DETERMINANTS OF COMMUNITY HEALTH POWER SEARCHING Fall 2003 2003, Faculty of Medicine, University of Toronto

GOAL To design search strategies that find the best research that find the best research

OUTLINE l Introduction l MEDLINE l practice l PsycINFO l practice l Questions and discussion

STEPS IN A SEARCH Choose a database Formulate a search question Identify primary topics Identify searchable terms Relate the concepts FILTER!

SELECTED DATABASES l MEDLINE, l CINAHL, l PsycINFO, l Cochrane Library, l EMBASE, 1974-

STEPS IN A SEARCH Choose a database Formulate a search question Identify primary topics Identify searchable terms Relate the concepts FILTER!

ORIGINAL QUESTION: How can we improve our methadone maintenance program? FORMULATING A SEARCH QUESTION

l precise, testable l narrowly focused l phrase as a question or hypothesis FORMULATING A SEARCH QUESTION

P I E

P population or problem I E

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I E

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I intervention or issue E

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I intervention or issue methadone E

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I intervention or issue methadone E effect or evaluation

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I intervention or issue methadone E effect or evaluation compliance

l What factors affect compliance in a methadone maintenance program for heroin addiction? FORMULATING A SEARCH QUESTION

P population or problem heroin addiction I intervention or issue methadone E effect or evaluation

FORMULATING A SEARCH QUESTION P population or problem heroin addiction I intervention or issue methadone E effect or evaluation effectiveness

l What factors affect compliance in a methadone program for heroin addiction? l Is methadone an effective intervention for heroin addiction? FORMULATING A SEARCH QUESTION

STEPS IN A SEARCH Choose a database Formulate a search question Identify primary topics Identify searchable terms Relate the concepts FILTER!

SEARCH TERMS PRIMARY TOPICS PRIMARY TOPICS l methadone l heroin addiction effectiveness effectiveness SEARCH TERMS SEARCH TERMS l vary with each database

COMBINE METHADONE

COMBINE HEROIN ADDICTION METHADONE

COMBINE HEROIN ADDICTION AND METHADONE

STEPS IN A SEARCH Choose a database Formulate a search question Identify primary topics Identify searchable terms Relate the concepts FILTER!

FILTER HEROIN ADDICTION AND METHADONE

FILTER HEROIN ADDICTION AND METHADONE FILTER

Is methadone an effective intervention for heroin addiction?

SAMPLE SEARCH ASSIGNMENT 1.IDENTIFICATION John Smith, Fitzgerald Academy Telephone Fax

2.SEARCH QUESTION My field placement is with the Metropolitan Toronto Detox Centre. We want to improve the effectiveness of the methadone maintenance program for heroin addiction. Since compliance is a major factor affecting the program’s success, we want to focus specifically on barriers to compliance. I therefore selected as my core concepts compliance, methadone, and heroin addiction. Rephrased as a question, my search question becomes “What factors affect compliance in a methadone program for heroin addiction?”

3.SEARCH PLANNING DATABASE I decided to search in MEDLINE (Ovidweb), because it provides good coverage of the addictions literature. I decided to search in MEDLINE (Ovidweb), because it provides good coverage of the addictions literature. PRIMARY TOPICS 1.Methadone 2. Heroin addiction 3. Compliance

3. SEARCH PLANNING (cont’d) RELATIONSHIP BETWEEN CONCEPTS methadone AND heroin addiction AND compliance QUALITY FILTER If the base set is large enough, I will narrow it down just to studies using questionnaires or surveys. This will give me a subset that is research-based, using the same type of instrument we want to use in our own study.

4.DISCUSSION When I typed methadone in Medline, it mapped to the MeSH heading methadone. I exploded methadone to pick up the narrower term, methadyl acetate. I then typed my second concept, heroin addiction. This mapped to the MeSH heading heroin dependence. I clicked on the term to see the hierarchy of terms, and decided to move up to the broader MeSH, opioid- related disorders. I exploded it to include heroin dependence and morphine dependence. My third concept, compliance, retrieved three terms, one of which was patient compliance. The scope note for patient compliance cited treatment refusal and patient dropouts as related terms.

4.DISCUSSION (cont’d) I therefore created sets for all three terms, and combined them with OR, so that any of these terms would be picked up in the search. I then combined the sets for methadone, opioid-related disorders, and the various terms for patient compliance using AND. I limited this set to English and human to get a base set of 41. For my quality filter, I selected the term data collection, which can be exploded to include questionnaires and surveys; I want articles using these qualitative research tools. When I ANDed data collection with my base set, I retrieved a final set of five items. Most of the items in the final set appeared to contain useful information relating to my question. I therefore created sets for all three terms, and combined them with OR, so that any of these terms would be picked up in the search. I then combined the sets for methadone, opioid-related disorders, and the various terms for patient compliance using AND. I limited this set to English and human to get a base set of 41. For my quality filter, I selected the term data collection, which can be exploded to include questionnaires and surveys; I want articles using these qualitative research tools. When I ANDed data collection with my base set, I retrieved a final set of five items. Most of the items in the final set appeared to contain useful information relating to my question.

5.SEARCH STRATEGY Database: MEDLINE Database: MEDLINE Search Strategy: exp METHADONE/ (834) 2 exp Opioid-Related Disorders/ (1533) 3 1 and 2 (475) 4 limit 3 to (human and english language) (409) 5 Patient Compliance/ (3902) 6 Patient Dropouts/ (565) 7 Treatment Refusal/ (1034) 8 5 or 6 or 7 (5303) 6 4 and 8 (41) 7 exp data collection/ (130425) 11 6 and 7 (5)

6.RESULTS <1>Authors Cushman P Jr. Cushman P Jr.Title Ten years of methadone maintenance treatment: some clinical observations. Ten years of methadone maintenance treatment: some clinical observations.Source American Journal of Drug & Alcohol Abuse. 4(4):543-53, American Journal of Drug & Alcohol Abuse. 4(4):543-53, 2002.<2>Authors Morral AR. Belding MA. Iguchi MY. Morral AR. Belding MA. Iguchi MY.Title Identifying methadone maintenance clients at risk for poor treatment response: pretreatment and early progress indicators. Source Drug & Alcohol Dependence. 55(1-2):25-33, 2001 Jun 1. Drug & Alcohol Dependence. 55(1-2):25-33, 2001 Jun 1.

6. RESULTS (cont’d) <3>Authors Belding MA. McLellan AT. Zanis DA. Incmikoski R. Belding MA. McLellan AT. Zanis DA. Incmikoski R.Title Characterizing "nonresponsive" methadone patients. Characterizing "nonresponsive" methadone patients.Source Journal of Substance Abuse Treatment. 15(6):485-92, 1999 Nov-Dec. Journal of Substance Abuse Treatment. 15(6):485-92, 1999 Nov-Dec.<4>Authors Zanis DA. Woody GE. Zanis DA. Woody GE.Title One-year mortality rates following methadone treatment discharge. One-year mortality rates following methadone treatment discharge.Source Drug & Alcohol Dependence. 52(3):257-60, 1999 Nov 1. Drug & Alcohol Dependence. 52(3):257-60, 1999 Nov 1.