The Literature Search:Getting Started

Elaine Morschhauser, DC

Evidence-Based Chiropractic

March 27, 2003

Searching the literature —

the starting point for ALL research

This presentation discusses: How to select topics you should include

in the Introduction and Discussion sections of your paper

It does not show you how to use computer databases.

What is a Case Report/Case Study?Describes the health history of a single

patient in the form of a storyRelatively weak scientific evidence, but…

Can convey information that would be lost in a structured trial or study

Immediately understandable by non-academic clinicians and the lay public

Forms a foundation from which more sophisticated studies can be designed

Can be combined to publish a case series More than one patient with a certain condition Describe an aspect of the condition, the

treatment, or adverse reaction

Anatomy of a Case Report Abstract Introduction Case Report

Case History/ExamMethodsResults

Discussion Conclusions

See Instructions to Authors

Introduction

• Introduces the case/condition of interest• Reviews and cites the scientific

literature on the topic (chiropractic & non-chiropractic literature)

• Includes recent, high quality references (articles are better than books)

Use of Literature in the Introduction

What do we already know about the condition and the type of care provided? Clinical manifestations Etiology Epidemiology Current/usual/medical management Chiropractic management

Use of Literature in the Introduction

Why is it important to do this study/report this case? Few other studies published on

chiropractic management of this condition in patients

Unusual or marked results Appropriately measured outcomes are

favorable (or unfavorable!)

Use of Literature in DiscussionCompare your case’s results to results

in literature outcomes type of care provided types of patients

Speculative neurophysiology only briefly, if at all

Search Index to Chiropractic Literature: the only

exclusively chiropractic journal literature index (not limited to “scientific” journals) www.chiroindex.org

PubMed.gov – (online tutorial) MedLine database a journal that is said to be “indexed”, usually

means MedLine Allied & complementary health resource

indexes AMED, CINAHL, MANTIS* *www.chiroaccess.com (membership fee)

Free via Palmer library

MedLine PubMed NLM’s database of

indexed journal citations for biomedicine and health

~4,500 journals >11 million citations U.S. and 70 other

countries 1966-present

Online tool developed by the National Center for Biotechnology Information at the NLM

Free access to MedLine Links to some full-text

articles Search using author

name, title words, text words, journal names or any combination

MeSH terms, too

MeSH: Medical Subject HeadingControlled vocabulary that is a

distinctive feature of MedLine Imposes uniformity and consistency to

the indexing of biomedical literatureTerms are arranged in a hierarchical

categorized manner

Suggested MeSH terms:Chiropractic ORManipulation, spinal ORManipulation, orthopedic OROsteopathyAND the topic/condition you are looking

forOr do separate searches for each subject,

then combine the results

Use recent referencesTypically limit references used to past 5

yearsOlder references used only if

landmark/seminal or otherwise important information

How do I get started? What is the topic of your paper?

Example: A pediatric patient with asthma. What does the reader need to know about

ASTHMA? Etiology Epidemiology and burden to society

What does the reader need to know about treatment of a child with asthma? Medical/other Chiropractic

Search MEDLINE for articles on etiology of condition (brief) epidemiology

prevalencewho is affectedburden to society in terms of $ and lost work

current treatmenthow effective, expensiveare there side effects

provide a rationale for why chiropractic may be a better approach

Search PubMed + MANTIS for articles on

Chiropractic management of this or similar conditions

Articles on the chiropractic management plan to be used in your paper

Be selective in obtaining full-text articles you may find more useful references within

those articles

Narrowing a MEDLINE search: “Asthma” --> 64,493 “Asthma”, 1996-2001 --> 10,243 “Asthma AND children”, 1996-2001 --> 3,761 Limits “human”, “English language”, “Review

articles” --> 514 Above limits plus 2002-2003 --> 177 “Asthma AND chiropractic” --> 5

Retrieval

Most searches allow perusal of abstractDetermine likely “fit” before retrieving full-textLocal college libraryAlumni services -- chiropractic colleges’

librariesCINAHL services (annual fee)www.freemedicaljournals.com (limited

selection)

Where in a case report? “Fractured Heterotopic Bone in Myositis

Ossificans Traumatica”, JMPT; 24(4). In most cases, the heterotopic bone formation

matures into a separate soft tissue mass within the involved muscle and is clinically silent

Clinical manifestations – typically described in the Introduction section

Where in a case report?

“Upper Cervical Chiropractic Management of a Patient with Parkinson’s Disease”, JMPT; 23(8).

An important aspect of this patient’s medical history was his recollection of head and/or neck traumas before the onset… The body of medical literature detailing a possible trauma-induced cause for PD, or at least a contribution, is substantial.

Compare your case’s results to results in the literature – typically in the Discussion section

Where in a case report? “Chiropractic Management of a Patient with

Lumbar Spinal Stenosis”, JMPT; 24(4). Although some authors have found conservative

measures to be of little long-term benefit, others recommend conservative therapy as the first choice of treatment, reserving surgical intervention for those patients who experience intolerable pain, progressive neurologic deficits, cauda equina syndrome (CES), or who fail to respond to conservative measures.

What do we already know? Current/usual/medical management – typically found in the Introduction section