1

Literature Searching Skills for Clinical Audit

www.knowledgenet.ashfordstpeters.nhs.uk/knet/

2014

2

Aims and Objectives

Aim

To carry out an effective literature search of healthcare databases and other key evidence-based resources.

Objectives

At the end of the session the learner will be able to: name healthcare databases and describe their coverage

� plan a search using PICO� carry out an Advanced Search using Boolean logic, thesaurus mapping� save a search strategy� perform basic searches of the Cochrane and other key resources� understand the importance of evaluating results and critical appraisal.

3

The Audit Cycle

9Re-audit practice8

Agree ActionPlan

7Feedback &Comparison

6Analysis

&Report 5

Collect Data

4DesignAudit Tool

3Agree

Standards

2222Review Review Review Review

LiteratureLiteratureLiteratureLiterature

1Agree Topic/

Design Audit

4

Why carry out a literature search?

� To justify your audit criteria with references

� To find out what has already been done

Preparation

What type of information is required?

Where are the most likely sources?

Can the information retrieved be relied upon?

5

Overview of today’s session

1. Sources of information

2. Carrying out a literature search

3. Evaluating results: critical appraisal

6

Sources

� Where can I find criteria for clinical audit?� Guidelines, performance indicators

� Where can I find information on service standards?� National Service Frameworks, Specialist Health Services

� Which organisations have information on clinical audit?� Royal Colleges, Professional Bodies

� Where can I find examples of clinical audit?� Medical Databases e.g. Medline, Cinahl

� Where else can I get advice?� Professional Bodies, Clinical Effectiveness & Audit Dept.

7

Finding the Evidence / Audit Criteria

� Guidelines

� Systematic Reviews of effectiveness

� Performance Indicators

8

NICE http://guidance.nice.org.uk/

9

2. Systematic Reviews

What are they?

� Results from many studies are examined in order to improve the accuracy of estimates of effectiveness, and to describe and investigate the discrepancies between individual studies.

10

Cochrane Library

� The Cochrane Library is an electronic publication designed to supply high quality evidence to inform people providing and receiving care, and those responsible for research, teaching, funding and administration at all levels.

www.thecochranelibrary.com/

2.How to Conduct a Literature Search

1. Formulate your question

2. Break it into concepts & think of all possible terminology

3. Identify relevant resources

Other search factors to consider

• Search terms: Are there other synonyms, alternative spellings or technical/layman terms for the subjects you require

• Which databases will be most appropriate?

• You may also want to consider the original language of articles

• The publication type e.g. clinical trials, systematic reviews, case report

• Or the period you wish to search, e.g. last five years

12

KEYWORDS AND SYNONYMS

Concepts can have more than one word to describe them

Footwear, slippers, shoes, boots, wellies, clogs, flip-flops, heels, trainers, takkies, Jimmy Choos,

ones and twos...

Wound HealingWound TherapyWound Management

MaggotsMaggot therapyLarva

Effective treatment of wounds with maggot therapy in the elderly

Patient/ Problem

Intervention OutcomeOR

OR

� List all relevant terms under each section

Question: Is the use of maggots effective in wound healing in the elderly?

www.knowledgenet.ashfordstpeters.nhs.uk

Step 1 Step 2

Register for an Athens acount

Your NHS Athens login gives you access to all the healthcare databases purchased nationally for use by the NHS.To get an NHS Athens log in click on Register for Athens

Log -in

Finding full-text journals

To see if a journal is available in print or full-text click on Journals then type in the journal name

Be aware some full-text title have embargos e.g. 6 months ago –therefore you cannot access online the last 6 months

Print copy available

Electronic copy available

Click on Healthcare Databases Advanced Search

NHS Athens ID allows you to search the following da tabases:

Click on the name of the database you want to search. You can only search one database at a time

Title and Abstract is the default setting.

For phrases use quote marks e.g. “wound healing” in the search box Click on SEARCH.

Type your first keyword/topic into the search box e.g. “wound healing”

Results are displayed in a Search history table that builds up as you enter new terms or phrases..

Each new search is labelled with a number. You can use these numbers and search lines to combine different searches.

Most of the databases index articles, assigning index terms or headings from a controlled thesaurus to each article. We can use these thesaurus terms to search for articles in addition to keyword searching.Select the Map to Thesaurusbox. Then SEARCH.

The number of articles found for each search is displayed as results. Clicking on the result number will display the records.

Type your first keyword/topic again into the search box e.g. “wound healing” and select Map to Thesaurus

• Typing two or more words will retrieve results that contain all of those words anywhere in the field criteria you selected.

• To enter phrases, type your words within double quotes. Your results will only include results that contain this exact phrase in the field criteria searched. Some phrase examples are:

• “cognitive behaviour therapy” “heart attack”

• You can use the * as a wildcard to search for words with the same beginning. For example therap* will find therap y, therap ist and therap eutic; nurs* will find nurs ing, nurs ed, nurs e

• To search for an author use the format “Shirkey BL” or if the initials are unknown, replace initial with the wildcard * eg. “Shirkey *” or “Shirkey B*” . The quotes are essential.

Each article record is assigned headings or terms from a controlled thesaurus. Selecting the Map to Thesaurus button will display suitable thesaurus terms for your search term.

Select the most appropriate Major Descriptor (if Major is NOT available choose Select heading and click on search.

Selecting Explode will search for all the articles that contain the term you have a chosen, as well as any narrower terms that branch off from the subject heading (descriptor) you have chosen.Major descriptor selecting this will return articles which have the term as a major focus.

Click on SEARCH.

