searching for and finding the evidence

Searching for & finding the evidence

Grainne McCabe, Mercer Library, RCSIgmccabe@rcsi.ie

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

In this session we will cover.....

• 5S approach to searching for the evidence– clinical summaries; systematic reviews; – primary studies

• Grey literature• Database search process

– Scoping topic; identifying search terms; testing searches; saving searches; setting up alerts

• Complex search strategy (from Cochrane Library)– “unpick” the elements of the search: keywords / subject

headings– Display it on the CINAHL database

Image: http://commons.wikimedia.org/wiki/File:Magical_books.jpg

Evidence-based healthcare

The practice of evidence based medicine

means integrating individual clinical expertise with

the best available external clinical evidence from

systematic research.

Source: Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn't. BMJ 312, 71-2.

StrategySystematicCriteriaExplicitReliableReproducibleDocumented

Searches

Where do YOU go to search for the evidence?

• Google?

CLINICAL SUMMARIESDynaMed / UptoDate /

Clinical Evidence

Cochrane Library

MEDLINE / CINAHL / databases for primary studies

Grey literature

Evidence Based MedicineEvidence Based Nursing

ACP Journal Club

B Haynes EBM v11 Dec 2006

Summaries - evidence-based digests

• Designed for use at point-of-care: wards, family practice• Summarise the evidence • Continually updated• However....may not deal with all aspects of a topic or

with very specialised topics• Each clinical summary has a different emphasis

Armstrong, DG . Basic principles of wound management. UptoDate [updated 28 Jan 2014 cited 24 Apr 2014]. Available from http://www.uptodate.com

Clinical Evidence

Cochrane Library

Grey literature

ACP Journal Club

Syntheses – systematic reviews

What is a systematic review?

• Identifies, appraises and synthesizes the evidence that meets pre-specified eligibility criteria to answer a given

research question.

• Explicit methods are used, aimed at minimizing bias, and producing more reliable findings.

Clinical Evidence

Cochrane Library

Grey literature

ACP Journal Club

Studies – primary journal articles

• Databases: a selection– Medline - PubMed, Ovid Medline, Ebsco Medline .....– CINAHL – Nursing & Allied Health– PsycInfo – psychology & psychiatry – Embase – particularly good for pharmacology topics, European

studies– Web of Science

• Good for conference abstracts• Citation searching

Studies – grey literature

• OpenGrey (System for Information on Grey Literature in Europe) www.opengrey.eu

• NLM (Nat Lib Med) www.nlm.nih.gov/nichsr/db.html – Databases:

• Health Services & Sciences Research Resources• Health Services Research & Health Care Technology• Health Services Research Projects• Health Services Technology Assessments

– LocatorPlus – NLM catalogue

• Reports• Official

Publications• Conference

Papers• Dissertation

s• Patents

Studies – grey literature

• Institutional repositories: digital collections of scholarly output from academic and professional organisations

OpenDOAR (www.opendoar.org)International

Bielefeld Base (www.base-search.net) European

CORE (http://core.kmi.open.ac.uk/search) UK

RIAN (http://rian.ie/) Irish

• Websites of relevant professional organisations– EWMA; American Professional Wound Care Association; Wound

Management Association of Ireland

Theses & Dissertations

• Repositories – see previous slide

• Networked Digital Library of Theses & Dissertations (NDLTD) (http://www.ndltd.org/home)

• DART-Europe E-theses portal (http://www.dart-europe.eu/basic-search.php)

Scoping the topic – background searches

• Overview – places your work in the context of research already published

– Size of the literature– Identify gaps – Types of studies / research designs– Spread of publications– Testing the search strategy on a group of documents – look for

other search terms / subject headings – What is missing from your search results?– What is included which is peripheral to your research?

Concepts

• Break the topic into concepts– Is zyban effective in smoking cessation? Two principal

concepts. Search for each separately, then combine

OR • Use the PICO framework:

– Patient / population / problem– Intervention: cause, prognostic factor, treatment– Comparison (if appropriate)– Outcome

• May need to look beyond PICO

Identifying search terms

• Using key papers – Find on the database– What words/phrases (keywords) & subject headings are used?

