Finding the best evidence 1. Walk through one 2. Do own searches

1. Finding the best evidence1. Walk through one2. Do own searches

2. Learning through play • Try all “buttons” • Make lots of “mistakes” • Have fun

3. EBM (quick & dirty) Steps Answerable Question Search Appraise Apply Time: 90 seconds < 20 articles This patient survives! Systematic Review Steps Answerable Question Search ++++ Appraise x 2 Synthesize Apply Time: 6 months < 2,000 articles This patient is dead EBM and Systematic Review Find a systematic review!!

4. Start up • Start Explorer and enter • www.pubmed.gov • Put on CAPS lock • So that AND and OR are in CAPITALS • Start 2nd Explorer window, enter • www.tripdatabase.com

5. Using the question to guide searching • Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. • Question • Population • Indicator (intervention, test, etc) • Comparator • Outcome

6. Using the question to guide searching • Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. • Question • Population – in elderly patients does • Indicator – a ‘poor’ whispered voice test • Comparator – a ‘normal’ whispered voice test • Outcome – predict abnormal audiogram • Underline the key terms • Number the order of importance from 1-4 • Think of alternate spellings, synonyms, & truncations

7. Using the question to guide searching • Scenario - You are interested in checking the hearing of elderly patients, and have heard that the ‘whispered voice test’ is good. • Question • Population – in elderly patients does • Indicator – a ‘poor’ whispered voice test • Comparator – a ‘normal’ whispered voice test • Outcome – predict poor hearing (audiogram) 3 1 2 • Underline the (root of the) key terms • Number the order of importance from 1-4 • Think of alternate spellings, synonyms, & truncations

8. Check the question type Check the emphasis AND means both terms required * Means any other letters

9. Stepwise searching • Search with #1 PICO item • Whisper* • Then go to “Clinical Queries”: diagnosis • Whisper* (again) • Add #2 PICO item • whisper AND (hear* OR audiogram)

10. Combining terms with Boolean operators – AND IN CAPITALS weight AND chitosan - has both terms weight chitosan

11. Combining terms with Boolean operators – OR weight OR chitosan - has either term weight chitosan

12. Your tasks • Search for the best single article (systematic review or trial) for • Your question from notes • Your own question(s) • When you are finished • Print just the abstract for each • Write your search strategy on the page

14. Boo-le-ans* • AND = both terms • OR = either term • NOT = not this term • (ADJacent, NEAR, … = AND + close) * George Boole (a man) is claimed to have invented “logic”

15. Where to the brackets go? • If you want • cheese AND fruit • Which do you ask for? • cheese AND (apple OR pear OR melon) • (cheese AND apple) OR pear OR melon • What does PubMed do with if AND and OR? • Cheese AND apple OR pear • (Look at DETAILS tab)

16. General structure of search • (Population OR synonym 1 OR …) AND • (Intervention OR synonym 1 OR …) AND • (Comparator OR synonym 1 OR …) AND • (Outcome OR synonym 1 OR …) AND • FILTER (for best study type)

18. Comparing Databases Medline Embase Cochrane Trials Registry Medline = Pubmed, Webspirs, OVID, …

19. Search Cascade

20. Shortcuts • Meta-search engines • www.tripdatabase.com • Sumsearch • Nelh

22. Other tips: • Search on Title only Eg [ti] (Others are [au] - author; [so], [yr], …) • ‘Related Articles’ button (PubMed) • previously identified study (PubMed) Look for the MeSH terms MeSH browser

24. Before you finish! • Print single most relevant abstract for each question – for both ‘set’ questions and your own questions