Revised January 2008 IUPUI University Library Randi L. Stocker, MLS developed for the Indiana University School of Nursing

1. Develop a searchable question 2. Search relevant databases, such as CINAHL, Medline, and others. Stocker, R. (2008). Finding articles and systematic reviews related to nursing [web page]. exes exes 3. Evaluate citations for potential relevance Read summaries to make sure responses are relevant to your practice, if not may need to go back to step 1 Steps:

PICO (most common) P – Patient or problem I – Intervention C – Comparison O – Outcome What is the effect of _________________________________ Intervention / Predictor Variable On _________________________________ Given Characteristic / Outcome For _________________________________ Specific group of patients / Patient Characteristics Alternate Template for Searching Alternate template: Thede, L. Q., Pierce, S., & Allen, M. (2003). Other Facets of Informatics: A wide Impact. In L. Q. Thede (Ed.), Informatics and Nursing: Opportunities & Challenges (2nd ed., pp ). Philadelphia: Lippincott. Two Search Methods

Select search tools Databases oriented to different practitioners: Nurses, Physicians, Psychologists, Educators, (& patients) Databases focusing on specific types of research: Guidelines, Systematic Reviews, Registers of studies, etc. Design search strategy that optimizes value of selected databases & their features Select Subject Headings Select Limits Review results; modify search

 Each article is coded with relevant official Subject Headings. (The coding is based on what the authors’ write.)  Different authors use different terminology.  To avoid misinterpretations or oversights in searches all articles are coded using that database’s “official” subject headings for that a given concept. Example:  If the author used any of the following phrases, the article would be coded with the official MeSH term, “Breast Neoplasms”  Used for: breast cancer, breast neoplasm, breast tumor, or breast tumors

 The “Official” lists of subjects used in CINAHL and Medline are similar, but not identical.  Medlne’s official list of Subject Headings is known MeSH (Medical Subject Headings).  CINAHL uses many MeSH headings, but, over time, has added many additional Subject Headings Additional topics indexed in CINAHL include: Research methodology and instruments Theories and models, Nursing concepts such as “wellness”

(in 2006)MEDLINECINAHL Journal titles4,800+1,800+ Other formatsSearch NLM gateway Many, including web Subject HeadingsMeSH - biomedicalMeSH-based 7,427 same + 4,987 unique SubheadingsYes; as many as needed Yes; up to 3 per heading Publication typesFormat/type of article Adds features included in item Cited referencesNoYes, * Allen M. (2006).

Each concept is coded only at the most specific level Example – Article focuses ONLY on Male Breast Cancer? It is only coded with the phrase: “Breast Neoplasms, Male” MeSH “Subject Tree” for Breast Neoplasms (used in both the Medline & CINAHL databases) All MeSH subject headings : Diseases category: Neoplasms: Neoplasms by Site: Breast Neoplasms Breast Neoplasms, Male Carcinoma, Ductal, Breast

Problem – Searching “Breast Neoplasms” using Ovid will only retrieve articles coded at that level. in the subject tree. It will miss the articles that ONLY discuss “Male Breast Neoplasms.” Solution – Select the Explode option to retrieve results using the selected term plus all of its more specific terms. Then “Breast Neoplasms” with Explode turned on also includes: “Breast Neoplasms, Male” “Carcinoma, Ductal, Breast” MeSH “Subject Tree” for Breast Neoplasms (as used in both the Medline & CINAHL databases) All MeSH subject headings : Diseases category: Neoplasms: Neoplasms by Site: Breast Neoplasms: (EXPLODED) Breast Neoplasms, Male Carcinoma, Ductal, Breast

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Problem – Searching “Breast Neoplasms” will retrieve articles that mention them, regardless of whether the they are just mentioned in passing or are a major focus of the article Solution – Select the Focus option to retrieve only those results where “Breast Neoplasms” is a major focus of the article. CINAHL results (as of 1/24/2008) Breast Neoplasms = articles Breast Neoplasms (Exploded) = articles Breast Neoplasms (Exploded & Focused) = articles

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CINAHL and MeSH terms are arranged in hierarchies, referred to as trees “Exploding” subject headings adds terms below the selected term in the hierarchy (PubMed automatically explodes subject headings and subheadings, unless user changes this default setting) Subject headings are selected for both major and minor mentions of a concept Use “Focus” to retrieve only those articles that concentrate on that concept References: Allen, M. (2007). MEDLINE and CINAHL Indexing Practices.