• Adapting other people’s strategies: • Be critical• Amend for your topic

Wound cleansing for pressure ulcers

ACTIVITY:

Wound Cleansing: – think of different ways of describing this concept– Include solutions used in wound cleansing

Pressure Ulcers:– think of different ways of describing this concept

Wound Cleansing Pressure Ulcers

Appendix 5. EBSCO CINAHL search strategyS28 S22 and S27S27 S23 or S24 or S25 or S26S26 TI (bed sore* or bedsore* ) or AB (bed sore* or bedsore*)S25 TI decubitus or AB decubitusS24 TI (pressure ulcer* or pressure sore*) or AB (pressure ulcer* or pressure sore*)S23 (MH ”Pressure Ulcer“)S22 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20or S21S21 TI ( wash* or scrub* or swab* or shower* or bath* or soak* or irrigat* or whirlpool ) or AB ( wash* or scrub* or swab* or shower* or bath* or soak* or irrigat* or whirlpool )S20 TI ( wound clean* or wound cleans* ) or AB ( wound clean* or wound cleans* )S19 (MH ”Hydrotherapy+“)S18 (MH ”Bathing and Baths“)S17 (MH ”Irrigation+“)S16 AB ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or disinfectant* or antiseptic* or detergent* or soap* or hydrogen peroxide or benzoyl peroxide or gentian violet or eusol or dakin* or permanganate or water or alcohol*1 or solution* )S15 TI ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or disinfectant* or antiseptic* or detergent* or soap* or hydrogen peroxide or benzoyl peroxide or gentian violet or eusol or dakin* or permanganate or water or alcohol*1 or solution* )S14 (MH ”Solutions+“)S13 (MH ”Alcohols+“)S12 (MH ”Water+“)S11 (MH ”Gentian Violet“)S10 (MH ”Hydrogen Peroxide“)S9 (MH ”Soaps“)S8 (MH ”Detergents+“)S7 (MH ”Disinfectants“)S6 (MH ”Antiinfective Agents, Local+“)S5 (MH ”Povidone-Iodine“)S4 (MH ”Chlorhexidine“)S3 (MH ”Saline Solution, Hypertonic“)S2 (MH ”Sodium Hypochlorite“)S1 (MH ”Sodium Chloride+“)

Moore ZEH, Cowman S. Wound cleansing for pressure ulcers.

Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.:

CD004983. DOI: 10.1002/14651858.CD004983.pub3

Subject Headings (added by indexers) v Keywords (authors’ words)

S14 (MH ”Solutions+“)S13 (MH ”Alcohols+“)S12 (MH ”Water+“)S11 (MH ”Gentian Violet“)S10 (MH ”Hydrogen Peroxide“)S9 (MH ”Soaps“)S8 (MH ”Detergents+“)S7 (MH ”Disinfectants“)S6 (MH ”Antiinfective Agents, Local+“)S5 (MH ”Povidone-Iodine“)S4 (MH ”Chlorhexidine“)S3 (MH ”Saline Solution, Hypertonic“)S2 (MH ”Sodium Hypochlorite“)S1 (MH ”Sodium Chloride+“)

Wound Cleansing

solutions – subject

headings (MH)

S16 AB ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or disinfectant* or antiseptic* or detergent* or soap* or hydrogen peroxide or benzoyl peroxide or gentian violet or eusol or dakin* or permanganate or water or alcohol*1 or solution* )

S15 TI ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or disinfectant* or antiseptic* or detergent* or soap* or hydrogen peroxide or benzoyl peroxide or gentian violet or eusol or dakin* or permanganate or water or alcohol*1 or solution* )

Wound Cleansing

solutions – title /

abstracts

S21 TI ( wash* or scrub* or swab* or shower* or bath* or soak* or irrigat* or whirlpool ) or AB ( wash* or scrub* or swab* or shower* or bath* or soak* or irrigat* or whirlpool )

S20 TI ( wound clean* or wound cleans* ) or AB ( wound clean* or wound cleans* )

S19 (MH ”Hydrotherapy+“)

S18 (MH ”Bathing and Baths“)

S17 (MH ”Irrigation+“)

