Presentation on theme: "EBP Workshop: RMH November 2012 searching the literature"— Presentation transcript:
1 EBP Workshop: RMH November 2012 searching the literature Peter GreenbergPhysician: Department of General Medicine and Melbourne EpiCentre, The Royal Melbourne Hospital (RMH)& Honorary Principal Fellow: Schools of Medicine & Population Health, The University of MelbourneCatherine VoutierClinical Librarian, Health Sciences Library, Royal Melbourne Hospital
2 searching the literature managing clinical research evidenceevidence based practice (EBP)information, knowledge and wisdomsearch techniques and strategies
3 managing clinical research evidence information can be pushed or pulled pushed: alerts us to information we might need * ‘just in case’ learning: a) lay resources radio; films; television; books; newspapers b) professional resources textbooks; journals; e-subscriptions; “e-feeds”....pulled: access information when we need it * ‘just in time’ learning: useful whenever questions arise!
4 evidence-based clinical practice (EBP) begins by clarifying patients’ issues, which arise during consultationsEBP involves a series of ‘steps’:asking questionsseeking answerscritical appraisal of retrieved literatureapplying data to patients’ problemsintegrating information with the patients’ values
5 information, knowledge and wisdom what do literature searches deliver? information which is considered and applicable“wisdom” knowledge applied with experiencesee “The Rock” by T.S. Eliot (1934) for the difference between information, knowledge and wisdom
6 more about asking questions 1) what is the question about? therapy? diagnosis? cause? risk? prognosis?……..2) is the question general (‘background’) or specific for this patient (‘foreground’)?3) how are questions best structured to facilitate searches for answers?
7 ‘background’ and ‘foreground’ questions background * topic (e.g. ‘disease’) orientated * general rather than specific* begin with: ‘how’; ‘what’; ‘which’; ‘why’; ‘do’; ‘does’….....foreground* patient-problem oriented* specific* rather then general * structured formatforeground question components become search terms!
8 ‘background’ and ‘foreground’ questions in reality, there is a continuous spectrum from ‘background’ to ‘foreground’ questions
9 why structure ‘foreground’ questions in PICO(T) format why structure ‘foreground’ questions in PICO(T) format? Patient (Population) Intervention Comparison Outcome Time1) requires you to consider questions carefully++2) you can search with some (or all) PICO(T) terms!3) practice is needed to choose terms which: * precisely address your questions * are not too specific to provide answers
10 searching the literature managing clinical research evidenceevidence based practice (EBP)information, knowledge and wisdomsearch techniques and strategies
11 search techniquesavailable e-resourcesMeSH* terms * medical subject headingsearching ‘secondary’ data sourcessearching ‘primary’ data sources
12 search techniques available e-resources* via “Clinicians Health Channel”via Hospital (University or other) libraryvia private subscriptionvia www at no cost
20 MeSHMEDLINE entries are indexed with ~30,000 thesaurus terms and ~85 sub-headings for sensitive, specific and efficient searchingMeSH terms * applied to publications as specifically as possible * cover ~106 conceptseach publication has ~10-20 MeSH termsMEDLINE# & ‘The Cochrane Library’ have: * MeSH browsers: which assign ‘MeSH’ to ‘text’ terms * MeSH tree displays * automatic mapping of text to MeSH terms # accessed through ‘PubMed’, ‘EBSCO’ (Clinicians Health Channel); Institute for Scientific Information (ISI): Thompson Scientific. (The University of Melbourne), “OVID”…….
22 search techniques‘secondary’ databases * ‘filtered’ or derived from research publications e.g. ‘critical appraisals’; comments; summaries; syntheses, texts… * fewer citations * faster, efficient, easier searching * less sensitive, but more specific searches fewer citations, both relevant and irrelevant‘primary’ databases * original research publications * many citations * harder, slower searching * more sensitive, but less specific searches more citations, both relevant and irrelevant
23 examples of ‘secondary’ databases content example evidence summariestextssystematic reviews‘filtered’ by peers for relevance/importancestructured abstracts and commentaries‘Clinical Evidence’ see “Best Practice” (CHC)CHC resources see ‘Best Practice’ & ‘DynaMed’other resources “UpToDate”……...‘Cochrane Reviews’ see ‘The Cochrane Library’‘BMJ/McMaster Evidence Updates’‘ACP* Journal Club’ * American College of Physicians
24 other secondary sources of evidence clinical practice guidelines*: ‘systematically developed statements to assist practitioner (and patient) -decisions about appropriate health care for specific clinical circumstances’(integrated) clinical pathways*: “multidisciplinary outlines of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes.”*their value depends on the rigour of the development process
26 search techniques‘primary’ databases * original research publications * many citations * harder, slower searching * more sensitive, but less specific searches more citations, both relevant and irrelevant‘secondary’ databases * ‘filtered’ or derived from research publications e.g. ‘critical appraisals’; comments; summaries; syntheses, texts… * fewer citations * faster, efficient, easier searching * less sensitive, but more specific searches fewer citations, both relevant and irrelevant
27 examples of ‘primary’ databases ‘MEDLINE’ access: * ‘PubMed’ * ‘ISI’ Institute for Scientific Information: Thompson Scientific. (The University of Melbourne.) * ‘EBSCO’ (Clinicians Health Channel) * ‘OVID’……...Cochrane Library: “Clinical Trials”‘CINAHL’ Cumulative Index to Nursing and Allied Health Literature‘EMBASE’ Excerpta Medica Database (drugs)PsycINFO American Psychological Association (psychological abstracts)other…. ?
