Searching Medical Sources

Searching Medical DatabasesMLIS 9320March 23, 2010

Robin Featherstone, BA, MLISClinical Medicine LibrarianAllyn & Betty Taylor Libraryrfeathe@uwo.ca

Presentation available at: http://www.slideshare.net/featherr

Agenda

• Sources of Medical Evidence (EBM) & PICO• Free Tools– PubMed– Trip Database

• Subscription databases– EMBASE (Ovid)– CINAHL (Ebsco)

Level of Evidence Pyramid

Qualitative Studies

Trip searches both

PICO

P: Patient, population or problem

I: Intervention or exposureC: Comparison (optional)O: Outcome

PICO Example

A patron calls the desk and asks if you have any information about jet lag. They travel frequently and would like to know more about prevention methods. Have you heard of using melatonin? They’ve also read that exercise can be used to prevent symptoms. What does the medical literature say?

Use PICO to identify keywords for your search

P: Patient with jet lagI: MelatoninC: ExerciseO: Prevention of symptoms

FREE TOOLS

PubMed/MEDLINE• Freely accessible database of biomedical literature from

the US National Library of Medicine• What you’ll find:

– Citations for: Primary research articles, review articles, Cochrane reviews

– Academic, scientific literature written for clinicians, researchers, chemists, biologists, etc...

• What you won’t find:– Plain language materials– Clinically appraised topics– Evidence grading

Key Features in PubMed

• Medical Subject Headings (MeSH)• Limits• Single Citation Matcher• Clinical Queries• Topic Specific Queries

PubMed Exercises

• What are the MeSH headings for “tranquilizers?”

• Find an article published in the journal Psychopharmacology by J.M. Nichols in 1993

• Find articles on therapies for Intermittent Explosive Disorder (IED)

• Find a randomized controlled trial on chocolate cravings

Trip Database

• Freely available clinical search tool from the UK that identifies high quality clinical evidence

• What you’ll find:

• What you won’t find:– Sophisticated search interface– Comprehensive coverage of the medical literature

Evidence Based SynopsesSystematic ReviewsGuidelinesClinical Q&A

Primary ResearcheTextbooksPatient Information News

Key features in Trip: http://www.tripdatabase.com/

• Allows filtering by level of evidence• Conclusions of systematic reviews available in

the citation• If available, results will include images• Links available to Medline articles

Trip Exercises http://www.tripdatabase.com/

• Run a search for bipolar disorder. – Limit your results to only the highest quality

evidence. – Identify Canadian guidelines.

• Locate images of hip replacements• Answer the question: Is tea tree oil effective in

treating dermatological conditions?

SUBSCRIPTION TOOLS

EMBASE (Ovid)• Subscription database (Ovid) • What you’ll find:

– Citations for: Primary research articles, review articles, Cochrane reviews– Academic, scientific literature written for clinicians, pharmacists,

researchers, etc...– European focus– Good coverage of drug information

• What you won’t find:– Plain language materials– Clinically appraised topics– Evidence grading

Key Features in EMBASE:

• Guided search in Ovid• EMTREE (Subject Headings)• Limits– Routes of drug administration

EMBASE Exercises:

• Find citations on use of gabapentin for patients with fibromyalgia

• Find citations on intracameral administration of lidocaine

CINAHL (Ebsco)

• Subscription database (Ebsco)• Nursing and allied health literature• What you’ll find:

– Citations for: Primary research articles (mix of qualitative and quantitative), review articles, opinion papers, editorials, letters

– Allied health information for nurses, physiotherapists, occupational therapists, etc...

• What you won’t find:– Clinically appraised topics– Evidence grading

Key Features in CINAHL

• CINAHL Headings (Subject Headings)• Search history• Combining your searches

CINAHL Exercises

• Find citations about hydrotherapy for patients with arthritis– Limit your results to research articles only

• Find citations about depression following mastectomy– Limit to Quality of Life Studies

Summary

• Use PICO when answering health-related information requests

• Be conscious of the levels of evidence – aim for the highest level which still answers the patrons needs

• PubMed and Trip as high-quality free resources• EMBASE (Ovid) for drug-related questions• CINAHL (Ebsco) for allied health questions

Challenge Exercise

A patron asks you to help her find a recent article (just published) about beta blockers versus calcium-channel blockers in preventing stroke. She remembers that the article discussed blood pressure variability.

QUESTIONS