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Efficient Searching of the Literature & Critical Appraisal. Rick Wallace March 9, 2007. Public Service Professional Librarians. Nakia Carter, MLS Maylene Qiu, MLS Rick Wallace, MLS. My Philosophy of the Literature- EBM: 6 Steps. Patient/Problem Question Search Critical Appraisal
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Efficient Searching of the Literature & Critical Appraisal Rick Wallace March 9, 2007
Public Service Professional Librarians • Nakia Carter, MLS • Maylene Qiu, MLS • Rick Wallace, MLS
My Philosophy of the Literature- EBM: 6 Steps • Patient/Problem • Question • Search • Critical Appraisal • Application • Evaluation
Before You Search • You must have a patient/problem- Step #1 • You must have a searchable question- Step #2
Clinical Scenario- Patient & Question • In pediatric patients with acute asthma exacerbation, does the inclusion of inhaled steroid improve outcomes such as hospitalization rates, length of stay, etc.
PICO the Question • P OPULATION/ PATIENT • I NTERVENTION • C OMPARATIVE INTERVENTION • O UTCOME
Our Scenario • Population- Pediatric patients w/ acute asthma exacerbation • Intervention- Inhaled steroids • Comparative- None • Outcome- Improve hospitalization rates - Generally ImprovedM&M
Well-Built, ANSWERABLEClinical Question • In pediatric patients with acute asthma exacerbation (P), do inhaled steroids (I/C) improve hospitalization rates (LOS, etc.), and general morbidities (relief of symptoms, reduction of side effects, etc.) (O) ?
Step #3: Searching- Two processes • Choose database • Search database
Skill #1- Choice of Database(s) Search What to Search How to Search
Secondary Literature • Evolution of the Secondary Literature InfoMastery- reduces the need for expertise in steps 3 & 4 Classic EBM- 6 steps
Secondary Databases • Transparent- levels of evidence • POEMS • Pre-validated • High level of evidence- evidence pyramid • Concise summaries to reduce work
Some Secondary Databases • UpToDate • Inforetriever • DynaMed • Clinical Evidence • Cochrane Database of Systematic Reviews • DARE/CCTR • FPIN • ACP Journal Club • National Guideline Clearinghouse • FirstConsult • PIER
Primary Databases • PubMed (MEDLINE) • MDConsult (textbooks) • StatRef (textbooks)
Secondary Database- UpToDate • Search “asthma” • Asthma exacerbation • Pediatrics-Pharmacologic Tx of Acute asthma exacerbation • Inhaled steroids
Secondary Database- Inforetriever • Asthma • Managing acute asthma exacerbations (LOE = 1a) • Guideline- “Managing an acute exacerbation of asthma • Initial therapy- #3- corticosteroids
Secondary Database- DynaMed • Asthma • Asthma exacerbation • Steroids (click for details) • Inhaled topical steroids…
Secondary Database- Clinical Evidence • Asthma • Asthma and other wheezing disorders in children • Corticosteroids (high dose inhaled)
Secondary Database- Cochrane Database of Systematic Reviews • asthma AND (child OR adolescent OR infant) AND (steroid* OR corticosteroid*) AND (inhale* OR nebulize*) AND (exacerbat*) –searched as tw • #23. Corticosteroids for hospitalised children with acute asthma • Note: we have already searched CDSR by searching other databases • Also DARE and CCTR
Secondary Database- AHRQ Evidence Reports • Asthma • Use “find”
Secondary Database- National Guideline Clearinghouse • asthma AND inhale* AND Exacerbate*
Primary Databases • “raw”- not pre-validated • Not transparent • Not summarized- lots of work- work equation • All levels of evidence- well done RCT with 10,000 pts. versus individual case study
Primary Databases- PubMed • PICO- MESH
MeSH- Medical Subject Headings • What? • Thesarus used to index citations in MEDLINE • MEDLINE vs PubMed • Updated to reflect changes in medicine • Why? • Higher retrieval of relevant articles • Synonyms • Search stop words: Hepatitis A
MeSH • Major/ non-major • Explosions • Sub-headings • Boolean • Tree structure • Pass out thesari
PICO MeSH • Population- Pediatric patients w/ acute asthma exacerbation • Intervention- Inhaled steroids • Comparative- None • Outcome- Improve hospitalization rates; generally improved M&M • Population- Asthma/tx; All Child • Intervention- Steroids/ tx use • Comparative- none • Outcome- length of stay; outcome assessment
Pearl Searching • Do a text word search • Look at the citation display • Do subject search with MeSH
Example • Question: Is the development of breast cancer affected by the intake of dietary fat? • Text word search- breast cancer fat • Relevant article- • Browse MeSH- review scope note, subheadings, etc.
Narrowing retrieval • Combine sets • Use Boolean AND • Limits- human, age, gender, language, publication type, date range
Example • In patients with asthma do steroids affect the outcome? • Search- asthma/ drug therapy • Major Mesh, English, human, last 5 years
Searching for Evidence • Use a publication type • Use a hedge • Use clinical queries filter
Other • My NCBI • Related Items • Displays • Save • SFX • LoansomeDoc • Details- automatic mapping
Exercises • Take a clinical scenario • PICO it • Construct a well-built clinical question • List type of clinical question • List best type of literature to answer it • Do a search – save search strategy and results- try at least one secondary database and PubMed