Mastering Literature Searches Heather O’Mara, DO MAJ, MC Faculty Development Fellow

Learning Objectives Formulated clinical question using PICO framework Discussed search engines available to answer clinical questions Conducted literature search

Steps in EBM ASK – Convert the need for information into a focused clinical question (PICO) ACQUIRE – Track down the best evidence with which to answer that question. APPRAISE – Critically appraise the evidence for its validity, impact, and applicability APPLY – Integrate the evidence with your clinical expertise and your patients characteristics and values ASSESS – Assess the results for your intervention

Formulating the Question: PICO P - Patient or Problem I - Intervention C - Comparison O - Outcomes

Case Example LT Upcoming Wedding is a 23 yo AD female in your outpatient clinic. She is a little frantic... she is scheduled to get married in 4 days and she has a scratchy throat and runny nose that started yesterday. She is inquiring if zinc will make her healthy for her wedding.

The Question P – Patient or Problem I - Intervention C - Comparison O - Outcomes Adult with common cold Zinc Lozenges No treatment Shorten recovery time In adults with the common cold, do zinc lozenges, compared to no treatment, shorten recovery time?

Activity 1 Think of a recent patient encounter where a question came up. Frame your question using the PICO format. Be prepared to share! 5 min

Which Resource? Background Question Ask to obtain general knowledge about an illness, condition, or disease Ask who, what, when, where, how, or why Medical textbooks, review articles, point of care tools and compilations (DynaMed, AccessMedicine) Foreground Questions Ask for specific knowledge to inform clinical decisions Deal with specific patient population; more complex than background questions MEDLINE, PubMed

Evidence Pyramid

So, Where to Begin?

With User ID and Password available from Medical Librarian you can use this from anywhere! Ovid

Zinc lozenges Ovid

What?! How Many Articles? Edvard Munch - The Cry, 1893

Ovid

19

Boolean Search Terms Boolean logic is a system of showing relationships between sets by using the words "AND," "OR," and "NOT.“ “Boolean logic” is recognized by many search engines as a way of defining a search string

Boolean Terms – “OR” Used when not getting enough results Broad net Medical OR Writer

Boolean Terms - AND Used when you need to narrow your search Only returns the blue shaded overlap point Medical AND Writer

Boolean Terms - NOT Used to narrow a search Will eliminate all hits that will include information on medical and writer Medical NOT Writer

Using Quotation Marks Most specific Returns only the exact phrase “Medical Writer”

Using Word Roots Another trick…use “$” Will allow you to look for many different types of the same word “Screen$” retrieves: – Screen – Screens – Screening – Etc.

BACK TO THE EXAMPLE …

Ovid

LETS TRY IT AGAIN…

TRIP database Turning Research Into Practice Search engine that finds high quality research evidence such as systematic reviews, CATs, peer reviewed articles, etc.

Trip

LETS TRY IT AGAIN…

Pub Med

Pub Med: PICO

MeSH Terms Medical Subject Headings National Library of Medicine controlled vocabulary thesaurus for indexing articles on PubMed

How about one last time!

Cochrane Library

Librarians = Best Friends Search databases you can’t reach Perform expert literature search Obtain articles you don’t have access to Tutorial in searching

Activity 2 1.Review the attached case and clinical question. 2.Using database assigned to your group, search for your evidence based answer. 3.Annotate the search terms you used. 4.Be prepared to discuss your findings. 15 min

Key Points Formulate clinical question using PICO format Type of database you use will depend on your type of question (background vs foreground) Several search engines available: Ovid, TRIPs, PubMed, Cochrane Use your librarian: – Remote access – Literature search

References 1. UCSF School of Medicine: Searching the Literature for Evidenced-Based Medicine. Accessed 7 December Duke University: Introduction to Evidence Based Practice. Accessed 7 December Himmelfarb Health Sciences Library: Evidence Based Medicine. Accessed 7 December Guilherme et al. Clinical questions raised by clinicians at the point of care. A systematic review. JAMA Intern Med. 2014;174(5):