Wound Cleansing

methods –

subject headings

title/abstract

S22 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21

All wound cleansing searches combined

into one set

S27 S23 or S24 or S25 or S26S26 TI (bed sore* or bedsore* ) or AB (bed sore* or bedsore*)S25 TI decubitus or AB decubitusS24 TI (pressure ulcer* or pressure sore*) or AB (pressure ulcer* or pressure sore*)S23 (MH ”Pressure Ulcer“)

Pressure ulcers:Subject headings;

title / abstracts

All combined into one set (S27)

S28 S22 and S27 Final set -

All results have to discuss wound

cleansing (S22) AS WELL AS pressure

ulcers (S27)

Putting that into practice!

https://www.flickr.com/photos/shindotv/3835365695/in/photolist-dQEffh-bKSERv-cL7gTW-P7XEF-ayTAnE-7Frdi-cL7gJs-bB8RAe-9nXSy4-9nXSqX-5W6qxG-6QVfAK-7DUk5-fKow7d-2xQ9VT-czfWj7-9hhbsY-9he4ax-9he44P-hWT88P-cNX7ZA-4b5Zk7-7odfak-3DEACY-75txKd-4dyNMq-cNX7Xy-8gAKm1-8iedyK-dYVCmw-85Rwed-aupZZW-61cUps-6T2aCS-sUnH-67TuU9-8K

CINAHL – the basicsIn this search, we are looking

for articles which discuss

medication adherence amongst asthma

sufferers

Leave Search Options /

Limits till later

AND = both ASTHMA

as well as MEDICATION ADHERENCE have to be in the results

Could we have missed some results?

In this approach, we will think of different ways to describe

medication adherence

Separate searches

OR = Either

COMPLIANCE or else

ADHERENCE has to be in the results

CD004983. DOI: 10.1002/14651858.CD004983.pub3

Back to the advanced search...

CINAHL search

S24 TI (pressure ulcer* or pressure sore*) or AB (pressure ulcer* or pressure sore*)

Keyword search:

Authors’ words

S25 TI decubitus or AB decubitus

Keyword search:

Authors’ words

S26 TI (bed sore* or bedsore* ) or AB (bed sore* or bedsore*)

Keyword search:

Authors’ words

Subject Heading Search

Click on “Pressure Ulcer”

for more information

Deep Tissue Injury & Heel Ulcer are narrower

headingsTick EXPLODE box to

include them

S23 (MH ”Pressure Ulcer“)

S27 S23 or S24 or S25 or S26

An abbreviated version for demo purposes - the full strategy should be run (S1-S21)

Record your searches

Reproducible & documented

• Set up personal accounts• Save searches • Set up alerts - email advising you of new results• Set up alerts for journal table of contents

• Image: http://commons.wikimedia.org/wiki/File:Power_of_Words_by_Antonio_Litterio.jpg

CD004983. DOI: 10.1002/14651858.CD004983.pub3

You may be asked to record number of

results also....

Limits

• Vary from database to database• “Weaken” the evidence?• Examples:

– Publication date– Language– Age group– Type of publication: review; randomised controlled trial; letter to

the editor/editorial; clinical query (studies relating to therapy/diagnosis/aetiology/prognosis)

• Use with caution

Translating searches into other databases• Each platform (eg EBSCO, OVID): different structure

– EBSCO (eg CINAHL, Medline): default search is keyword– OVID (eg Medline, PsycInfo): default search is subject heading– PubMed (Medline): default search is a combination of both

• Subject headings vary / or no headings at all– More detailed nursing subject headings on CINAHL– Web of Science doesn’t use subject headings – you rely on

authors’ words

• KNOW the database structure

• Take your time!

Clinical Evidence

Cochrane Library

Grey literature

ACP Journal Club

Sources of help.....

• Cochrane Handbook for Systematic Reviews of Interventions– www.cochrane-handbook.org

• Centre for Reviews and Dissemination, University of York. Systematic Reviews: CRD’s guidance for undertaking reviews in health care– www.york.ac.uk/inst/crd/index_guidance.htm

• Your Librarian

Thank you!

Grainne McCabe

Mercer Library, Royal College of Surgeons in Ireland

www.rcsi.ie/library

gmccabe@rcsi.ie

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