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Anatomy of a Literature Search

Part 1 Webinar – March 13, 2013

Prepared by Deb Monkman, PABC Clinical Librarian

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What town are you

Webinaring from tonight?

Please type in

the chat box to

everyone!

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+ Purpose: Database Anatomy &

Physiology

Learn how a

bibliographic

biomedical

database (EBSCO

Medline or

CINAHL) works

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+ Survey Says….

Less than half of you have searched

Medline & CINAHL (66% & 33%)

Mixed group! About 25% are comfy

with searching while the other 75%

range from very uncomfy to neutral

Biggest needs: working with results,

setting up Alerts, etc. - will be in Part

2 next week

33% private – 40% public – 25% both

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+ The Reality of Searching for

Physiotherapy Research

It’s easy to find medical treatment (drug therapy, surgery, etc) of a

disease or condition, e.g., medical management for hip

replacement ……… BUT

It’s harder to find physiotherapy (less research published, not

indexed as well, may be a line in a medical paper “physiotherapy

recommended,” maybe not as specific as you’d like – e.g., exercise

program for post-surgical treatment of hip replacement)

Search both Medline and CINAHL for best coverage of PT

Use both keywords and subject headings [see online tutorials]

Don’t forget me – a resource for you!

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+ Learning Objectives: By the end of the Webinar, you will be able to describe how to:

1. Write a clinical question using PICO

2. Access EBSCO Medline and CINAHL on the PABC eLibrary

3. Do a keyword search using EBSCO Medline

4. Do a subject heading search using EBSCO Medline

5. Do a combined keyword and subject heading search

6. Use Boolean logic – and, or, not

7. Narrow or broaden a search

In part 2, we learn: how to apply limits, how to tease out

physiotherapy-specific literature, how to set up alerts, and

how to search both Medline and CINAHL together

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Google PEDro

Rehab+ PubMed

EBSCO

Medline,

CINAHL,

& PsycINFO

With full-text

OVID Medline &

EBMR, including Cochrane

Library

With full-text

Continuum of databases to learn to search

Via e-HLbc FREE

Review: Covered in Absolute Beginner Webinar + watch

all 5 PABC eLibrary tutorials http://www.youtube.com/user/BCPhysio#p/search/4/pdy5W5OzqGM

+ A note about Rehab Reference

Centre (RRC) via CPA

New Jan 2013 – freely available to CPA members

RRC is great for:

Clinical reviews on a topic

Exercise handouts

Patient education

For lit searching (articles, guidelines) – use PABC’s Medline &

CINAHL (RRC does not have Medline and CINAHL)

PABC has more full-text journals (from several different sources)

RRC has Rehab & Sports Medicine Source, which PABC does not

have, but there is much duplication with Medline & CINAHL

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+ A note for public practice

members

All health authorities and their hospital library

services have the eHLbc (the Electronic Health

Library of BC), to which PABC also subscribes

Hospital libraries will have access to MORE

journals than PABC and will provide inter-library

loan/document delivery services = your best bet

for getting articles!

VIHA is the only health authority that we are aware

of that also has access to Rehab Reference Centre

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1. Asking a

Clinical Question

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+ Process of evidence-informed practice

Step 1: Formulate a well-built question – tutorial

Step 2: Find articles and other evidence-based resources that answer

the question – View all tutorials

Step 3: Critically appraise the evidence to assess its validity (JOURNAL

CLUB) – see Alison’s Journal Clubs and worksheets

Step 4: Apply the evidence

Step 5: Re-evaluate the application of evidence and areas for improvement

DEB

ALISON

+ Formulate a well-built clinical

question using PICO PABC tutorial http://www.youtube.com/user/BCPhysio#p/u/1/pdy5W5OzqGM

Population:

What age? Paeds, adults or elderly

What diseases or conditions? Hip clicking, tennis elbow

How long? Acute or chronic

Intervention:

What type of treatment? Stretching, exercise, LASER, lymphatic

drainage

Comparison:

Another type of intervention, wait and see, surgery, no treatment

Outcome:

Pain, range of motion, strength

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+ Anatomy of a Citation

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Major & Minor Subject

headings = CINAHL

Headings or MeSH (Medical

Subject Headings)

Subheading = physiology,

etiology, rehab, therapy,

drug therapy, etc.