Primary Research Individual studies Abstracts and commentaries Need to evaluate and synthesize findings Research is sometimes limited to specifics and results do not always apply Evidence Summaries – Synthesis Systematic Reviews: Integrative Reviews; Meta-Analysis Critical Appraisal with implications for practice Translation Literature

Proven practices, not new findings Practice guidelines Care plans Critical paths Protocols Standards Clinical innovations

1. Translation Literature Are they evidence-based? Just because it’s a gold standard doesn’t mean that it is common knowledge 2. Look for Evidence Summaries Systematic reviews; Meta-analyses; Critical appraisals 3. What’s new? Primary Research Research Abstracts Research in progress Propose new research?

Evidence Based Guidelines Systematic Reviews / Meta-Analyses Critically-Appraised Topics & Articles Randomized Control Trials Cohort Studies Case Studies & Reports Background Information/Expert Opinion

Think about question Use of official Subject Headings EBP filters Explode, Indexing, Focusing Other limits? Sample Search: What should we do to prevent pressure ulcers in our elderly patients? *Allen, M. (2006).

What is the effect of Nursing care/interventions Intervention (Predictor Variable) On Preventing pressure ulcers Given Characteristic (Outcome) For Elderly________________ Specific group of patients (Patient Characteristics) What should we do to prevent pressure ulcers in our elderly patients? Sample Search: *Allen, M. (2006).

Subject Headings Limits CINAHL version of the search Pressure Ulcer Pressure Ulcer/ nursing; prevention & control Limit to Nursing Journals subset? Evidence Based Practice (Specific Interest Category) Systematic Review (Publication Type) Research Aged & Clinical Queries MEDLINE version of the search Pressure Ulcer/ nursing; prevention & control Limit to Nursing Journals subset? Evidence Based Medicine Reviews Systematic Reviews (subset) Practice Guidelines All Aged (65 and Over) Clinical Queries

CINAHLPubMed/MEDLINE Translation LiteratureCare Plan [PT] OR Clinical Innovations [PT] OR Critical Path [PT] OR Practice Guidelines [PT] OR Protocol [PT] OR Standards [PT] OR Algorithm [PT] OR Evidence Based Care Sheet [PT; C+ only] Optional: CEU [PT] Practice Guideline [PT] OR Guideline [PT] Clinical Protocols [MH] OR Critical Pathways [MH] OR Decision Trees [MH] OR Standards [subheading] Systematic [sb] NOT (Clinical Trial OR Review [PT] OR Meta-Analysis [PT]) Evidence SummariesSystematic Review [PT] Commentary [PT] with Research or Review Systematic [sb] AND (Review [PT]) OR Meta-Analysis [PT]) Primary ResearchResearch [PT]Clinical Trials [PT] OR RCT [PT] Validation Studies [PT] Has abstract Clinical queries OR SUMsearch Clinical queries [PT] = Publication Type; [MH] = MeSH Subject Heading; [sb] = Subheading *Allen, M. (2006).

MEDLINE Ovid PubMed EBSCOhost others CINAHL EBSCOhost Only source for CINAHL Plus Ovid through 2008 others COCHRANE Reviews Ovid Wiley Interscience CINAHL MEDLINE others

Read more about it: Allen, M. (2006). Teaching clinicians to fish: Library skills for EBP [PowerPoint show]. FishWeb.pps Allen, M. (2007). MEDLINE and CINAHL indexing practices [Handout].