EBP & Database Basics

Roy Brown, MLIS

Education and Research Librarian

Tompkins-McCaw Library, VCU Libraries

CONFIDENCE IN YOUR SEARCHING SKILLS

Objectives: By the end of this class you will :

• Be aware of the process for doing effective research & where it falls in the practice of EBP

• Understand the difference between keyword and subject heading searching

• Know how to use Boolean operators & limits• Be able to identify appropriate databases for different information

needs

Effective Searching = Less Time & Reading

• In order to keep up with what’s new in the literature, you would have to read 43 articles a day for 365 days a year!!

Why do you need to search efficiently?

WHAT IS EVIDENCE BASED PRACTICE?

Patient Values

Clinical Data/

Knowledge

Research Evidence

Optimal Decision

• What does the patient want?

• What are they willing to do?

• What does your experience tell you?

• What has been the experience of your

colleagues?

What does the research say?

Evidence Based Practice Inquiry Process

Box 4 Focus

the question

Box 6Adequate evidence?

Box R2Assign /

Find mentor

Box R3IRB

proposal

Box R4Data

collection

Box R5Data

analysis

Box 7Disseminate

Box R6Impactand/or

outcome

Box 1Initial

question

Box 2 Unit

ordepartment

resource

Box E2Assess

translation of evidence

into practicesetting

Box E3Create action plan and

implement change

Box E4Evaluate outcome

and/or impact

Box E1Finalize team membership

and schedule conferences

Box E5Report results

to decision-makers

Box E6Adopt

changeand

identify next steps

Box R1Contact Research Advisory Council

or Group (If Applicable)

Box 6Appraisal

of literature

Box 3Assemble

initial project

team

If answer is yes, proceed to EBP

Project.

If answer is no, proceed to research

project

Box 5Consult Librarian

Adapted from VCUHS Nursing Inquiry Process Diagram

Levels of EvidenceR

ealit

y

Start of S

earch (Id

eal)

Practice Guideline

Practice Guideline

Advantages Created by panels of experts Based on professional published

literature

http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html

Statement produced by a panel of experts that outlines current best practice to inform health care professionals and patients in making clinical decisions.

Where Can They Be Found? o PubMedo CINAHLo National Guidelines Clearinghouse

Disadvantages Slow to change or be updated Not always available, espeically

on controversial topics Recommendations might be

affected by the type of organization creating the guideline

Review Articles Review Articles

• Provide Overview of a field or subject• Synthesize Previous Research • Useful when you need background information and additional references

Systematic Review • Evidence based search and review of the literature on a topic by an

established method.

Meta-Analysis • A systematic method that takes data from a number of independent studies

and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health Consumers)

Research Articles • Present new and original scientific findings • Explain research methodology and provide data

Randomized Controlled Trials (RCT’s)

Cohort Studies

Case-Controlled Studies

Studies that randomly assign individuals to an intervention group or to a control group,

in order to measure the effects of the intervention.

Study in which a particular outcome, such as death from a heart attack, is compared in groups of people who are alike in most ways but differ

by a certain characteristic

Study that compares patients who have a disease or outcome of interest (cases) with

patients who do not have the disease or outcome (controls), and looks back

retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk

factor and the disease.

Types of Research Articles

Cause & Effect

Selecting the Right Resource

• Research Guides • Nursing Research Guide

• Important Databases• PubMed/Medline (Free) • CINAHL• APA PsycNet/PsychInfo• Cochrane Library • TRIP Database (Free)• National Guidelines

Clearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)

Practice Guideline

http://guides.library.vcu.edu/nursing

THE SEARCH PROCESS

The Search Process Search Steps

2.

5. Evaluate the Results

6. Good Results = Use the Data • Bad = Start Over

3. Choose the appropriate database(s) or resource for

your topic

4. Perform the Search

1. Problem/ Construct Question

Image: http://evidencebasedhealth.blogspot.com/

Formulate Your Search Strategy

• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits

Starting Your Search……..Step 1

Starts with a Problem or Need

for Information

The Problem……….

• Helping a patient to deal with the pain/issues of

fibromyalgia

• Improve Quality of Life

Question - Brings Focus to Search of the Literature

Formulate Your Question

Question Is therapeutic touch or guided

imagery more effective when treating a patient with fibromyalgia?

P I C O T T

Type of Question/ Best Type of Study

 Type of Question

 Best Type of Study

TherapyHow to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using

them

Randomized Control Trial (RCT)

PreventionHow to prevent a disease or condition

RCT/ Cohort Study / Case Control

PrognosisHow to estimate the patient's likely clinical course over

time and anticipate likely complications of disease

Cohort Study/ Case Control/ Case Series or Case Report

DiagnosisHow to select and interpret diagnostic tests

Blind RCT Compared to the Gold Standard (best treatment/test for diagnosis)

Etiology/HarmHow to identify causes for disease

RCT/ Cohort Study /Case Control

Cost analysisEconomic costs of all facets of a intervention or disease

treatment

Economic Analysis

Search Process Checklist

20

PICO & Breaking Search Into Concepts

Main Concepts Break Search in Groups/Concepts

Fibromyalgia | Guided Imagery & Therapeutic Touch

These concepts will be used to search the databasesFind Synonyms/ Related Terms for Concepts

