1. The Literature Search: Getting Started Elaine Morschhauser, DC Evidence-Based Chiropractic March 27, 2003

2. Searching the literature — the starting point for ALL research

3. This presentation discusses: How to select topics you should include in the Introduction and Discussion sections of your paper  It does not show you how to use computer databases.

4. What is a Case Report/Case Study?  Describes the health history of a single patient in the form of a story  Relatively weak scientific evidence, but…  Can convey information that would be lost in a structured trial or study  Immediately understandable by non-academic clinicians and the lay public  Forms a foundation from which more sophisticated studies can be designed  Can be combined to publish a case series  More than one patient with a certain condition  Describe an aspect of the condition, the treatment, or adverse reaction

5. Anatomy of a Case Report Abstract Introduction Case Report Case History/Exam Methods Results Discussion Conclusions See Instructions to Authors

6. Introduction Introduces the case/condition of interest Reviews and cites the scientific literature on the topic (chiropractic & non-chiropractic literature) Includes recent, high quality references (articles are better than books)

7. Use of Literature in the Introduction  What do we already know about the condition and the type of care provided?  Clinical manifestations  Etiology  Epidemiology  Current/usual/medical management  Chiropractic management

8. Use of Literature in the Introduction  Why is it important to do this study/report this case?  Few other studies published on chiropractic management of this condition in patients  Unusual or marked results  Appropriately measured outcomes are favorable (or unfavorable!)

9. Use of Literature in Discussion  Compare your case’s results to results in literature  outcomes  type of care provided  types of patients  Speculative neurophysiology only briefly, if at all

10. Search  Index to Chiropractic Literature: the only exclusively chiropractic journal literature index (not limited to “scientific” journals)  www.chiroindex.org  PubMed.gov – (online tutorial)  MedLine database  a journal that is said to be “indexed”, usually means MedLine  Allied & complementary health resource indexes AMED, CINAHL, MANTIS*  *www.chiroaccess.com (membership fee)  Free via Palmer library

11. MedLine PubMed  NLM’s database of indexed journal citations for biomedicine and health  ~4,500 journals  >11 million citations  U.S. and 70 other countries  1966-present  Online tool developed by the National Center for Biotechnology Information at the NLM  Free access to MedLine  Links to some full-text articles  Search using author name, title words, text words, journal names or any combination  MeSH terms, too

12. MeSH: Medical Subject Heading  Controlled vocabulary that is a distinctive feature of MedLine  Imposes uniformity and consistency to the indexing of biomedical literature  Terms are arranged in a hierarchical categorized manner

13. Suggested MeSH terms:  Chiropractic OR  Manipulation, spinal OR  Manipulation, orthopedic OR  Osteopathy  AND the topic/condition you are looking for  Or do separate searches for each subject, then combine the results

14. Use recent references  Typically limit references used to past 5 years  Older references used only if landmark/seminal or otherwise important information

15. How do I get started?  What is the topic of your paper?  Example: A pediatric patient with asthma.  What does the reader need to know about ASTHMA?  Etiology  Epidemiology and burden to society  What does the reader need to know about treatment of a child with asthma?  Medical/other  Chiropractic

16. Search MEDLINE for articles on  etiology of condition (brief)  epidemiology  prevalence  who is affected  burden to society in terms of $ and lost work  current treatment  how effective, expensive  are there side effects provide a rationale for why chiropractic may be a better approach

17. Search PubMed + MANTIS for articles on  Chiropractic management of this or similar conditions  Articles on the chiropractic management plan to be used in your paper  Be selective in obtaining full-text articles  you may find more useful references within those articles

18. Narrowing a MEDLINE search:  “Asthma” --> 64,493  “Asthma”, 1996-2001 --> 10,243  “Asthma AND children”, 1996-2001 --> 3,761  Limits “human”, “English language”, “Review articles” --> 514  Above limits plus 2002-2003 --> 177  “Asthma AND chiropractic” --> 5

19. Retrieval  Most searches allow perusal of abstract  Determine likely “fit” before retrieving full-text  Local college library  Alumni services -- chiropractic colleges’ libraries  CINAHL services (annual fee)  www.freemedicaljournals.com (limited selection)

20. Where in a case report?  “Fractured Heterotopic Bone in Myositis Ossificans Traumatica”, JMPT; 24(4).  In most cases, the heterotopic bone formation matures into a separate soft tissue mass within the involved muscle and is clinically silent  Clinical manifestations – typically described in the Introduction section

21. Where in a case report?  “Upper Cervical Chiropractic Management of a Patient with Parkinson’s Disease”, JMPT; 23(8).  An important aspect of this patient’s medical history was his recollection of head and/or neck traumas before the onset… The body of medical literature detailing a possible trauma- induced cause for PD, or at least a contribution, is substantial.  Compare your case’s results to results in the literature – typically in the Discussion section

22. Where in a case report?  “Chiropractic Management of a Patient with Lumbar Spinal Stenosis”, JMPT; 24(4).  Although some authors have found conservative measures to be of little long-term benefit, others recommend conservative therapy as the first choice of treatment, reserving surgical intervention for those patients who experience intolerable pain, progressive neurologic deficits, cauda equina syndrome (CES), or who fail to respond to conservative measures.  What do we already know? Current/usual/medical management – typically found in the Introduction section