28 searching ‘Medline’ (‘PubMed’) some tips MeSH browser note the 2 option boxes below the sub-headings: * “Restrict to MeSH Major Topic” * “Do not include MeSH terms found below this term in the MeSH hierarchy”after retrieving publications, check: * “ Search details” to see how the search was undertaken # # truncation (e.g. Palliat*) removes ‘mapping’ to MeSH terms * “Related citations in PubMed” for additional, relevant citations * “Search History” to combine searches: see “Advanced” * MeSH terms allocated: alternative MeSH terms are displayed beneath citations“Clinical Queries” provides efficient, specific searching with “in-built” search filterslimits or qualifiers avoid these unless absolutely necessary, at the end of search
30 searching ‘The Cochrane Library’ some tips always do a MeSH search as well – type in a single term and locate appropriate MeSH term by clicking on “Thesaurus” button’– select best term from list– click on “View Results”• if searches involve > 1 search term, repeat the above• combine search results via ‘Search History’avoid adding limits or qualifiers until necessary
31 search strategy depends on… what the question is about: therapy, diagnosis, cause, risk……..question type: ‘background’, ‘foreground’availability of and experience with particular databasesthe purpose of the literature searchwrite a paper use primary sources of research datasystematic review use primary sources of research dataresearch project use primary sources of research datamanage a patient use secondary resources firsttime available secondary sources if there is little timeprevalence of issue secondary sources for common issues
34 search techniques and strategy summary formulate the best PICO(T) questionuse MeSH termsuse secondary databases first
35 further reading asking questions Straus S, Richardson SR, Glasziou P, Haynes BR. Evidence-Based Medicine. How to practice and teach EBM. 3rd ed. Elsevier Churchill Livingstone. 2005Glasziou , Del Mar C. Evidence-based Practice Workbook, 2nd Ed.Blackwell/BMJ Books. 2007Oxman AD, Sackett DL, Guyatt GH, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature: I. How to get started. JAMA 1993:270:Richardson WS, Wilson MC, Nishikawa J, Hayward RSA. The well-built clinical question: a key to evidence-based decisions. [Editorial]. ACP J Club 1995; 123(3):A12-13Richardson WS. Ask, and ye shall retrieve. [EBM Note]. Evidence Based Medicine 1998; 3:Mitchell G. Reframing the question. A way of applying evidence based medicine to a common clinical situation. Aust Fam Physician 1998; 27:875-6.Stone PW. Popping the (PICO) question in research and evidence-based practice. Appl Nurs Res 2002; 15:197-8.Onady GM, Raslich MA. Evidence-based medicine: asking the answerable question (question templates as tools). Pediatr Rev 2003; 24:Southern Health Centre for Clinical Effectiveness: Evidence-Based Answers to Clinical Questions for Busy Clinicians. Workbook‘Asking focused questions”. Centre for Evidence-Based Medicine Oxford(UK)An interactive tool from the Centre for Evidence Based Medicine Toronto
36 searching the literature for answers further readingsearching the literature for answersStraus S, Richardson SR, Glasziou P, Haynes BR. Evidence-Based Medicine. How to practice and teach EBM. 3rd ed. Elsevier Churchill Livingstone. 2005Glasziou , Del Mar C. Evidence-based Practice Workbook, 2nd Ed.Blackwell/BMJ Books. 2007“Help” and “Tutorials” sections within e-databasesJAMA ‘Users’ guides’ series. Oxman AD, Sackett DL, Guyatt GH, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature: I. How to get started. JAMA. 1993;270:Greenhalgh T. How to read a paper: the basics of Evidence-based Medicine. BMJ, London.1997Ebbert JO, Dupras DM, Erwin PJ. Searching the medical literature using PubMed: a tutorial. Mayo Clin Proc.2003; 78:87-91).Robinson A, Day S. The value of PubMed and HighWire Press for the busy general practitioner. Australian Prescriber 2004; 27(Number 1):16-18.Sood A, Erwin PJ, Ebbert JO. Using advanced search tools on PubMed for citation retrieval. Mayo Clin Proc 2004; 79:Giustini G. How Google is changing medicine. BMJ 2005; 331:Steinbrook R. Searching for the right search -Reaching the medical literature. N Eng J Med 2006; 354:4-7Tank H, Ng JHK. Googling for a diagnosis-use of Google as a diagnostic aid: internet based study. BMJ 2006; 333: