How to…find evidence-based advice on the internet

Authors


S Kirtley, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Level 3, Women’s Centre, John Radcliffe Hospital, Oxford, UK. Email shona.kirtley@obs-gyn.ox.ac.uk

Introduction

This article is aimed at those working in healthcare professions in low-resource settings who need to find the latest evidence-based advice about how to manage a particular clinical problem. There are a variety of ways to search for the latest information—the main determining factor is the amount of time you have available.

Time scales

Option one—if you have many hours to spare

  • • Search the primary literature using databases such as Medline or Embase (subscription-only databases) or Pubmed (a freely available database). Identify relevant papers and critically appraise them to ensure that the study results can be trusted and that they are transferable to your setting.

Option two—when time is of the essence

  • • Search key websites such as DARE (Box 1) or NHS Evidence—women’s health (Box 1) where resources have already undergone critical appraisal or a quality check. Bear in mind, however, that these resources may not specifically address your question, the information may be out of date, and/or may not be applicable to your particular setting.
Table Box 1.. 
Freely available key websites Bandolier
http://www.medicine.ox.ac.uk/bandolier/
CEBM
http://www.cebm.net/index.aspx?o=1001
Clinical Knowledge Summaries
http://cks.www.nhs.uk/home
DARE
http://www.crd.york.ac.uk/crdweb/Home.aspx?DB=DARE&SessionID=&SearchID=&E=0&D=0&H=0&SearchFor=
DUETs
http://www.library.nhs.uk/duets/
Freemedical journals.com
http://www.freemedicaljournals.com/
HIFA2015
http://www.hifa2015.org/
HINARI
http://www.who.int/hinari/en/
NHS Evidence - women’s health
http://www.library.nhs.uk/womenshealth
Pubmed
http://www.ncbi.nlm.nih.gov/pubmed/
TRIP & TRIP Answers
http://www.tripdatabase.com/index.html
http://www.tripanswers.org/
WHO Global Index Medicus
http://www.who.int/ghl/medicus/en/
Subscription-only key websites
(free access can be provided to low-income countries based on the World Bank list)
BMJ Clinical Evidence
http://group.bmj.com/products/evidence-center/clinical-evidence
Cochrane Library
http://www.cochrane.org/reviews
Global Health
http://www.cabi.org/datapage.asp?iDocID=169
WHO Reproductive Health Library
http://apps.who-int/rhl/en
Freely available guidelines
RCOG (UK)
http://www.rcog.org.uk/womens-health/clinical-guidance
SOGC (Canada)
http://sogc.org/guidelines/index_e.asp
RANZCOG (Australia and New Zealand)
http://www.ranzcog.edu.au/publications/collegestatements.shtml
NICE (UK)
http://www.nice.org.uk/guidance/&set=true
National Guideline Clearing House (US)
http://www.guideline.gov/
National Library of Guidelines (UK)
http://www.library.nhs.uk/guidelinesFinder
GFMER
http://www.gfmer.ch/Guidelines/Obstetrics_gynecology_guidelines.php

Money matters

A major difficulty that frustrates those in search of online evidence-based medical information is the fact that many websites and databases are subscription-only. These resources can be very expensive; hence, alternative, freely available sources of evidence-based information often need to be identified.

For low-resource settings, a number of country-specific agreements have been established to allow access to full-text journals, databases and other materials for healthcare professionals. If you are in a country with a gross national income (GNI) per capita of less than $1250, your institution may be eligible for free access to thousands of journals through Hinari (Box 1); this may also apply in countries with a GNI per capita between $1250 and $3500.

In addition, access to scientific information and knowledge is provided by the International Network for the Availability of Scientific Publications (INASP) through their journal services, training and workshops. The WHO Reproductive Health Library (Box 1) also provides access to commentaries on Cochrane reviews and evidence-based videos of surgical procedures.

Freely available access to journal papers can be obtained from freemedicaljournals.com (Box 1), although in many cases research papers do not become freely available until 6 months to 1 year after publication.

Searching for the evidence

If you have time available (option one), the main steps to identifying high quality, evidence-based information on the internet are:

  • 1Formulating a PICO (population, intervention, comparison, outcome) question.
  • 2Composing and performing a search for the evidence.
  • 3Critically appraising the evidence retrieved.
  • 4Using the evidence to inform decision making.
  • 5Evaluating the outcome.

Guidance on these processes can be found in the Centre for Evidence Based Medicine (Box 1) website which provides access to online advice, tools and presentations on the processes involved.

As mentioned above, there are several online medical databases that can be searched such as Medline, Embase and CINAHL, all of which are subscription only. Greenhalgh’s 1 article on how to use the biomedical database Medline is very useful. EMBASE is a biomedical and pharmacological database and CINAHL provides access to nursing and allied health information. A number of region-specific, freely available databases such as the African Index Medicus (Box 2) have been established, providing access to research that is specific to healthcare professionals working within particular settings (Box 2). Global Index Medicus (Box 1), produced by the WHO, provides access to general literature as well as medical and health resources from sources outside the main industrialised countries. The Pubmed database is freely available on the internet and provides access to millions of medical abstracts, a small proportion of which are freely available in full-text.