+ Clinical Question example: tennis

elbow & LASER

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Is low-level LASER effective

for improving function (pain,

grip strength) in patients with

acute tennis elbow?

+ What are all the possible keywords

for the various search concepts?

Use the Worksheet to plan your

search

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Tennis elbow

Elbow tend?nitis/oses

Elbow tendinopath*

Lateral epicondylitis

Grip strength

Pain

Low-level laser*

Low intensity laser*

Low power laser*

Laser therap*

LLLT

Acute

+ What does “Truncation” mean?

Tendinitis

Tendonitis

Tendinosis

Tendinoses

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Truncate to: [this is

what you type in]

Tend* - picks up

all the possible

endings (but also

tendon

Or

Tend?n* - picks up

variant spellings

Or

Tend?nit* or

tend?nos* might

work out best

+ Nikki’s worksheet: What is the best

conservative treatment for FAI?

1. My clinical question is… What physical or

conservative therapies reduce pain and improve

function in adults with FAI

2. The PICO is…

Population: adults with FAI

Intervention: physio, conservative, non surgical

Comparison: surgery, physio

Outcome: improve function, reduce pain

3. The database I will use is… Medline & CINAHL

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+ Nikki’s worksheet: cont…

4. The limits I want are…

highest levels of evidence (RCTs, systematic reviews,

metaanalyses)

2005 to present

5. The concepts are… (1) FAI and (2) physio/non surg/conservative

6. Keywords for FAI are… femoracetabular, femoroacetabular,

femoral acetabular, femoroacetabular

7. Keywords for physio… specific types of physio (e.g., exercise,

manual therapy). Physical therapy/ies, physiotherapy/ies, non

surgical, non operative, conservativ*

8. Subject headings are… TO BE LOOKED UP!

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+ How do I make my searches MORE

RELEVANT?

Answer = Use PICO and the

‘worksheet’ to get clear on what

you’re looking for

Suggestions to get clear:

- Google/Google Scholar – what terms are

used?

- Quick PubMed search

- EBSCO search in “TITLE” field

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2. Select a

Database - EBSCO

CINAHL & Medline

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Google PEDro

Rehab+ PubMed

EBSCO

Medline,

CINAHL,

& PsycINFO

With full-text

OVID Medline &

EBMR, including Cochrane

Library

With full-text

Continuum of databases to learn to search

Via e-HLbc FREE

How to select a database: Covered in

Absolute Beginner Webinar + watch all 5 PABC eLibrary

tutorials http://www.youtube.com/user/BCPhysio#p/search/4/pdy5W5OzqGM

+ EBSCO Medline & EBSCO CINAHL

Medline – largest database of biomedical

research, indexes many physiotherapy journals

CINAHL – largest database of nursing and allied

health research (Cummulative Index of Nursing &

Allied Health Literature), indexes many

physiotherapy journals

Journals found in Medline overlap with journals

found in CINAHL but some are unique, so it’s

important to search BOTH databases

Learn one interface and link to full-text articles

(but use A-Z Journals List to find more)

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3. Keyword searching –

BASIC:‘Hands-on’

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+ Exercise 1 & 2: Keyword searching

in EBSCO Medline (The “Googly”

way) Login to EBSCO Medline (Exercise 1)

Basic search: (Exercise 2) [Click on ‘Basic Search’]

Elbow tendinopathy and laser. Explore the results

Then try tennis elbow and laser. Explore those results – how many

more?

Now try lateral epicondylitis and laser

Explore the areas of the screen – what can you do? Try to limit

What would be the best SUBJECT HEADING to search for this

topic? Hint: look at a citation to see the subject headings

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+ Now move to the ADVANCED

search screen and explore…

Tennis elbow or elbow tend?nit* or elbow tend?nos* or

lateral epicondylitis

AND

Laser

Tennis elbow - as a subject

AND

Laser*

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4. What is “Boolean

logic”?

Using and, or, not

in ADVANCED ‘Hands-

on’

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+ Advanced Search – Author

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+ Boolean Logic And, Or, Not

(“Boolean Operators”)

Pilates

Low back or lumbar or [specific muscles]

Reduce pain or increase

function Age 15 – 85

Systematic review or

clinical trials

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Use ‘or’ to combine

similar concepts

Use ‘and’ to find ALL

these different

concepts together in

one article

+ Exercise 3: Keyword ‘Advanced

Search’ in EBSCO Medline + Email

Results

Advanced search: [Click on ‘Advanced Search’]

Pilates and low back

Put at least one result in your folder – ‘Add to folder’

Email results in your folder to yourself

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5.

