Nutrition: Find Evidence Based Practice Resources

What is Evidence Based Practice?

What is evidence based practice" Dr. David Sackett explains:

"Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice".

Evidence-based practice (or evidence-based medicine) involves 5 steps:

1. Ask a focused question to satisfy the health needs of a specific patient

What is your clinical question? Use the PICO model to help inform your research question.
What type of clinical question are you considering?
What is the best study design to answer this type of slinical question?

Type	Explanation	Types of evidence to answer
Therapy (Treatment)	Questions look at the effectiveness of interventions in improving outcomes in sick patients/patients suffering from some condition. Most frequently asked type of question.	Randomised Controlled Trial (RCT)
Prevention	Questions examine the effectiveness of an intervention or exposure in preventing morbidity and mortality. When assessing preventative measures, it is important to evaluate potential harms as well as benefits.	RCT or Prospective Study
Diagnosis	Questions look at the ability of a test or procedure to differentiate between those with and without a condition or disease.	RCT or Cohort Study
Prognosis (Forecast)	Questions root out the probable cause of a patient's disease or the likelihood that she or she will develop an illness.	Cohort Study and/or Case-Control Study
Etiology (Causation)	Questions about the harmful effect of an intervention or exposure on a patient	Cohort Study
Meaning	Questions concerning patients' experiences	Qualitative Study

This table is adapted from Fineout-Overholt, E. & Johnston, L. (2005), Teaching EBP: asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160. doi: http://dx.doi.org/10.1111/j.1741-6787.2005.00032.x

2. Find the best evidence by searching the literature

What is the highest level of evidence/literature available to support your question?
Where should begin to look for this material?

Meta Search Engines (searches all levels of evidence at once)	TRIP Database, The Cochrane Library
Systematic Reviews or Meta-Analyses	Medline, PubMed, Cochrane Database of Systematic Reviews (CDSR)
Critically Appraised Topics	DynaMed PLUS
Critically Appraised Articles	ACP Journal Club, JAMAevidence
RCTs, Cohort Studies, and Case-Controlled Studies	Medline, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL)
Background Information or Expert Opinion	Textbooks, periodicals, editorials

TRIP Database
TRIP is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

Cochrane Library This link opens in a new window
A collection of databases that contain high-quality, independent evidence to inform healthcare decision-making. Cochrane reviews represent the highest level of evidence on which to base clinical treatment decisions.
License Information: This license was negotiated by the Saskatchewan Health Information Resources Program (SHIRP). There are no restrictions to the number of simultaneous users. Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and to "walk-in" users of the University of Saskatchewan Library for educational, research, and non-commercial personal use. It is accessible in the library, on campus, and remotely. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law.
MEDLINE: Ovid MEDLINE This link opens in a new window
Major bibliographic database for clinical medicine, including: internal medicine, general medicine, primary care, family medicine, and general practice, as well as: veterinary medicine, nursing, allied health, dentistry, and pre-clinical sciences.
Access Note: Internet Explorer versions 8, 9, and 10 will not be supported after December 31, 2018.
License Information: There are no restrictions to the number of simultaneous users. Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and to "walk-in" users of the University of Saskatchewan Library for educational, research, and non-commercial personal use. It is accessible in the library, on campus, and remotely. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law. Access Note: When creating an Ovid personal account, users will be asked to sign an End User License Agreement. Existing users will be asked to update their accounts by signing this new agreement, effective March 2021.
PubMed This link opens in a new window
Index and abstract database covering the fields of "medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences. It includes access to MEDLINE and to citations for selected articles in life science journals not included in MEDLINE. ..[It] also provides access to additional relevant Web sites and links to the other NCBI molecular biology resources."
Access Note: As of July 2021, in order to access your personal MyNCBI account for saved search strategies, etc. you must authenticate via third-party Multi-Factor-Authentication. Please use the link below to choose which third-party option is best for you.
https://ncbiinsights.ncbi.nlm.nih.gov/my-ncbi-login-transition-tips/#choosing. If you just wish to search PubMed for locating resources then no further login is required.
License Information: There are no restrictions to the number of simultaneous users. This is an Open Access resource freely available on the Internet. However, the University of Saskatchewan site requires authentication for the convenience of faculty and student access to full text link out. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law.
DynaMed
DynaMed includes thousands of medical graphics and images to help make accurate diagnoses. Topics include concise summaries and detailed recommendations based on the most current evidence. Specialty content can be found in the following areas: Allergy, Cardiology, Critical Care, Dermatology, Ear, Nose, and Throat (ENT), Emergency Medicine, Endocrinology, Gastroenterology, Gynecology, Hematology, Infectious Diseases, Nephrology, Neurology, Obstetrics, Oncology, Orthopedics & Sports, Medicine, Pediatrics, Primary Care, Psychiatry, Pulmonary Medicine, Rheumatology, Surgery, Vascular Medicine. DynaMed content is extensively reviewed by clinical experts.
Access Note: For seamless and secure access to DynaMed, please upgrade to the latest version of Firefox, Chrome, or Edge.
License Information: This license was negotiated for the Saskatchewan Health Information Resources Program (SHIRP). There are no restrictions to the number of simultaneous users. Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and to walk-in users of the University of Saskatchewan Library for educational, research, and non-commercial personal use. It is accessible in the library, on campus, and remotely. Systematic copying or downloading of electronic resource content is not permitted by Canadian and International Copyright law.

