1. Searching for Evidence Evidence in Practice (MiC/PPD) December 2014

2. Focus on “the literature” what is it? finding it using it in the context of EBM and asking answerable questions to find the “evidence”

3. Types of literature Published - widely available –books, journals, newspapers, web pages Semi-published - smaller circulation –a.k.a. grey literature –internal reports e.g. NHS departments, hospitals, regions Unpublished –theses, correspondence, patient records

4. Types of resources Primary –case reports, clinical trials, original research Secondary “distilled knowledge” –textbooks, reviews, systematic reviews Tertiary –finding aids – indexes/abstracts e.g. Medline, Cochrane Library, NICE Evidence

5. Finding answers What are you looking for? In an adult with cold-like symptoms does treatment with antibiotics improve time to recovery? –Patient/problem –Intervention –Comparison intervention –Outcomes

6. PICO P - adult (middle-aged female) with cold- like symptoms I - treatment with antibiotics C - no treatment, other remedies O – faster recovery

7. Planning a search strategy key terms to search with one concept per column common cold treatment antibiotics

8. Combining terms AND common cold AND antibiotics OR amoxycillin OR penicillin

9. Boolean operators use the Boolean operators to help you express your search logically AND common coldtreatmentantibiotics AND increases SPECIFICITY

10. Synonyms and spellings think about other terms which mean the same i.e. synonyms, or related terms –treatment, therapy remember alternative spellings e.g. US vs British –organisation/organization –behaviour/behavior –oestrogen/estrogen

11. Synonyms need OR AND OR common cold treatmentantibiotics upper respiratory tract infection therapypenicillin AND increases SENSITIVITY

12. Widening a search Other options with keyword searching: use truncation to pick up plurals or other word endings –e.g. therap* = therapy, therapies use wildcards to pick up spelling variants – e.g. wom?n= woman, women

13. Where to search? What kind of information do you want? Which finding aids/tertiary resources cover this type of information? e.g. –Library Catalogue for books or Discover for books, journal articles, theses, images, and more –Databases e.g. Medline for journal articles –Cochrane Library for systematic reviews –NICE Evidence for UK guidelines, etc

14. Key resources for EBM NICE Evidence Search (formerly NHS Evidence) NICE Clinical Knowledge Summaries Cochrane Library TRIP database Evidence-based Medicine Reviews (via Ovid) –ACP Journal Club –Cochrane Database of Systematic Reviews –Database of Abstracts of Reviews of Effects See Library’s subject information page for MedicineMedicine

15. Scenario Mr Smith, 45, has recently been diagnosed with moderate depression. He thinks antidepressants will help as he can’t take time off work. Is this the best option? In pairs create a PICO structure for this question and then identify your key search terms...

16. P – 45yr old male with moderate depression I – antidepressant therapy C – no treatment, psychological therapy O – recovery, improved quality of life moderate AND antidepressants depression

21. Moderate-to-severe depression — antidepressants are effective for treating people with moderate or severe depression. It is estimated that for people with moderate-to- severe depression: if no treatment is given, 20% will recover; if a placebo is given, 30% will respond; and if an antidepressant is given, 50% will respond [Anderson et al, 2008; Taylor et al, 2012b]. This means that it is necessary to treat three people with an antidepressant compared with 'true' no treatment for one additional person to respond (NNT 3), and that it is necessary to treat five people with an antidepressant compared with placebo for one additional person to respond (NNT 5).Anderson et al, 2008Taylor et al, 2012b

22. Summary literature – types + primary, 2ndry planning a search – PICO combining searches (using Boolean operators) widening searches selecting the right “finding aids” key EBM resources

23. Help with using resources Have a look at the Library’s Subject Information page for MedicineMedicine Contact your Academic Liaison Librarian Heather Robb (heather.robb@dur.ac.uk) (heather.robb@dur.ac.uk) Workshops in February –using Medline & Embase via Ovid