Pediatric Fellowship Course Seminar Series 2013

1. Pediatric Fellowship Course Seminar Series 2013 Health Sciences Library Resources: Searching Questions and Identifying Research February 11, 2014 Janice Lester, MLS Reference and Education Librarian - LIJ Health Sciences Library

2. Objectives/Outcomes for this session: 1. Identify a clear structured searchable question. 2. Execute an appropriate search strategy to search the literature for specific types of study designs based on the topic. 3. Determine appropriate resources to answer background or foreground information questions.

3. Session Timeline: 7:30-7:45Learning Objectives and Creating a Searchable Question 7:45-8:00Finding Library Resources and the Evidence Pyramid 8:00 – 8:30Effective PubMed Search Techniques and Q&A

4. Tips When Searching • Be Methodical • Leave yourself adequate time to search…But don’t spend too much time doing it • Document where you searched, what you searched and when you searched • Store all of your citations in the same place (EndnoteWeb or Zotero) • Seek help when you need it, but do not wait until the last minute

5. Steps of Basic Research 1. Create an answerable research question 2. Break your research question into searchable components 3. Choose the database 4. Generate subject headings and synonyms 5. Execute your search and select limiters 6. Analyze your search results, modifying and re-executing searches as needed 7. Review the Articles

6. Background Versus Foreground:Experience Determines Need Background Questions - About conditions Foreground Questions - About choices

7. Create an Answerable Research Question based on your Hypothesis Know the difference between background and foreground questions. Background Questions: Ask for general knowledge about a condition or thing. Have two essential components: • A question root (who, what, when, etc.) with a verb • A disorder, test, treatment, or other aspect of healthcare Foreground Questions: Ask for specific knowledge to inform clinical decisions or actions. • Usually have 3 or 4 essential components • Patient and/or problem • Intervention • Comparative intervention (not always needed) • Clinical outcome

8. Break your research question into searchable components PICO • Patient/Population – Includes age, race, sex, geography • Problem – Current health concern • Intervention – Exposure of interest • Comparison – Alternate exposure (if any) • Outcome – What is the desired outcome? Does this mean that every research question can/should be answered this way?

9. Creating the Question Create one sentence (elevator statement) that epitomizes what concept you are looking to search which includes PICO elements. Does giving Prophylactic Acetaminophen to infants (age 2 months) after immunizations decrease sleep duration compared to a placebo? What are our PICO Elements?

10. Bad Question What is the best way to treat children with asthma? • Best how? Fewer asthma attacks? Less severe attacks? A treatment that is cheaper? Fewer side effects? Fewer adverse reactions with other medications? • What type of asthma? Chronic? Exercised Induced? • How are we diagnosing asthma and who is doing it? • Best compared to what? What type of treatment are we considering? • Is there a more specific age group that we are addressing? • Are we measuring any of these concerns? If so, how?

11. Good Question Among young children with acute asthma exacerbation, is a single dose of IM dexamethasone comparable to five days of oral prednisolone for resolution of asthma symptoms? More detail is usually better; not always possible, but generally better.

12. Selecting and Searching the Databases Wait a minute… Where did you say the databases are again?

13. Accessing EMIL from Healthport

14. Access through LIJMC/CCMC

15. Finding e-textbooks on EMIL by subject – eg. Pediatrics

16. Finding journals and books by subject

17. Finding journals – e-Journal portal 360 Link-search by Pubmed or DOI

18. Pediatric Care Online

19. ACP Journal Club summarizes the best new evidence for internal medicine from over 130 clinical journals accessible through ‘E-journal portal’ on EMIL

20. Example of a Point of Care - Evidence Based Clinical Database • Available Remotely • Tutorials Available • Can be accessed through mobile devices

21. Locating Pubmed and OvidSP

22. PubMed is Useful For the Following: • When searching for the newest information (pre-pub) • Very obscure cases [bot fly] • Special types of articles (case reports, trials) • Articles that have been corrected or retracted • Limiting by specific factors, like females and age • Seeking Higher Levels of Evidence and specific search filters

23. Access PubMed Through HealthportNot the Internet Tutorials

24. Back to Our Clinical Questions… Find all of the searchable elements of the sentence. Then look up the appropriate subject headings and two synonyms (usually). If you can’t find the exact subject heading, do the best you can. If you need more than 2 synonyms, add them.