P I C O T T

Patient with Fibromyalgia

Therapeutic Touch

Guided Imagery

Alleviating the

symptoms of Fibromyalgia

Therapy RCT

Background

Informatio

n

What are some alternative terms…

• Guided Imagery

• Fibromyalgia

• Therapeutic Touch

Fibromyalgia Therapeutic Touch Guided Imagery

Fibromyalgia Therapeutic Touch Guided Imagery

"Fibromyalgia"[Majr] OR "Fatigue Syndrome, Chronic"[Majr] OR "Diffuse Myofascial Pain Syndrome" OR "Fibromyalgia" OR "Fibromyalgia-Fibromyostitis Syndrome" OR "Chronic Fatigue Syndrome" OR "Chronic Fatigue and Immune Dysfunction Syndrome" OR "Postviral Fatigue Syndrome"

"Massage"[Mesh]) AND "Therapeutic Touch"[Mesh:NoExp]OR “Therapeutic Touch” OR “Laying-on-of-Hands” OR “Reiki” OR “Massage” OR Zone Therap* OR Bodywork* OR Reflexology

("Imagery (Psychotherapy)"[Mesh] OR Imagery OR "Guided Imagery" OR "Directed Reverie Therapy" OR Hypnoses OR Mesmerism) OR "Hypnosis"[Mesh:NoExp]

Background Information

• Good Sources:

1. Point-of-Care Tools

2. Government Sites

3. Google Scholar

Term/Concept Mining

Google vs. Google Scholar

main purpose of is to hunt for text in Web pages

Displays results based on Page Rank

Does not really cover information contained in library catalogs, official government documents, phone books, etc.

• Indexes the full text of scholarly literature across an array of publishing formats and disciplines

• Includes most peer-reviewed online journals of Europe and America's largest scholarly publishers

• Tends to put weight on citation counts when displaying search results

Falagas, M. E., Pitsouni, E. I., Malietzis, G. A., & Pappas, G. (2008). Comparison of PubMed, scopus, web of science, and google scholar: Strengths and weaknesses The FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology, 22(2), 338-342. doi:10.1096/fj.07-9492LSF Vine, #., & Rita. (2006). Google scholar Journal of the Medical Library Association, 94(1), 97–9. Wikipedia contributors.Google search Retrieved, 2012,

Step 2: Formulate Your Search Strategy

Partly Based

on the

Database

The Search Process Search Steps2.

5. Evaluate the Results

6. Good Results = Use the Data • Bad = Start Over

3. Choose the appropriate database(s) or resource for

your topic

4. Perform the Search

1. Problem/ Construct Question

Image: http://evidencebasedhealth.blogspot.com/

Formulate Your Search Strategy

• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits

DESCRIBE THE FOLLOWING ITEM

Keyword• Also called natural language searching• Search for words or phrases found in title, abstract, or

other parts of articles• Keyword searching used for

• New terminology• Rare terms• Other terms that have no related subject heading• Spelling variations

• Truncation - Train*• Trained, Trainer, Training, etc.

• Grouping Using “Guided Imagery”• Use Quotation Marks • Without Quotes – AND Terms Together

Perspective

Synonyms

All searched when searching by keyword

All Places that are searched when doing a keyword search in PubMed

Pepsi Coke Pop

Soda Soda

Pop

Subject Headings/ Controlled Vocabulary • Controlled Vocabulary – Thesaurus

• Help to return results that directly apply to subject of the search

• Hierarchy – Tree Structure • Broad –Specific

• Minor / Major Heading • Major Heading - Focuses your search

results to returning articles that specifically address the topic• PubMed – have stars beside them• CINAHL – Divided into Major & Minor

Headings

• Scope Note – Term Definition

Soda Pop

Soft Drink

May need to move backward in order to move forward……

Searched when searching with Subject Headings/ Controlled Vocabulary

Subject heading field in PubMed

Fibromyalgia Therapeutic Touch Guided Imagery

"Fibromyalgia"[Majr] OR "Fatigue Syndrome, Chronic"[Majr] OR "Diffuse Myofascial Pain Syndrome" OR "Fibromyalgia" OR "Fibromyalgia-Fibromyostitis Syndrome" OR "Chronic Fatigue Syndrome" OR "Chronic Fatigue and Immune Dysfunction Syndrome" OR "Postviral Fatigue Syndrome"

"Massage"[Mesh]) AND "Therapeutic Touch"[Mesh:NoExp]OR “Therapeutic Touch” OR “Laying-on-of-Hands” OR “Reiki” OR “Massage” OR Zone Therap* OR Bodywork* OR Reflexology

("Imagery (Psychotherapy)"[Mesh] OR Imagery OR "Guided Imagery" OR "Directed Reverie Therapy" OR Hypnoses OR Mesmerism) OR "Hypnosis"[Mesh:NoExp]

