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!