Transcript Library Database Searching for EBP

LIBRARY DATABASE SEARCHING FOR
EVIDENCE BASED PRACTICE (EBP)
developed for the
Indiana University
School of Nursing
Revised January 2008
IUPUI University Library
Randi L. Stocker, MLS
CLINICIAN DATABASE COMPETENCIES:
STEPS TO A MORE EFFICIENT SEARCH
Steps:
1.
Develop a searchable question
2.
Search relevant databases, such as CINAHL,
Medline, and others.
•
3.
Stocker, R. (2008). Finding articles and systematic
reviews related to nursing [web page].
http://www.ulib.iupui.edu/prod/subjectareas/nursing/ind
exes
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
DEVELOP A SEARCHABLE QUESTION
PICO
Two Search Methods
Alternate Template for Searching
(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: 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. 243 258.). Philadelphia: Lippincott.
SEARCH STRATEGY PLANNING
•
Select search tools
•
Databases oriented to different practitioners:
•
•
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
•
•
•
Nurses, Physicians, Psychologists, Educators, (& patients)
Select Subject Headings
Select Limits
Review results; modify search
WHEN ARTICLES ENTER MEDLINE OR CINAHL:

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
WHEN ARTICLES ENTER MEDLINE OR CINAHL:

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”
MEDLINE & CINAHL INDEXING PRACTICES*
(in 2006)
Journal titles
Other formats
Subject Headings
MEDLINE
4,800+
CINAHL
1,800+
Search NLM
Many, including
gateway
web
MeSH - biomedical MeSH-based
7,427 same +
4,987 unique
Subheadings
Yes; as many as
needed
Yes; up to 3 per
heading
Publication types
Format/type of
article
Adds features
included in item
Cited references
No
Yes, 1993 -
* Allen M. (2006).
ONE DETAIL ABOUT ARTICLE CODING:
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
USING “EXPLODE” TO RETRIEVE ARTICLES
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”
MeSH “Subject Tree” for Breast Neoplasms
with Explode turned on
(as used in both the Medline & CINAHL databases)
All MeSH subject headings :
also includes:
•
Diseases category: Neoplasms:
• Neoplasms by Site:
“Breast Neoplasms, Male”
• Breast Neoplasms: (EXPLODED)
Breast Neoplasms, Male
“Carcinoma, Ductal, Breast”
•
•
Carcinoma, Ductal, Breast
SELECTING “EXPLODE” IN AN OVID DATABASE




USING “FOCUS” TO LIMIT TO MAJOR EMPHASIS
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 = 16028 articles
Breast Neoplasms (Exploded) = 16102 articles
Breast Neoplasms (Exploded & Focused) = 12613 articles
SELECTING “FOCUS” IN AN OVID DATABASE







SUBJECT HEADINGS -- SUMMARY
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.
http://www.pegallen.net/Documents/Indexing.pdf
TYPES OF SEARCH FINDINGS FOR EBP
•
Primary Research
•
•
•
•
•
Evidence Summaries – Synthesis
•
•
•
Individual studies
Abstracts and commentaries
Need to evaluate and synthesize findings
Research is sometimes limited to
specifics and results do not always apply
Systematic Reviews: Integrative Reviews;
Meta-Analysis
Critical Appraisal with implications for
practice
Translation Literature
TRANSLATION LITERATURE
•
•
•
•
•
•
•
Proven practices, not new findings
Practice guidelines
Care plans
Critical paths
Protocols
Standards
Clinical innovations
START WITH THE QUALITY-FILTERED RESOURCES
Translation Literature
1.
•
•
Are they evidence-based?
Just because it’s a gold standard doesn’t
mean that it is common knowledge
Look for Evidence Summaries
2.
•
Systematic reviews; Meta-analyses;
Critical appraisals
What’s new?
3.
•
•
•
•
Primary Research
Research Abstracts
Research in progress
Propose new research?
IUPUI RESOURCES FOR NURSING EBP - PYRAMID
Evidence
Based
Guidelines
Systematic
Reviews /
Meta-Analyses
Critically-Appraised
Topics & Articles
Randomized Control Trials
Cohort Studies
Case Studies & Reports
Background Information/Expert Opinion
EBP SEARCH DEMONSTRATION*
•
•
•
•
•
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).
EBP SEARCH STRATEGY*
Sample Search:
What should we do
to prevent
pressure ulcers
in our elderly
patients?
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)
*Allen, M. (2006).
SUMMARY: EBP SEARCH STRATEGY
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 <65-79> & <80 and Over>
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
USEFUL LIMITS FOR EVIDENCE-BASED SEARCHING*
CINAHL
PubMed/MEDLINE
Translation Literature
Care 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 Summaries
Systematic Review [PT]
Commentary [PT] with
Research or Review
Systematic [sb] AND (Review [PT])
OR Meta-Analysis [PT])
Primary Research
Research [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).
ACCESSING CORE DATABASES
CINAHL
• EBSCOhost
MEDLINE
• Ovid
•Only source for
• PubMed
CINAHL Plus
• EBSCOhost
• Ovid through 2008
• others
• others
COCHRANE
Reviews
•Ovid
•Wiley
Interscience
•CINAHL
•MEDLINE
•others
QUESTIONS?
Read more about it:
•
Allen, M. (2006). Teaching clinicians to fish: Library skills for
EBP [PowerPoint show].
• http://www.pegallen.net/Documents/TeachingClinician2
FishWeb.pps
•
Allen, M. (2007). MEDLINE and CINAHL indexing practices
[Handout].
• http://www.pegallen.net/Documents/Indexing.pdf