Good Search – Combination of Subject Headings and Keywords

Boolean Operators - AND

• Combines concepts

• Relationship

• Retrieves records that contain BOTH terms entered

Soda Pop Weight Gain

Boolean Operators - OR

• Combines synonyms or like concepts

• No Relationship Necessary

• Retrieves records that contain EITHER term entered

Coke Pepsi

When Searching………..Combining Terms Together

Group 1

Combine Terms with OR

Group 2

Combine Terms with OR

AND AND

Group 3

Combine Terms with OR

When Searching………..Combining Terms Together

Fibromyalgia (SH/KW)

ORChronic Fatigue

Syndrome (SH/KW)

Therapeutic Touch (SH/KW)

OR Massage (KW)

AND AND

Guided Imagery (SH/KW)

OR Hypnotism

(KW)

Ways to Expand Your Results Ways to Focus Your Results

• Explode Your Terms• Keyword Searching• Look At Related or Citing

Articles

• Major Concept/Subject• Subheadings• Limits

Keep in Mind……

Keep in Mind……

Break Your Search into Concepts – Don’t Marry Early/ Let Them Date!!!!

Start Your Search Broad and Then Focus – Don’t Put Blinders on the Horse Too Soon !!

Be sure to come up with alternative or related terms for your topic

Always search in at least two databases.

CHOOSING THE RIGHT RESOURCE

The Search Process Search Steps

2.

5. Evaluate the Results

6. Good Results = Use the Data • Bad = Start Over

3. Choose the appropriate database(s) or resource

for your topic

4. Perform the Search

1. Problem/ Construct Question

Image: http://evidencebasedhealth.blogspot.com/

Formulate Your Search Strategy

• Synonyms for Search Terms• Subject Heading vs. Keyword• Boolean Operators & Limits

Selecting the Right Resource • Research Guides

• Nursing Leadership Institute: Evidence Based Practice

• Important Databases• PubMed/Medline (Free) • TRIP Database (Free)• National Guidelines

Clearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)• CINAHL• APA PsycNet/PsychInfo• Cochrane Library

TRIP – TURNING RESEARCH INTO PRACTICE

TRIP – Turning Research into Practice Free database free clinical search engine that searches several databases at once. Primary

function is to help identify the best available evidence when it comes to patient care.

Results displayed by hierarchy of evidence

Results displayed

chronologically

Clinical Areas

Links to Clinical

Trials.Gov & PubMed Clinical Queries

PUBMED CLINICAL QUERIES

Pub Med Clinical QueriesTools that allow clinicians to quickly and easily search for relevant clinical literature on

etiology, prognosis, diagnosis and therapy of diseases and

diagnostics.

Not intended to be comprehensive!!

Direct Link: http://www.ncbi.nlm.nih.gov/pubmed/clinical

PubMed Homepage

Click here to access but not before performing your search

in PubMed.

Categories of Queries:• There are five study categories or filters

to choose from based on your clinical question:

• Etiology - information addressing causation/harm of disease

• Diagnosis - information addressing disease diagnosis

• Prognosis - information addressing disease prognosis

• Clinical prediction guidelines - data addressing the likelihood of disease presence or absence

• Therapy - information addressing the treatment of disease *Note: therapy is the search default.

Two scope categories or filters are provided:

• narrow, specific search -- will get more precise, relevant citations but less retrieval

• broad, sensitive search -- includes relevant citations but probably some less relevant; will get more retrieval

Place the last number of your search strategy here

or you can use combination of keywords

Study Categories/ Scope

Displays citations for systematic reviews,

meta-analyses, reviews of clinical

trials, evidence-based medicine, consensus

development conferences, and

guidelines

Study Results

• Health Topics • Medical Encyclopedia • Interactive Health Tutorials • Drugs, Supplements, & Herbal

Information • Current Health News • Dictionary• Multiple Languages - links to health

information in over 40 languages • Directories - locations and

credentials of doctors, dentists and hospitals

http://www.nlm.nih.gov/medlineplus

/

• Specializes in reviews of clinical effectiveness research • What Works in Medical Care?

• Reviews based on systematic reviews of clinical trials

• Information partners:• Agency for Health Care Research and Quality (US) 

(AHRQ)• Centre for Reviews and Dissemination (CRD)• The Cochrane Collaboration (CC)• German Institute for Quality and Efficiency in Health

Care (IQWiG)• National Cancer Institute (NCI)• National Institute for Health and Clinical Excellence

guidelines program (NICE)• National Institute for Health Research (NIHR) Health

Technology Assessment Programme (NIHR HTA)• Oregon Health and Science University's Drug

Effectiveness Review Project (DERP)• Department of Veterans Affairs' Evidence-based

Synthesis Program from the Veterans Health Administration R&D (VA ESP)

http://www.ncbi.nlm.nih.gov/pubmedhealth

/

If You Need Help……..• Get in touch with Me…..

Roy Brown, MLIS

Education and Research Librarian

Tompkins-McCaw Library, VCU Libraries

rebrown2@vcu.edu / Ph. 804-828-1592