The Wildcard * option e.g. maggot* will return maggot, maggots etc

e.g. of wildcards

OVASCULAR

OLOGYACOGRAM

CARDI* NALOGRAPHOGRAMOPULMONARYOMYOPATHY

TREATTREATSTREATMENT

TREAT* TREATINGTREATED

Repeat this process for all our terms. Lines 1 and 3 are keyword searches, lines 2 and 4 thesaurus or index term searches. We need to combine these searches to finalise our search.

To combine related thesaurus and keyword searches tick relevant boxes and use OR and click on Combine Selected

• Use the combine function AND to search for results that include bothor all terms . AND will reduce the number of articles you retrieve. Usually used to combine different topics, for example,

diabetes AND insulin “art therapy” AND “mental health”

• Use the combine function OR to search for results that include eitherterm. OR will increase the number of articles retrieved. Usually used with similar topics, synonyms or alternative spellings. Some examples are pediatric OR paediatricstroke OR cvayoga or “tai chi” or pilates

• NOT is also available but should be used with caution. For example diabetes NOT adult would exclude clinical trials involving both adults and children, not just those involving adults.

Boolean operators

Maggot* Larva

OR

AND

Maggots Wound healing

OR – broadens the search

AND – narrows the search

Use AND to combine different terms together to get articles which contain maggot and wound healing and click on Combine Selected

Limiting your search

Click on Apply Limits on the search you want to limit - then limit one by year e.g. by year, age, human etc

Our combined search has retrieved several articles. We could view these by clicking the number of results e.g. 129. We can also use the Limits function to reduce the number of results further

Select ONE limit at a time – this example the age limit then click on Search .

Below is the search limited by Date and Age

Clinical Queries Limit

The Clinical Queries Limit will restrict your results to clinically sound studies. They are only available in EMBASE and MEDLINE. Nine categories are provided, the emphasis may be:Sensitive : Most articles are relevant but may also retrieve some less relevant ones.Specific : Most articles are relevant but may omit a few.Optimized : a combination that optimizes the trade-off between sensitivity and specificity.These filters are based on the work of R Brian Haynes MD, PhD et al of the Health Information Research Unit HIRU. For more detail see the original web page http://hiru.mcmaster.ca/hiru/HIRU_Hedges_home.aspx

Using limits has reduced the number of retrieved articles.

To display your results select the blue link to records in the hit column

Displaying records

Click Display Abstracts to show abstracts when available.

You can increase the number of results per page

Records are normally displayed by publication date. If there are less than 500 records, the sort order can be changed by selecting from the drop down menu, then selecting SORT.

To see more details about a record, select the record title (in blue). Details provided will depend on the database but might include an abstract, publication type or thesaurus index terms.

Print and full-text online links

Some records will include links to the full-textcontent of an article. Selecting the blue supplier link will display the article.

Print holdings are also displayed if available.

To select results for saving or emailing, click the small box beside the title.

No full-text or print available

Saving or emailing results

We recommend you choose PDF to e-mail or export your results. It is also worth including your Search History.

To save selected articles use the form at the bottom of the results page. You can Save or Email Results in PDF, MS Word or Text output format. You can also export selected results into Reference Manager software, using the RIS output format.

Choose the Full Display Format

Saving searches to use again

It is possible to save searches from the Search History page . Saved searches include all details of the original search including terms, search criteria, databases and limits. Select the appropriate rows and then SAVE ALL or SAVE SELECTED LINES

The search is then saved in Saved Searches until you delete it.

Give your search a relevant name and SAVE or SAVE & CREATE ALERTClick on Save – it will be saved until you personally delete it from Your saved searches .

Running a Saved Search

Click on Saved Searches – click the search you want to re-run. NOTE: Each database has different thesaurus, if you use a different database you will need to remap your terms to the thesaurus in your new search. RUN SEARCH will run the search in the same database as the original search.

Create an Alert

If you select the ALERT option you will be asked to fill in this simple form including email address and frequency. Complete all parts and then SAVE ALERT

Changing database and Deleting the Search history

To delete the search history – either click Select All then Delete Selectedor tick each line you want to delete then Delete Selected

The below box will appear to delete click OK to stop and return to the search click Cancel

Select the database you want to search in and re-enter your search terms.

44

3. Evaluate Critical Appraisal

� What is critical appraisal? Skills to find and make sense of research evidence,

helping to put knowledge into practice.

� Why use critical appraisal?To ensure the information is methodologically sound

and is applicable in a real world setting.

45

Summary

� A systematic and thorough search for information.

� Many sources of information e.g. guidelines.

� Search strategy is very important – plan ahead.

� Always evaluate your findings – be sure you are dealing with the best quality information available.

� Keep your findings organised and always cite your sources.

46

Where do you find information?

� Ashford and St. Peters Health Sciences library www.knowledgenet.ashfordstpeters.nhs.uk/knet/

� Health Information Resources (medical databases) www.library.nhs.uk� NICE http://guidance.nice.org.uk/� SIGN www.sign.ac.uk/guidelines/index.html� Map of Medicine www.mapofmedicine.com/� Cochrane Library www.thecochranelibrary.com/� The Audit Commission – Health Sections

www.audit-commission.gov.uk/� The National Clinical Audit Support Programme

www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp� Critical Appraisal Resources

www.phru.nhs.uk/Pages/PHD/resources.htm� Critical Appraisal Skills Programme (CASP) www.casp-uk.net/

� If you require further help please contact the library on ext. 3213

� sandy.komiliades@asph.nhs.uk 01932 722047� alison.paul@asph.nhs.uk 01932 723461

� Various training courses are run throughout the year, please look at the library website for details www.knowledgenet.ashfordstpeters.nhs.uk/knet/ or contact the library.

� 1-2-1 sessions or groups training can also be provided either in the library or your own department. To discuss your needs please contact Alison Paul on ext 3461.