Presented by: Robyn Butcher, Sandra Kendall, Carla Hagstrom and Gail Nichol Advanced Searching Methods Family Medicine
Learning Objectives Summarize evidence based medicine Plan a search using PICO Develop advanced searching strategies in Medline Describe the importance of critical appraisal Examine open access journals in Africa
What Is Evidence Based Medicine? “Evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient” – Dave Sackett
EBDM – What Is It? Clinical Expertise Research Evidence Patient Preferences EBDM
Why Use EBM? Advances quality of care provided Increases satisfaction of patients Refocuses practice away from habits and tradition to evidence and research Allows you to keep up to date with current literature
A cquire the best evidence A ppraise the evidence A pply evidence to patient care Assess your patient A sk clinical questions 5 Step EBM Cycle
Adapted from: Brian Haynes, R Evid Based Med 2006;11: Systems Computerized decision support Summaries Evidence-based textbooks Synopses Evidence-based journal abstracts Syntheses Systematic Reviews Studies Original journal articles Haynes Tiers
Type of Question Suggested Type of Study TherapyRCT>cohort>case control>case study DiagnosisProspective, blind comparison to a gold standard Etiology/HarmRCT>cohort>case control>case series PrognosisCohort study>case control>case series PreventionRCT>cohort study>case control>case series CostEconomic analysis Adapted from Duke library guide Introduction to Evidence Based Practice.
Planning a Search Formulate an answerable question Pull the main concepts from the question List the terms that relate to your concepts Combine your terms Choose your database Search!
Formulating an Answerable Question PICO Model P= Patient, Problem, Population I= Intervention C= Comparison O= Outcome
Example Your hospital wants to implement a policy of placing all HIV+ patients on INH prophylaxis therapy. You have been asked to do a review to see if that is successful in preventing tuberculosis, in particular in other African countries.
PICO Example Continued P – HIV positive in African countries I – INH prophylaxis therapy C – n/a O – decreased rates of tuberculosis Answerable Question: In African countries does INH prophylaxis therapy help reduce the rates of tuberculosis among HIV positive patients?
Putting Together A Search Strategy Pull the main concepts from your question In African countries does INH prophylaxis therapy help reduce the rates of tuberculosis among HIV positive patients? List the terms that relate to your concepts
PICO Clinical Question Search Strategy PICOClinical QuestionSearch Strategy Patient PopulationHIV positive patients in African countries HIV positive, HIV infection, human immunodeficiency virus, Africa, Ethiopia, Eastern Africa Intervention INH prophylaxis therapyINH prophylaxis therapy, INH preventive therapy, Isoniazid, IPT Comparison (if any) n/a OutcomeReduction of cases of tuberculosis Tuberculosis
Medline Search
MeSH: Medical Subject Headings Every database has its own indexing system They often use their own thesaurus or controlled vocabulary Medline uses MeSH When searching you want to match your keyword to the subject heading Example: keyword=cancer, MeSH=neoplasms
Example – Medline Search
Select the Subject Heading
View the Scope Note
View the Tree
View Results and Enter Next Search Term
Select the MeSH Heading
View Results and Enter Next Search Term
Combine Search Terms With “And”
Apply Limiters
View Results
Get Full Text
Full Text Article
HIV Or HIV Infections?
Can You Use DynaMed Or Clinical Evidence For Advanced Searching? Yes and No No It should not be your sole or even primary searching tool Yes Monographs do have links to original studies Think of it as a supplementary tool
DynaMed-example
DynaMed-example (cont’d)
Another Example Patient was diagnosed with diabetes mellitus within the last year. He is a Muslim and wants to know what he should do during Ramadan.
PICO Example Continued P – Diabetic Muslims I – Management of diabetes during Ramadan C – n/a O – Safe fasting guidelines Answerable Question: In Muslims with diabetes mellitus are there guidelines or treatment options for safely observing the Muslim fasting month?
Putting Together a Search Strategy Pull the main concepts from your question In Muslims with diabetes mellitus are there guidelines or treatment options for safely observing the Muslim fasting month? List the terms that relate to your concepts
PICO Clinical Question Search Strategy PICOClinical QuestionSearch Strategy Patient Population Muslims with diabetesMuslims, Islam, diabetes type 1 or type 2, diabetes mellitus InterventionManagement of diabetes during Ramadan Ramadan, fasting Comparison (if any) n/a Outcome Safe fasting guidelinesGuidelines, treatment
Example – Medline Search
Select the Subject Heading
View the Scope Note
View the Tree
View Results and Enter Next Search Term
Select the MeSH Heading
View Results and Enter Next Search Term
Combine Search Terms With “And”
Too Few Results? Remove a Search Term
Apply Limiters (Practice guidelines or reviews)
View Results
Next Steps
A cquire the best evidence A ppraise the evidence A pply evidence to patient care Assess your patient A sk clinical questions 5 Step EBM Cycle
Why Do We Need To Critically Appraise? To ensure research is valid and reliable To ensure the statistics match the information in the discussion section To decide whether this article is going to help you with your decision making
Basic Critical Appraisal What journal did it appear in? Who are the authors? What is the broad question they are asking? Did they actually address this question? Was the methodology appropriate? Did it produce reliable data? What are the reported results?
Critical Appraisal Forms SIGN (Scottish Intercollegiate Guidelines Network) Centre for Evidence-Based Medicine
Where Can I Find This Presentation? Programs Library Science Training
Any Questions?