Subject Heading Search in

Medline/CINAHL in 3 STEPS:

(1) Explode,

(2) Major Concept &

(3) Subheadings

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+ For adults with FAI

what is the best

conservative/physical

therapy (compared to

surgery) for improving

function?

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+ If you’re not sure how to start...

Search for your terms in the TITLE field – this

ensures the articles retrieved will be highly

relevant. THEN look at subject headings

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+ Why use subject headings? You don’t have to type in all the keywords!

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Sean John Combs = Puff Daddy

= P Diddy = Diddy = Puffy, etc

Subject heading = Diddy

Femoral acetabular impingement,

femoroacetabular impingement,

femoracetabular impingement, etc

Subject heading in Medline (MeSH) =

Femoracetabular impingement

+ Demo & Exercise # 4 Search in MESH Headings and do separate searches for each

one. Start with FAI

This is a 3 step process: Find the subject heading femoral

acetabular impingement

Step 1 = Should I ‘Explode’ the subject heading to include all the

more specific types? Not an option in this case

Step 2 = Should I make it a ‘Major Concept’? I will not in this case.

Step 3 = Do I need to add a ‘Subheading’ to be more specific?

E.g., rehabilitation. I will not in this case.

Then search for it. Start again with the next term – physiotherapy

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+ Medline – let’s use subject headings – what is

the tree for FAI? CLICK ON MeSH

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Click on it – there are

no narrower terms in

the ‘Tree’ so we cannot

‘Explode’

+ Medline – using subject headings – how do I

select a Subheading for rehabilitation?

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Subheadings create a more specific SUBJECT

HEADING – for example, REHABILITATION of FAI. In

this case, we Include All Subheadings.

This is a way of getting more relevant results – but

may be too restrictive at times

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+ Medline – Finally, click on ‘Search Database’

to do the subject headings search

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Search each term separately – look for FAI as a subject

heading, using explode, major concept and subheadings

as appropriate

Also, search for FAI as a keyword:

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+ Medline – search each term separately and

then combine using AND, OR (or NOT)

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The next step is to search for

the next term, physiotherapy.

NOT Googly! VERY precise!

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We have just searched for the 1st

term (FAI) as a subject heading

and a keyword in Medline.

Whew!

+ Let’s search Physical Therapy in

the same way

Go the MeSH – Physical Therapy

The most appropriate term is Physical Therapy Modalities

Do you want to Explode it? (YES!)

Do you want to make it a Major Concept? (probably not)

Are any subheadings relevant? (not in this instance)

Search it… and then go to the Search History, and combine it with

other terms using AND, OR

Femoracetabular impingement AND physical therapy modalities+

(where + means explode)

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+ Explode Physical Therapy

Modalities (then click on SEARCH

DATABASE)

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6.

Let’s supplement Subject

Headings with KEYWORDS

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+ Keyword searches

Think of all the relevant spellings and

terms

Use ‘truncation’ - * at the end of a

word, or $ or ? In the middle of a word

Remember to ‘or’ like concepts

together

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7.

Let’s combine Subject

Headings & keywords using

“AND”, “OR” (sometimes

“NOT”) the ‘Boolean

Operators’

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Keyword Search = 95

Subject Search = 6

+ Now What?

Go through the same process in

CINAHL as well!

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8.

Tips & Tricks

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Tip: Remember to Clear previous

searches, then start a new one

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Tip: CINAHL Headings and MeSH

Headings may be different

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+ What are the CINAHL Headings?

Are they different from MeSH?

FAI is NOT a heading in CINAHL!

There is a CINAHL heading for HIP INJURIES, but

it may be too broad (not specific enough)

Use the keywords for FAI and don’t use a subject

(CINAHL) Heading

Physical therapy is the CINAHL Heading (instead

of Physical Therapy Modalities, which is the MeSH

heading).

Explode it.