Table Box 2..   Regional specific websites (freely available to individual low-resource countries)
Africa
Association for Health Information and Libraries in Africa
http://www.ahila.org/
African Index Medicus A database of information published in or related to Africa
http://indexmedicus.afro.who.int/
Latin America and the Caribbean
The Virtual Health Library provides searching facilities for many evidence-based resources.
http://www.bireme.br/php/index.php?lang=en
The Scientific Electronic Library Online provides free full text access to health research information aimed at countries in Latin America and the Caribbean
http://www.scielo.org/php/index.php?lang=en
Eastern Mediterranean
Eastern Mediterranean Index Medicus is a database of information published in or related to countries in the Eastern Mediterranean
http://www.emro.who.int/Library/Databases/wxis.exe/Library/Databases/iah/?IsisScript=iah/iah.xic&base=imemr&lang=i
General
Managers may find useful support and guidance for improving access to evidence based information within their institution via the International Network for the Availability of Scientific Publications
http://www.inasp.info/

In everyday practice, clinicians do not have the luxury of having hours to spare to search primary literature (option two). Evidence that has been synthesised in some way is usually more helpful. National guidelines are a good place to find advice on evidence-based practices (Box 1). The strength of the evidence behind recommendations is usually included so the reader is aware of the evidence base behind each statement. Although guidelines should be based solely on the evidence available, they may also reflect the opinions of the group/organisation developing them. For example, Tricoci et al.2 found that the latest American College of Cardiology/American Heart Association clinical guidelines were largely made up of lower level evidence and expert opinion. Guidelines should therefore be critically appraised and careful thought given to whether they are appropriate for local implementation.

To save time searching individual country guidelines, the US National Guideline Clearing House (Box 1) and the UK National Library of Guidelines (Box 1) provide access to databases of evidence-based, clinical practice guidelines. The Geneva Foundation for Medical Education and Research (GFMER) website (Box 1) also signposts to a large number of freely available guidelines produced by different institutions throughout the world.

The Cochrane Library (Box 1), containing comprehensive systematic reviews on a number of clinically important topics, is another source of good quality information.

The TRIP database (Box 1) performs searches simultaneously in several databases providing links to evidence-based literature from various sources.

BMJ Clinical Evidence provides access to a range of evidence-based summaries. These reviews summarise the evidence without giving specific recommendations, allowing it to be weighed up by the reader and the knowledge gained applied to the unique local situation (Box 1). A subscription is usually required but through Hinari this resource is freely accessible in many developing countries. Bandolier (Box 1) also produces evidence-based summaries free of charge. Other subscription websites such as PIER and UPTODATE offer similar summary services. The freely available NHS Evidence—women’s health website (Box 1) provides full-text access to a range of evidence-based resources, placing emphasis on secondary evidence. The freely available NHS Clinical Knowledge Summary Service (Box 1) offers a source of evidence-based information and practical ‘know how’ relevant to clinicians working in primary care.

Question answering

In addition to the resources mentioned above, there are a number of online databases containing clinical questions and evidence-based answers including details of how the evidence was found and applied, such as TRIP answers (Box 1). Practical clinical questions are addressed and evidence-based answers are provided together with the evidence base that has been used to answer the question. For questions that remain unanswered, DUETs, the UK Database of Uncertainties about the Effects of Treatments (Box 1) is a repository for known uncertainties.

Other sources of electronic information

Access to the internet is often problematic in low-resource settings, as is a stable power source and bandwidth provision. Alternative sources of electronic information are therefore very important. The Royal College of Obstetricians and Gynaecologists (RCOG) in the UK provide an email service to members: literature searches can be requested and the resulting reference lists are then returned by email. The WHO Reproductive Health Library and the Cochrane Library also provide their services on CD-ROM. Other information dissemination tools include journal content alerting services and RSS feeds which can be delivered by email to keep clinicians informed of the latest research and electronic document delivery services.

Improving access to evidence-based information for healthcare professionals working in low-resource settings is the primary aim of a number of organisations around the world. One current campaign, Health Information for All 2015 (HIFA2015), is working to ensure that by 2015 every person worldwide will have access to an informed healthcare provider. HIFA2015 (Box 1) has been established to bring together and facilitate communication, understanding and advocacy among supporting organisations and individuals worldwide. Working together it is hoped that solutions will be found to address the information needs of all healthcare professionals around the world.

Conclusion

This article briefly addresses the technical aspects of finding online, evidence-based information; however, the translation of any information identified into an applicable and useable form for a specific clinical setting is a skill that must be left to individual healthcare professionals.

Disclosure of interests

Catriona Murray is a National Institute for Health Research Clinical Fellow. The remaining authors have no potential conflicts to declare.

Contribution to authorship

Catriona Murray prepared the first draft of this short paper. The paper was then reviewed by Shona Kirtley and further changes/editing were made. Stephen Kennedy then reviewed the paper for final edits.

Details of ethics approval

Not Applicable

Funding

Not Applicable

Acknowledgements

None.

Ancillary