Exercises Suggested Solutions

Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008 Hilde Strømme. Ullevaal University Hospital, Medical Library

Exercise 1 – Suggested solution Question:

What is the survival rate of extremely premature infants?

1. Patient/problem Extremely premature infants

2. Intervention or Exposure

3. Comparison

4. Outcome Survival rate

What type of question is this?

Diagnosis

Prognosis

Etiology

Therapy

Experience

Which search terms should be used?

Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always necessary or smart to search for all the different parts of the question, decide which parts are essential.

P

Patient/problem

I

Intervention/exposure

C

Comparison

O

Outcome

extremely premature

premature infant

very low birth weight

survival rate

survival time

Suggested search strategies: PubMed Clinical Queries:

This stragegy will give more results: (extreme* premature OR very low birth weight) AND survival rate With MeSH database:

Identify the correct MeSH terms via MeSH database and search for these. In this case it may be smart to search for Infant, Premature OR Infant, Very Low Birth Weight first. Then do a new search for Survival Rate. Go to History to combine the searches with AND. Then find the number of the combined MeSH search. Go to Clinical Queries and put in the number of the MeSH search.



Exercise 2 – Suggested soulutions Question:

Can the use of mobile phones cause brain cancer?

1. Patient/problem Everybody who use mobile phones

2. Intervention or Exposure Mobile phones

3. Comparison

4. Outcome Brain cancer


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

mobile phone

cellular phone

cell phone

cellular telephone

mobile telephone

bran cancer

brain tumor

brain tumour

brain neoplasms

intracranial cancer

intracranial tumor

intracranial tumour

intracranial neoplasms


With MeSH database:

Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the number of the MeSH search. Go to Clinical Queries and put in the number of the MeSH search.



Exercise 3 - Suggested solutions Question:

In patients with a suspected lower limb deep venous thrombosis, does the presence of Homan's sign accurately diagnose a deep vein thrombosis?

1. Patient/problem

Patients with a suspected lower limb deep venous thrombosis

2. Intervention or Exposure Homan's sign

3. Comparison

4. Outcome Accurate diagnosis of deep vein thrombosis


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

homan’s sign

deep vein thrombosis

dvt

venous thrombosis


Narrow, specific search will produce 0 results. Broad, sensitive search gives av few results. Search for Homan’s sign in MeSH database gives no hits, therefore you have to use text words.



Exercise 4 – Suggested solutions: Question:

Is paracetamol effective for reducing fever in children?

1. Patient/problem Child with fever

2. Intervention or Exposure Paracetamol

3. Comparison

4. Outcome Reduction of fever


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

child

fever

hyperthermia

pyrexia

paracetamol

acetaminophen

acetamidophenol

hydroxyacetanilide

panadol

acamol

acetaco

anacin

datril

algotropyl

acephen

tylenol

Suggested search strategies: The Cochrane Library:

PubMed Clinical Queries:

With MeSH database:

Identify the correct MeSH terms via MeSH database and search for these. Limit to All child 0-18 years. Go to History and find the number of the limited MeSH search. Go to Clinical Queries and put in the number of the MeSH search.




Is acupuncture more effective than nicotine replacement therapy for smoking cessation?

1. Patient/problem Smokers

2. Intervention or Exposure Acupuncture

3. Comparison Nicotine replacement therapy

4. Outcome Smoking cessation


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

acupuncture

nicotine replacement

nicotine gum

nicotine patch

smoking cessation


Combining smoking cessation AND acupuncuture AND nicotine replacement (search #4) will produce just a few RCTs. In this case it might be more appropriate to combine the intervention (acupuncture) and comparison (nicotine replacement) with OR (search #5) and then combine this with the outcome (smoking cessation) as in search #6. This will produce several systematic reviews. Two relevant titles: Nicotine replacement therapy for smoking cessation Acupuncture and related interventions for smoking cessation Maybe you will find the answer to your question by reading, appraising and comparing these two. PubMed Clinical Queries:

With MeSH database:

Identify the correct MeSH terms via MeSH database and search for these. In this case there is no MeSH term for nicotine replacement. A possible solution is to do a text word search for the relevant synonyms for nicotine replacement and then combine this with the MeSH terms for acupuncture and smoking cessation. Note: The MeSH term Acupuncture is about the dicipline (those performing acupuncture therapy) while Acupuncture therapy is the actual treatment. In this case the combination of smoking cessation, acupuncture and nicotine replacement only gives 7 hits. No point in taking it to Clinical Queries.




What is the difference between Ciclesonide and other inhaled steroides for chronic asthma in children and adults with regards to improvement of lung function and side effects?

1. Patient/problem Asthma

2. Intervention or Exposure Ciclesonide

3. Comparison Other inhaled steroides

4. Outcome Improved lung function. Side effects.


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

asthma

ciclesonide

alvesco

omnaris

desisobutyrylciclesonide

pregnenedione

steroids

corticosteroids

corticoids



With MeSH database:

Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the number of the MeSH search. Enter this number in Clinical Queries.




Is group therapy effective for patients suffering from post-traumatic stress disorder (PTSD)?

1. Patient/problem Post-traumatic stress disorder (PTSD)

2. Intervention or Exposure Group therapy

3. Comparison

4. Outcome Reduction of PTSD symptoms


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

post-traumatic stress disorder

ptsd

post-traumatic neurosis

group therapy

group psychotherapy



With MeSH database:





Is phototherapy effective in treating seasonal affective disorder?

1. Patient/problem Seasonal affective disorder

2. Intervention or Exposure Phototherapy

3. Comparison

4. Outcome Reduction of symptoms of seasonal affective disorder


Diagnosis

Prognosis

Etiology

Therapy

Experience



P

Patient/problem

I


C

Comparison

O

Outcome

seasonal affective disorder

seasonal mood disorder

phototherapy

photoradiation therapy



With MeSH database:



Health & Medicine

Exercises Suggested Solutions