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+ Useful physiotherapy subject

headings (check for explosions+)

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CINAHL Headings Medline Medical Subject

Headings (MeSH)

Physical fitness+ Physical fitness

Therapeutic exercise+ Exercise therapy+

Physical therapy modalities+ Physical therapy+

Orthoses+ Orthotic devices+

Laser therapy, low-level Laser therapy+

Athletic injuries+ Athletic injuries+

Arthroplasty, replacement, knee Arthroplasty, replacement, knee

Balance, postural Postural balance

Low back pain Low back pain

+ Subject Heading Explosions!

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CINAHL Headings Medline Medical Subject Headings

(MeSH)

Therapeutic exercise+ Exercise therapy+

- Abdominal exercise - Motion therapy, continuous passive

- Aerobic exercises+ - Muscle stretching exercises

---Aquatic exercises -Resistance training

- Back exercises -Pylometric exercise

- Breathing exercises+ Hydrotherapy

--- various terms

- Closed kinetic chain exercises

- Conditioning, cardiopulmonary

- Many more…………

+ Tip: Handy subheadings for

subject headings

Athletic injuries -- prevention & control

Any condition (e.g., osteoarthritis)–

rehabilitation, surgery

Any treatment (e.g., therapeutic exercise)

-- contraindications, adverse effects

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+ Ways to get less (narrow your

results)

Use subject heading, e.g., Therapeutic exercises

Select the Major Concept subject heading

Add a Subheading to the subject heading – Osteoarthritis-

rehabilitation

Use limits (year, age group, publication type, full-text)

Add more concepts using AND, e.g., electrotherapy AND manual

therapy – articles discussing both treatments

NOT out irrelevant concepts, e.g., low-level laser NOT acupuncture

Use a more specific term, e.g., sacrotuberous ligament

Search in Title (then see how it’s indexed and search again)

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+ Ways to get more (broaden your

results)

Use keywords plus subject headings, e.g., tennis elbow or

tendinopathy or tendinitis or tendinoses

Think of synonyms or similar concepts, e.g., back* or

lumbar or thoracic or cervical or spine or spinal or disc or

disk or pelvis or sacrotuberous ligament

Truncate to pick up alternate spelling, e.g., tendin* will

search -itis, opathy, opathies, osis, oses, etc.

Use a more general term, e.g., knee instead of ACL

Add more related terms using OR, e.g., manual therapy OR

mobilisation* OR mobilization* OR manipulation* OR

maitland OR mulligan etc.

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+ Very Important Tip about Search

Results!

When you email search results to yourself

(or I email them to you)…

Log on to the members site > Clinical

Library > Library Databases & Journals >

Databases --- this will “authenticate” you

Go back to your email and click on the links

– they should open in EBSCO (no password)

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9. To be covered in Part 2

(A Sneak Peak):

Limits - Years, Full-text,

Publication types,

Age groups

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+ But where did the LIMITS go???

Click on “Advanced Search”

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Hold down

Control to

select more

than one

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10. To be covered in Part 2:

A sneak peak:

Searching EBSCO

Medline and CINAHL

together

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+ Working with Multiple Databases

CINAHL & MEDLINE

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Keyword search + use both

CINAHL Headings & MeSH:

e.g., CINAHL uses Adhesive

Capsulitis

Medline uses Bursitis

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11. To be covered in Part 2:

a sneak peak –

Set up an Alert

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+ Save Searches / Alert – ‘Search

History’ > Save… /Alert > login

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+ 12. How to get the full-text?

Webinar on this special topic!

May be linked to your search results. If not:

1. Check A-Z Journals List to see if it’s one of

the full-text journals we have

2. Google to see if it’s freely available

3. Ask me – I can access other sources

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13. Recap!

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+ Recap:

Write a clinical question using PICO and select

a database (view tutorials on website)

Access EBSCO Medline & CINAHL on the PABC

eLibrary

Do a keyword and subject heading search using

EBSCO CINAHL (CINAHL Heading, explode, major

concept, subheading)

Use Boolean logic – and, or, (not)

Work with search results by sorting, adding to

folders, displaying, printing, emailing

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+ Recap cont… but more to come in

part 2:

Apply limits to a search

Search Medline & CINAHL together –

but note subject headings will be

different so check them first

Create a search alert (or save your

search permanently)

Tips for physiotherapy searching

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+ Homework?

Watch all 5 videos (Library Services >

Tutorials & Training)

Practice using subject headings along with

keywords

Ask me

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Questions? Thanks! You will receive a POST-TEST & EVALUATION!

The recording on the webinar can be found in

the Clinical Library on the members site

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