E V I D E N C E A I D
M I C H E L E M A L L O Y
R E S E A R C H L I B R A R I A N , H E A LT H P O L I C Y
C O N G R E S S I O N A L R E S E A R C H S E R V I C E ,
L I B R A R Y O F C O N G R E S S
Searching for the Best Evidence (Even under Limitations!)
The views expressed herein are those of the author and are not presented as those of the Congressional Research Service or the Library of Congress.
O B J E C T I V E S
E B P & S E A R C H I N G F O R B E S T E V I D E N C E
R E S O U R C E S
Introduction
Objectives
Identify sources of external evidence, and understand their contribution to EBP
Locate and use various resources & collections
Discuss and mitigate limitations
Demonstrate understanding of database structures and choose the right database(s) for a clinical & research questions
Design a search strategy and participate in a database search for pertinent evidence
Understand the purpose of strong secondary sources, such as reviews (narrative & systematic), meta-analysis and meta-synthesis
L I N K E D PA R T N E R S H I P
C L I N I C A L V S . R E S E A R C H
B A C K G R O U N D V S . F O R E G R O U N D
EBP & Searching for the Evidence
What is EBP?
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient's unique values and circumstances.”
-Centre for Evidence Based Medicine (CEBM), Toronto, CA
Clinical Questions Research Questions
Time sensitive
Directly apply to patient care
Background / Foreground elements
Focus on quick evaluation
Less time sensitive
Often involve teams
More intense & inclusive searches
May include comparative elements
Different Questions, Different Searches!
Background vs. Foreground
Background Questions
• Basic Information about a Medical Topic
• You think you’re supposed to know!
Foreground Questions
• Directly involves a patient
• PICO(T) format
Clinical Questions Research Questions
Background Guidelines / Procedures
Clinical Tools
Textbooks
Foreground Clinical Tools
Databases
Specialized Databases MEDLINE (Ovid or PubMed)
CINAHL
PsycINFO
EMBASE
Google Scholar
Other Resources Advanced Google Search
Websites; Gray Literature
Where do we search?
A C C E S S
T Y P E S O F R E S O U R C E S
G E T T I N G H E L P !
(Library) Resources
Accessing Resources
Assess Available Tools Libraries and/or Librarians
Affiliated Organizations or Researchers
HINARI
“Free” Web searches
Organize & Share Topic Guides
Bibliographies
Cloud-based Collections
“Favorites”
Types of Resources
Databases (CINAHL, MEDLINE, EMBASE)
Clinical Tools (DynaMed, Nursing Reference Center)
eBooks (STAT!Ref, UCentral, MDConsult)
Journal Articles
Drug Reference Tools (Micromedex, Drug Information Portal)
Reference Management Tools (RefWorks, Zotero)
Procedures & Guidelines
Patient Education
Get Help!
Librarians & Information Professionals
Colleagues & Collaborators
Organizations
O V E R A L L P R O C E S S
S E A R C H I N G B E S T P R A C T I C E S
C L I N I C A L V S . R E S E A R C H
D E M O N S T R AT I O N
B E Y O N D T R A D I T I O N A L D ATA B A S E S
Searching Techniques
Searching: Overall Process
Identify your Question
Select the best Resource(s)
Formulate your Search Strategy
Search, using Best Practices
Save your Results
Evaluate & Refine your Search
Repeat!
Clinical Question Research Question
Background / Foreground
PICO(T)
Brainstorm keywords
Weigh the importance of individual elements
Break into Concepts
Brainstorm keywords
Gather from existent sources
Ask colleagues / experts
Identify your Question
Select the Best Resource(s)
For Health-related Questions:
Databases (consider the focus of your question)
Secondary Resources (Reviews and Syntheses)
Ask a Specialist!
Subject Librarians
Mentors & Instructors
Colleagues & Collaborators
Formulate your Search Strategy
Boolean Search
• AND = all terms included
• OR = rough synonyms, any are OK
• NOT= eliminate this term
Discovery Search
• Build terms list
• Determine relevancy
Search, using Best Practices
Search Concepts Individually
Use Subject Terms (MeSH, CINAHL headings)
Check Scope Notes
Explode (if applicable)
Use Subheadings Appropriately
Use AND, OR, and NOT to Combine Searches
Include Keywords when Needed (“exact phrase”)
Truncate Words (psych*) for Variant Endings
Apply Limits Last (Language, Year, Publication Type)
Within Databases Reference Managers
MEDLINE, CINAHL, etc.
Create individual or group accounts
Save variations of searches
Keep internal folders for individual results
RefWorks/Zotero
Export references from databases
Share with co-investigators
Generate style-specific reference lists
Save your Results
Evaluate and Refine your Search
Examine Results
Identify the most applicable
Use these to find more search terms & resources
Broaden your concepts to similar fields
Ex. Training Skilled Birth Attendants in Rural Areas
Rural Health Providers– too broad
Maternal Health Providers and/or Community Health Workers!
Consult with Experts
Refine your Search
Think about other Sources
Sample Search Demonstration
G O O G L E
W E B S I T E S
G R AY L I T E R AT U R E
E B O O K S
M E D I C A L A P P S
Beyond Traditional Databases
Google?
Use Google… but be smart.
Advanced Search
Limit to sites/domains (.gov, .edu, who.int)
Google Scholar
Evaluate ALL Resources Skeptically
Discover Gray Literature!
(Some) Credible Websites
General Health Evidence Aid Resources http://www.evidenceaid.org/resources/
WHO http://www.who.int/en/
CDC http://www.cdc.gov/
AHRQ http://www.ahrq.gov/
MedlinePlus http://www.nlm.nih.gov/medlineplus/
Hinari http://www.who.int/hinari/en/
Statistics
Guidelines National Guidelines Clearinghouse http://guidelines.gov/
Q U E S T I O N S ?
Thank you!