25. Our Question Will providing patient education reduce admissions for head trauma caused by parental abuse or neglect of children? PICO PATIENT = Children PROBLEM = Parental abuse INTERVENTION = Patient Education COMPARATIVE = No Action (In other Situations Watchful Waiting/Placebo) OUTCOME = Reduce Head Trauma Admissions

26. How to find Subject Headings and Synonyms • MeSH Database • Pearl Growing • Abstract view of PubMed results or other articles • Synonym generation • Plurals • Hyphenation • Different Spellings (British) • Narrow MESH Headings

28. Synonyms – Why you should use them BUT 2476 Results In a PubMedGeneral Search 2000-2014: Nosebleed – 3745 Results Nose Bleed – 3748 results Nosebleeds – 120 results Epistaxis (MeSH) – 2385 results

29. Generate Subject Headings and Synonyms Will providing patient education reduce admissions for head trauma caused by parental abuse or neglect of children? PICO Children = This is a limiter so we do not necessarily need a Subject term- It depends on the database. Parental abuse = Child Abuse OR child neglect OR infant abuse OR child maltreatment Patient Education= Patient Education as Topic OR parent education OR education of patient OR patient education Head Trauma= Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome

30. PubMed Regular PubMed can be searched two ways: • Creating one large search. • Doing smaller searches and adding them together later. (Child Abuse OR child neglect OR infant abuse OR child maltreatment) AND (Patient Education as Topic OR parent education OR education of patient OR patient education) AND (Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome) PubMed Clinical Queries can also be searched both ways, but the second way tends to be a little more difficult.

32. Database Filter and Study Design Before you search the PICO elements of your clinical question, it’s important to know: • What TYPE of question are you asking? • What is the best STUDY DESIGN to search for to find evidence to answer your clinical question?

33. What Kind Of Question is This? As a physician, you would like to know the prevalence of headaches three and 12 months after mild, moderate or severe traumatic brain injury (TBI) in children ages 5 to 17. Which of the following clinical query filters would you want to apply to receive the most relevant and specific results? • Etiology • Therapy • Prognosis • Diagnosis • Clinical prediction guidelines

34. The prognosis filter in Pubmed Clinical Queries automatically applies a specific search strategy (prognos*[Title/Abstract] OR (first[Title/Abstract] AND episode[Title/Abstract]) OR cohort[Title/Abstract]) to the search terms entered in order to retrieve article and study types that best address the concept of prognosis. In this case we are interested in following the course of the disease (TBI) to see what the outcome and frequency of headaches will be in these patients. This is different from etiology/harm how?

36. Execute Your Search • Execute your search and select limiters if needed • Select the appropriate filter Advanced search building and limiters may depend on Database.

37. Limit Your Search

38. Analyze Your Search Results This may be the point where you discover that you either have too many results or too few (or off topic results). • Too Many - Apply more or stricter limiters, look for higher levels of evidence or make search terms more specific. • Too Few (or off topic) – Remove any limiters, execute a general PubMed search, add search terms or generalize search terms (think drug class as opposed to specific drug)

40. Read the Abstracts/Review Articles At this point you should be able to discover some basic information about the results by looking at the titles and abstracts. Look to see what type of results you have, and whether it suits your purpose. Does this mean that you have found everything ever written because you searched in Pubmed?

42. Of course not. In most cases, if you are doing searching that is clinical or research based you will not be doing yourself a disservice simply searching Pubmed. If, on the other hand, you are writing a literature review, systematic review, or meta-analysis you may also need to search grey literature, which includes conference proceedings, institutional publications, white papers, unpublished trials, and foreign language journals.

43. New Resources • Visual DX • Web Of Knowledge

44. Visual DX Differential Builder-by lesion

45. Web of Knowledge Journal Citation Reports will organize journals by impact factor

46. Journal Citation Reports

47. Web of Science Cited 18 times

48. Web of Science

49. Web of Science- Citation map – Backward and Forward Web of Science- Citation Map

50. EMIL Mobile EMIL MOBILE provides 24 hour mobile access (iPhone, iPads, Android…) to all library resources. Over 10,000 medical journals, nursing literature, evidence based databases, literature search requests and many other resources are available. To access EMIL Mobile: go to Healthport via RAP, enter your Universal ID/password and click on EMIL. See handout For NSLIJ owned devices contact emilmobile@nshs.edu