1. Step Two Finding the best evidence 1. Walk through one 2. Do own searches

2. Learning through play Try all “buttons” Make lots of “mistakes” Have fun

3. EBM and Systematic Review EBM (quick & dirty) Steps Answerable Question Search Appraise Apply Time: 90 seconds < 20 articles This patient survives! Systematic Review Steps Answerable Question Search ++++ Appraise x 2 Synthesize Apply Time: 6 months < 2,000 articles This patient is dead Find a systematic review!!

4. Start up Start Explorer and enter www.pubmed.gov Put on CAPS lock So that AND and OR are in CAPITALS Start 2nd Explorer window, enter www.tripdatabase.com

5. Using the question to guide searching Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. Question Population Indicator (intervention, test, etc) Comparator Outcome

6. Using the question to guide searching Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. Question Population – in elderly patients does Indicator – a ‘poor’ whispered voice test Comparator – a ‘normal’ whispered voice test Outcome – predict abnormal audiogram 1. Underline the key terms 2. Number the order of importance from 1-4 3. Think of alternate spellings, synonyms, & truncations

7. Using the question to guide searching Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. Question Population – in elderly patients does Indicator – a ‘poor’ whispered voice test Comparator – a ‘normal’ whispered voice test Outcome – predict poor hearing (audiogram) 1. Underline the (root of the) key terms 2. Number the order of importance from 1-4 3. Think of alternate spellings, synonyms, & truncations 1 2 3

8. * Means any other letters AND means both terms required Check the question type Check the emphasis

9. Stepwise searching Search with #1 PICO item Whisper* Then go to “Clinical Queries”: diagnosis Whisper* (again) Add #2 PICO item whisper AND (hear* OR audiogram)

10. Combining terms with Boolean operators – AND chitosan weight weight AND chitosan - has both terms IN CAPITALS

11. Combining terms with Boolean operators – OR chitosan weight weight OR chitosan - has either term

12. Your tasks Search for the best single article (systematic review or trial) for Your question from notes Your own question(s) When you are finished Print just the abstract for each Write your search strategy on the page

13. Boo-le-ans* AND = both terms OR = either term NOT = not this term (ADJacent, NEAR, … = AND + close) * George Boole (a man) is claimed to have invented “logic”

14. Where to the brackets go? If you want cheese AND fruit Which do you ask for? cheese AND (apple OR pear OR melon) (cheese AND apple) OR pear OR melon What does PubMed do with if AND and OR? Cheese AND apple OR pear (Look at DETAILS tab)

15. General structure of search (Population OR synonym 1 OR …) AND (Intervention OR synonym 1 OR …) AND (Comparator OR synonym 1 OR …) AND (Outcome OR synonym 1 OR …) AND FILTER (for best study type)

16. Medline Embase Cochrane Trials Registry Comparing Databases Medline = Pubmed, Webspirs, OVID, …

17. Search Cascade

18. Shortcuts Meta-search engines www.tripdatabase.com Sumsearch Nelh

19. Other tips: Search on Title only Eg [ti] (Others are [au] - author; [so], [yr], …) ‘Related Articles’ button (PubMed) previously identified study (PubMed) Look for the MeSH terms MeSH browser

20. Before you finish! Print single most relevant abstract for each question – for both ‘set’ questions and your own questions

22. More Tips on Effective Searching Decide the TYPE of question (Rx, Dx, Px, …) Chose the right database for the type of question, e.g., Intervention: Cochrane Library, PubMed, … Diagnostic: Common Diagnostic Strategies (in BE), or PubMed: Clinical Queries Prognosis, Etiology: PubMed: Clinical Queries

23. Hearing problems in childhood Scenario - An immunisation and screening booklet asks parents whether they think their child has any problems with hearing. While on a committee reviewing these questions, you wonder about the usefulness of this. Question Population Indicator (intervention, test, etc) Comparator Outcome Question Type - Rx, Dx, Px, … Database

24. Hearing problems in childhood Scenario - An immunisation and screening booklet asks parents whether they think their child has any problems with hearing. While on a committee reviewing these questions, you wonder about the usefulness of this. Question Population – In well children Indicator - does parental report of concern Comparator - nil Outcome – predict true hearing problems? Question Type - Rx, Dx, Px, … - Diagnostic Accuracy Database – PubMed: Clinical Queries - diagnosis

25. Using the question to guide searching Question Population – (child OR children) AND Indicator – (parent OR parental) AND Comparator - nil Outcome – (hearing) Question Type Dx – Diagnostic Accuracy Database – PubMed: Clinical Queries

26. Using truncation to save on ORs – the * Question Population – (child*) AND Indicator – (parent*) AND Comparator - nil Outcome – (hearing) AND Question Type Dx – Diagnostic Accuracy Database – PubMed: Clinical Queries

27. ‘Wildcards’ malig* means malignancy malignant malign but not malunion malaligned etc

28. Special tricks

29. Write a “search” to get the green & red areas only