Presented by: Robyn Butcher, Sandra Kendall, Carla Hagstrom and Gail Nichol

Advanced Searching MethodsFamily Medicine

dfcm.librarian@utoronto.ca

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 researchAllows you to keep up to date with current

literature

Acquire the best evidence

Appraise the evidence

Applyevidence to patient care

Assess your patient

Ask clinical questions

5 Step EBM Cycle

Adapted from: Brian Haynes, R Evid Based Med 2006;11:162-164

SystemsComputerized

decision support

SummariesEvidence-based textbooks

SynopsesEvidence-based journal abstracts

SynthesesSystematic Reviews

StudiesOriginal journal articles

Haynes Tiers

Type of Question

Suggested Type of Study

Therapy RCT>cohort>case control>case study

Diagnosis Prospective, blind comparison to a gold standard

Etiology/Harm RCT>cohort>case control>case series

Prognosis Cohort study>case control>case series

Prevention RCT>cohort study>case control>case series

Cost Economic analysis

Adapted from Duke library guide Introduction to Evidence Based Practice.

Planning a Search

Formulate an answerable questionPull the main concepts from the questionList the terms that relate to your conceptsCombine your termsChoose your databaseSearch!

Formulating an Answerable QuestionPICO 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

PICO Clinical Question Search Strategy

Patient Population HIV positive patients in African countries

HIV positive, HIV infection, human immunodeficiency virus, Africa, Ethiopia, Eastern Africa

Intervention INH prophylaxis therapy INH prophylaxis therapy, INH preventive therapy, Isoniazid, IPT

Comparison (if any) n/a n/a

Outcome Reduction 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

View Results and Enter Next Search Term

Combine Search Terms With “And”

Combine Search Terms With “And”

Apply Limiters

View Results

Get Full Text

Full Text Article

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

PICO Clinical Question Search Strategy

Patient Population Muslims with diabetes Muslims, Islam, diabetes type 1 or type 2, diabetes mellitus

Intervention Management of diabetes during Ramadan

Ramadan, fasting

Comparison (if any) n/a n/a

Outcome Safe fasting guidelines Guidelines, 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

View Results and Enter Next Search Term

Combine Search Terms With “And”

Combine Search Terms With “And”

Too Few Results? Remove a Search Term

Apply Limiters (Practice guidelines or reviews)

View Results

Next Steps

Acquire the best evidence

Appraise the evidence

Applyevidence to patient care

Assess your patient

Ask 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)http://www.sign.ac.uk/methodology/checklists.html

Centre for Evidence-Based Medicinehttp://ktclearinghouse.ca/cebm/teaching/worksheets

Where Can I Find This Presentation?

www.TAAAC.com

Programs Library Science Training

Any Questions?