 4, where you are kind of still asked to maybe solidify your PICOT question more. So they definitely are baby stepping you through that throughout this course. It's not set in stone. Nobody has a chisel. So you're still OK to change it.

Librarian Two: Great. Thank you very much. OK, we had one more person ask about how to get to all these goodies. So I'm going to come back to the library home page. Can you see the library home page?

Librarian One: Yes. We see it. You're good to go.

Librarian Two: OK. So two things you want to note. This Subject Resources here is how you get to the Nursing page. And that's one way to do it.

And then the Course Guide-- if you only remember one thing from this webinar, I hope it's the Course Guides, because they are so incredibly useful that we want to make sure that you know how to get to them and use them throughout your Walden career. So you can go to "N" for nurse or you can type in the 5052, 6052. They're both the same here.

And this will get you to the Course Guide. And then Week 2-- we're in Week 2 now. So that will link to your levels of evidence pyramid and then all the instructions that we're showing you now. So I am going to copy and paste that to the chat, and you may bookmark it to your heart's content. But you do want to remember how to do these things.

So we're into the unfiltered resources. So I'm going to click on that here. And as we talked about them earlier, unfiltered resources include the randomized controlled trials. And it's really easy to find those, because there is a nice little checkbox for that.

So if we go over here-- and I'm just going to go to the library home page, because I know what database I want to use. Because I'm going to use CINAHL for all three of those bottom levels of unfiltered information. And so we're getting CINAHL here. And we put in the NICU, and we put in the infection.

And then we scroll down here, and past our little peer reviewed, scholarly journals that everybody should know where that is now, but we keep going, we keep going. And oop, there it is-- randomized controlled trials. It's just that easy to find your RCTs in CINAHL, which is really nice because not all those databases have that box for you to pick there.

And I'm going back to our little guide here. So we found one randomized controlled trial. Then we're going to scroll down to Cohort Studies. Well, there is no box for Cohort Studies. We're going to use the phrase "Cohort Study." And I'm going to put in the NICU and my infection here-- whoops, I can type.

And then in that third box, I'm just going to put "Cohort Study" in quotes. The quotes glues that together so that you only find those two words together. And there's our results for that.

And then we have one more unfiltered resource. And if we scroll down on this page, Case Study is the last type of resource. And there isn't a checkbox. And we're not going to use the technique we just used, but we're going to use the publication type.

So if I come back here, I type in my NICU and my infection. And then I'm going to scroll all the way down here, past all these crazy ones to the publication type. And then I want to go to Case Study. Highlight Case Study, click Search, and that is how you find your randomized controlled trials, your cohort studies, and your case controlled studies or case reports. It can be interchangeable for this particular topic.

Do we have any questions about that?

Librarian One: We are all good.

Librarian Two: OK. Did you want to do another quiz?

Librarian One: Sure. Yeah. I can go ahead and do that. All right. We have one last question for you. Let's see--

Librarian Two: Oh.

Librarian One: --if you already know the answer to this, even though I'm not sure we mentioned it yet.

So this is a really good trick question for you. Is it true or false that CINAHL Plus with Full Text is a filtered database? So think a little bit about what filtering has meant in this webinar-- about someone being in between you and the resources, or a specific type of resource. And do you think that whole database is filtered or unfiltered?

And I'll just give this a few more seconds. All right. I love it when at least half of you have participated. I'll go ahead and close it in 3, 2, 1. All right.

65% of you got this correct, because it is false. CINAHL Plus with Full Text is not a filtered database. And so what we mean by that-- resources can be filtered or unfiltered. Databases can also be filtered or unfiltered.

What we mean by CINAHL not being a filtered database-- an unfiltered database-- there are all different kinds of study types or article types even in that database. We saw that we can limit to and search just for randomized controlled trials. We can search for cohort studies. We can search for case studies with all those special limiters.

Because we would have to do that. Because if we don't limit the search, you'll get a lot of different types of resources in our search. There are even opinion pieces, like letters to the editor, in CINAHL. So we really need to tell it what we want to see.

Yeah, if you go in and you just do a keyword search on your topic, you may happen upon or just happen to find a randomized controlled trial. But you don't want to waste your time sifting through all of these other things. You want to just get to it.

Yeah, so some people are, like, oh, OK. It could have meant can you filter or not. You can filter it for just what you want, because as a whole, it's not filtered already. You have to tell it what you want. So it's kind of a trick question.

So there are a few questions coming in now that I want to address. So one was-- let's see. Where did it go? Oh, I don't see the question anymore. Maybe somebody deleted-- I'm not sure if I deleted it or somebody else did.

Oh, another question I can answer right now-- somebody asked, can you find a systematic review in CINAHL? Yes, you might happen upon a systematic review in CINAHL. Because you probably are going to want to use CINAHL to find all of the unfiltered types that we just saw-- your randomized controlled trial, your cohort study, and your case study. It's OK just to use the one database for those.

So because of that, the requirement of the discussion is that you use separate databases for your filtered information. So yes, while it is possible to find a systematic review in CINAHL, really, the purpose of the discussion is also to get you familiar with other databases and other places to search. So that's why, while you can, you really can't for this discussion. Because you need to use a different database for each of the filtered resource types. Yeah, you might come across that on other days when you're doing research.

Librarian Two: I think the other question you wanted was do you search RCT cohort study and publication study all together or separately?

Librarian One: Oh. OK, thank you. Yeah, you would want to look for those individually to make sure that you're finding a randomized control trial. Then you need to find a cohort study. Then you need to find a case study. I think maybe that person was also asking, can you search for them in the same database? And the answer to that is yes, but one at a time.

