Step TwoFinding the best evidence

1. Walk through one2. Do own searches

Learning through play Try all “buttons” Make lots of

“mistakes” Have fun

EBM and Systematic Review

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

Find a systematic review!!

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

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

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

1. Underline the key terms2. Number the order of importance from 1-43. Think of alternate spellings, synonyms, &

truncations

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)

1. Underline the (root of the) key terms2. Number the order of importance from 1-43. Think of alternate spellings, synonyms, &

truncations

1

2

3

* Means any other letters

AND means both terms required

Check the question type Check the

emphasis

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)

Combining terms with Boolean operators – AND

chitosanweight

weight AND chitosan - has both terms

IN CAPITALS

Combining terms with Boolean operators – OR

chitosanweight

weight OR chitosan - has either term

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

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”

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)

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)

MedlineEmbase

Cochrane Trials Registry

Comparing Databases

Medline = Pubmed, Webspirs, OVID, …

Search Cascade

Shortcuts Meta-search engines

www.tripdatabase.com Sumsearch Nelh

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 termsMeSH browser

Before you finish!

Print single most relevant abstract for each question – for both ‘set’ questions and your own questions

More Tips on Effective Searching

Decide the TYPE of question (Rx, Dx, Px, …)

Chose the right database for the type of question, e.g., Intervention: Cochrane Library, PubMed, … Diagnostic: Common Diagnostic Strategies (in

BE), or PubMed: Clinical Queries Prognosis, Etiology: PubMed: Clinical Queries

Hearing problems in childhood Scenario - An immunisation and screening

booklet asks parents whether they think their child has any problems with hearing. While on a committee reviewing these questions, you wonder about the usefulness of this.

Question Population Indicator (intervention, test, etc) Comparator Outcome

Question Type - Rx, Dx, Px, … Database

Hearing problems in childhood Scenario - An immunisation and screening booklet

asks parents whether they think their child has any problems with hearing. While on a committee reviewing these questions, you wonder about the usefulness of this.

Question Population – In well children Indicator - does parental report of concern Comparator - nil Outcome – predict true hearing problems?

Question Type - Rx, Dx, Px, … - Diagnostic Accuracy Database – PubMed: Clinical Queries - diagnosis

Using the question to guide searching Question

Population – (child OR children) AND Indicator – (parent OR parental) AND Comparator - nil Outcome – (hearing)

Question Type Dx – Diagnostic Accuracy

Database – PubMed: Clinical Queries

Using truncation to save on ORs – the * Question

Population – (child*) AND Indicator – (parent*) AND Comparator - nil Outcome – (hearing) AND

Question Type Dx – Diagnostic Accuracy

Database – PubMed: Clinical Queries

‘Wildcards’ malig* means

malignancymalignantmalign

but notmalunionmalalignedetc

Special tricks

Write a “search” to get the green & red areas only