ACP Journal Club
ACP Journal Club helps you stay current with the latest evidence-based clinical information relevant to internal medicine and its subspecialties. Reviewing over 120 leading medical journals, this monthly feature in Annals of Internal Medicine contains an editorial, easy to read abstracts, and a page of other notable articles.

JAMAevidence This link opens in a new window
Using evidence-based medicine, JAMAevidence "helps decision makers identify the best available evidence by providing guides to the systematic consideration of the validity, importance, and applicability of claims about the assessment of health problems and the outcomes of health care." Access Note: Mobile access is available. Access is limited; users must self-register (free) username and password.
License Information: This license has been negotiated for the Saskatchewan Health Information Program (SHIRP). There are no restrictions to the number of simultaneous users. Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and to "walk-in" users of the University of Saskatchewan Library for educational, research, and non-commercial personal use. It is accessible in the library, on campus, and remotely. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law.
PEN: Practice-based Evidence in Nutrition This link opens in a new window
Current and authoritative guide to answers to day-to-day nutrition questions encountered in dietetics practice in all settings. Access Note: Since access to this resource is restricted to 9 simultaneous users, please click on Log Out at the end of your session.
License Information: Access is restricted to nine (9) simultaneous users. Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and to "walk-in" users of the University of Saskatchewan Library for educational, research, and non-commercial personal use. It is accessible in the library, on campus, and remotely. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law.
ACCESSSS This link opens in a new window
ACCESSSS is a federated search engine which provides current best evidence for clinical decisions. It conducts literature searches simultaneously in several different evidence-based information services.
*Note:* Users will have to create an account to search for resources.
License Information: There are no restrictions to the number of simultaneous users but there are restrictions in place on simultaneous use in some of the databases it searches.This is an open access resource freely available on the Internet. Systematic copying or downloading of electronic resource content, including the downloading of a full issue, is not permitted by Canadian and International Copyright law.

3. Critically appraise the literature. You are testing for validity, clinical relevance, and applicability

What are the results of the study?

University of Oxford, CEBM: Critical Appraisal Tools
Contains useful tools and downloads for the critical appraisal of different types of medical evidence. Example appraisal sheets are provided together with several helpful examples.
A Simple Method for Evaluating Clinical Literature
Flaherty, RJ. A simple method for evaluating the clinical literature. Fam Pract Manag. May 2004: 47-52.

4. Apply the results in clinical practice

5. Evaluate the outcomes in your patient

Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

Clinical Guidelines

CPG Infobase: Clinical Practice Guidelines
The CPG Infobase is a database of evidence-based Canadian clinical practice guidelines (CPGs). Maintained by Joule™, a CMA company, it includes approximately 1,200 CPGs developed or endorsed by authoritative medical or health organizations in Canada.
National Center for Complimentary and Integrative Health
Issued by third-party organizations, and not NCCIH, these guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients.
Canadian Diabetes Association : Clinical Practice Guidelines
Patient-centered care and chronic disease management

Evidence Based Practice Journals

International Journal of Evidence-Based Health Care
Fully refereed journal that publishes original scholarly work relating to the synthesis (translation), transfer (distribution) and utilisation (implementation and evaluation) of evidence to inform multidisciplinary health care practice. The journal also publishes original scholarly commentary pieces relating to the generation and synthesis of evidence for practice, the use and evaluation of evidence in practice, and the process of conducting systematic reviews (methodology) as well as providing a forum for the debate of issues surrounding evidence-based healthcare.
Journal of Evidence-Based Integrative Medicine
Peer-reviewed open access journal which focuses on hypothesis-driven and evidence-based research in all fields of complementary, alternative, and integrative medicine.

New Evidence-Based Journal Articles in Nutrition

Nutrition Interventions from WHO

e-Library of Evidence for Nutrition Actions (eLENA) from World Health Organization has many ideas for nutrition interventions.

PICO Model

Breaking up your question into these 4 elements (which you can easily remember with the mnmeonic device PICO) will make your literature search process easier:

Patient, population, or problem

Description of the patient, population and/or the target disorder of interest
What are the most important characteristics of the patient?
How would you describe a group of patients similar to yours?
What is the disorder and condition of interest?

Intervention

Which intervention, prognostic factor, diagnostic tool, or exposure are you considering?

Comparison intervention

What alternative do you want to compare with the intervention?
Examples: standard of care, reference standard, Placebo

Outcome

What outcome you hope to accomplish or measure?