Librarian Two: Yes.

Librarian One: Maybe, I'm not sure.

Librarian Two: Yeah, you can use CINAHL for all three of those types. But you're not going to find one study that is a randomized controlled trial [INAUDIBLE].

Librarian One: Right. Right. Yeah. If it's a randomized controlled trial, it's just a randomized controlled trial. Cool. Are there any other questions? We do have some time. Do you recommend CINAHL and Medline combined? That's another question that just came in.

So they work differently to limit to these specific types, which is why we don't recommend them for this very particular discussion post. Because they are going to limit to a randomized controlled trial differently than each other. They're going to limit to a cohort study differently than each other.

If you don't want to use CINAHL for this, you absolutely can just use Medline alone. And you can do all those limits in Medline, as well, mostly in the same way. Some of it will be slightly on a different part of the screen.

But when you use that simultaneous search-- this person is asking about our special database where you can search CINAHL and Medline at the same time. It just gives a little messy, because they limit differently. So for this particular discussion, use one or the other, either CINAHL or Medline. You could use Medline, absolutely. And you would look for those options the same way. And in the future, for other research scenarios or assignments, you might use the simultaneous search and it would be just fine.

All right. Another question that just came in-- you guys are asking really good questions-- are the background information or expert opinion just the regular results that we find? No. I think what that person means is when you just go into a database, and you just do a keyword search, and you get a whole mix of different results, you might find some background information or expert opinion. But they're not just like regular research articles. So I think that confuses a lot of people.

But yes, when you just go into a regular database, and so you just go into CINAHL and you do a keyword search and you don't filter anything, you don't select any special thing, then you're going to get a lot of different articles in your results. And some of them actually might just be like a qualitative study. They still did a study. It's not background information or an expert opinion. It's a qualitative study.

But that's not a level of evidence type. So there are lots of different study types out there that don't fall on this pyramid of being levels of evidence. That background information and expert opinion-- you don't have to find that, you don't have to find one of those for this discussion.

It's just kind of part of, but separate from, the pyramid. Because sometimes, you don't even know much about a topic and you need to just read some background information before you get started even researching it and looking for evidence. All right. Before I answer any more questions, since we are getting close to time, I do want to just grab control really fast and show you where you can get further help if you do need more help with this.

So let me just start sharing my screen. And I'm going to go back to the library home page. And I just want to point out our Ask A Librarian service. So if you go up to the top right corner of our web site, you'll see Ask A Librarian. There it is.

And I can click on that, and I can email the library. We will respond within 24 hours. Usually, it's faster than that, but we get 24 hours to respond to you.

You can ask for specific help with your keywords. Let's say you're not sure what keywords to try. You can ask us for help with breaking apart your PICOT again to identify those keywords. Or if you can't remember how to get to the guide or anything like that, or you can't tell if something's in full text, those are all great questions to ask us.

We do have a chat service. It's not all the time every day. But it's during certain hours, and you can find our hours right here. It's live right now. So I could chat with a librarian, a real live librarian right now.

If you call, you'll go to voicemail, and you can leave us a message and then we will respond by email. We will not call you back. But Julie and I are very understanding, I think. This is a challenging discussion. You have to go in and do a lot of searches, and it can be easy to get a little bit lost in it.

So even though this says doctoral research appointment, if you want to have an appointment with Julia or I, please feel free to click on that and make an appointment with Erin or Julie. And we would be happy to call you. That's the only way that you could talk to us about this, would be using this doctoral research appointment. And we will help you out that way. So feel free to use that. I know--

Librarian Two: I think we have time--

Librarian One: --that it's due this week.

Librarian Two: --for one more question. All right?

Librarian One: OK. Yes.

Librarian Two: For this discussion, we're explaining the results for the six different searches. Are we explaining what each research article is discussing?

Librarian One: You know, I'm not sure that you need to do that. I can't remember what it talks about in the discussion beyond the requirements that we are familiar with for what you actually need to search for. I'm pretty sure you are going to want to discuss though, kind of what you've figured out from all of these searches. Things like-- there isn't a systematic review on your PICOT question.

Or you know, you could find the highest level of evidence you found that really relates to your topic was such and such, and you had to go really broad to find anything above a randomized controlled trial, something like that. You know, like, I couldn't search very specifically for the filtered information. But I sure found a lot more randomized controlled trials. And I was able to find things that really relate to my topic that way, that are randomized controlled trials.

Or just the things that you noticed about the result-- so not to give answers away. But just pay attention to kind of what you see and what this is like, searching for each of these different levels of evidence. And then, what conclusions can you draw about levels of evidence and about what that means for your topic?

Librarian Two: Well, another student has the assignment at hand and agrees with you.

Librarian One: Oh, good. Great. Fantastic. I love that. I love it when people agree with me. Well, we are out of time. So I am going to go ahead and end the recording. But if you have more questions, we can stick around for a few more minutes.

Librarian Two: And one other person said, or asked, whether it needs to be within five years. And that is specified in the assignment.

Librarian One: Right. It doesn't mention that in the assignment. This assignment says nothing about limiting to the last five years. And again, it would be pretty impossible to find a systematic review at all that would be from the last five years. So any systematic review that you find that relates to any part of your PICOT question, use it, and it's fine, even if it's old. Because sometimes, there just isn't-- there's not a new or a recent systematic review on every topic.

Now I'm going to stop the recording. Because that was important and I wanted to get that in there. So thank you again for attending this. And let us know if you need more help.