pediatric fellowship course seminar series 2013 health sciences library resources: searching...
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Pediatric Fellowship Course Seminar Series
2013Health Sciences Library Resources: Searching Questions and Identifying
ResearchFebruary 12, 2013
Janice Lester, MLSReference and Education Librarian - LIJ Health Sciences
Library
Jennifer L. Boxen, MLS, AHIPEducation and Liaison Librarian - Hofstra North Shore-LIJ
School of Medicine
Objectives/Outcomes for this session:
1. Identify a clear structured searchable question.
2. Execute an appropriate search strategy to search the literature for specific types of study designs based on the topic.
3. Determine appropriate resources to answer background or foreground information questions.
Session Timeline:
7:30-7:45 Learning Objectives and Creating a Searchable Question
7:45-8:00 Finding Library Resources and
the Evidence Pyramid
8:00 – 8:30 Effective PubMed Search Techniques and Q&A
Tips When SearchingBe MethodicalLeave yourself adequate time to
search…But don’t spend too much time doing it
Document where you searched, what you searched and when you searched
Store all of your citations in the same place(EndnoteWeb or Zotero)
Seek help when you need it, but do not wait until the last minute
Steps of Basic Research1. Create an answerable research
question2. Break your research question
into searchable components 3. Choose the database4. Generate subject headings and
synonyms5. Execute your search and select
limiters6. Analyze your search results,
modifying and re-executing searches as needed
7. Review the Articles
Background Versus Foreground:Experience Determines Need
Background Questions- About conditions
Foreground Questions- About choices
Create an Answerable Research Question based on your Hypothesis
Know the difference between background and foreground questions.
Background Questions:
Ask for general knowledge about a condition or thing.
Have two essential components:
A question root (who, what, when, etc.) with a verb
A disorder, test, treatment, or other aspect of healthcare
Foreground Questions:Ask for specific knowledge to
inform clinical decisions or actions.
Usually have 3 or 4 essential components ◦ Patient and/or problem ◦ Intervention ◦ Comparative intervention
(not always needed) ◦ Clinical outcome
Break your research question into searchable components
PICOPatient/Population – Includes age, race,
sex, geographyProblem – Current health concern Intervention – Exposure of interestComparison – Alternate exposure (if any)Outcome – What is the desired outcome?
Does this mean that every research question can/should be answered this
way?
Creating the QuestionCreate one sentence (elevator statement)
that epitomizes what concept you are looking to search which includes PICO elements.
Does giving Prophylactic Acetaminophen to infants (age 2 months) after immunizations decrease sleep duration compared to a placebo?
What are our PICO Elements?
Bad QuestionWhat is the best way to treat children with asthma?Best how? Fewer asthma attacks? Less severe
attacks? A treatment that is cheaper? Fewer side effects? Fewer adverse reactions with other medications?
What type of asthma? Chronic? Exercised Induced? How are we diagnosing asthma and who is doing it?Best compared to what? What type of treatment are
we considering?Is there a more specific age group that we are
addressing? Are we measuring any of these concerns? If so, how?
Good Question
Among young children with acute asthma exacerbation, is a single dose of IM dexamethasone comparable to five days of oral prednisolone for resolution of asthma symptoms?
More detail is usually better; not always possible, but generally better.
Selecting and Searching the Databases
Wait a minute… Where did you say the databases are again?
Accessing EMIL from Healthport
Access through LIJMC/CCMC
Finding e-textbooks on EMIL by subject – eg. Pediatrics
Finding journals and books by subject
Finding journals – e-Journal portal 360 Link-search by Pubmed or DOI
Pediatric Care Online
ACP Journal Club summarizes the best new evidence for internal medicine from over 130 clinical journals accessible through ‘E-journal portal’ on EMIL
Example of a Point of Care - Evidence Based Clinical Database
Available RemotelyTutorials AvailableCan be accessed through mobile
devices
Locating the Pubmed and OvidSP
PubMed is Useful For the Following:
When searching for the newest information (pre-pub)
Very obscure cases [bot fly]Special types of articles (case
reports, trials)Articles that have been corrected
or retractedLimiting by specific factors, like
females and ageSeeking Higher Levels of Evidence
and specific search filters
Tutorials
Access PubMed Through HealthportNot the Internet
Back to Our Clinical Questions…
Find all of the searchable elements of the sentence. Then look up the appropriate subject headings and two synonyms (usually). If you can’t find the exact subject heading, do the best you can. If you need more than 2 synonyms, add them.
Our QuestionWill providing patient education reduce
admissions for head trauma caused by parental abuse or neglect of children?
PICOPATIENT = ChildrenPROBLEM = Parental abuseINTERVENTION = Patient Education COMPARATIVE = No Action (In other Situations
Watchful Waiting/Placebo)
OUTCOME = Reduce Head Trauma Admissions
How to find Subject Headings and Synonyms
MeSH DatabasePearl Growing
◦Abstract view of PubMed results or other articles
Synonym generation◦Plurals◦Hyphenation◦Different Spellings (British)◦Narrow MeSH Headings
In a PubMed General Search
2000-2013:
Nosebleed – 2,432 Results
Nose Bleed – 2,427 results
Nosebleeds – 81 resultsEpistaxis (MeSH) –
2,413 results
Nosebleed
Nosebleeds
Nose Bleed
Epistaxis
Synonyms – Why you should use them
2476 Result
s
BUT
Generate Subject Headings and Synonyms
Will providing patient education reduce admissions for head trauma caused by parental abuse or neglect of children?
PICOChildren = This is a limiter so we do not necessarily need a
Subject term- It depends on the database.
Parental abuse = Child Abuse OR child neglect OR infant abuse OR child maltreatment
Patient Education = Patient Education as Topic OR parent education OR education of patient OR patient education
Head Trauma= Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome
PubMedRegular PubMed can be searched two ways:
1. Creating one large search.2. Doing smaller searches and adding them together
later.
(Child Abuse OR child neglect OR infant abuse OR child maltreatment) AND (Patient Education as Topic OR parent education OR education of patient OR patient education) AND (Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome)
PubMed Clinical Queries can also be searched both ways, but the second way tends to be a little more difficult.
Database Filter and Study Design
Before you search the PICO elements of your clinical question, it’s important to know:
What TYPE of question are you asking?
What is the best STUDY DESIGN to search for to find evidence to answer your clinical question?
What Kind Of Question is This?As a physician, you would like to know the
prevalence of headaches three and 12 months after mild, moderate or severe traumatic brain injury (TBI) in children ages 5 to 17. Which of the following clinical query filters would you want to apply to receive the most relevant and specific results?
Etiology TherapyPrognosisDiagnosisClinical prediction guidelines
The prognosis filter in Pubmed Clinical Queries automatically applies a specific search strategy (prognos*[Title/Abstract] OR (first[Title/Abstract] AND episode[Title/Abstract]) OR cohort[Title/Abstract]) to the search terms entered in order to retrieve article and study types that best address the concept of prognosis. In this case we are interested in following the course of the disease (TBI) to see what the outcome and frequency of headaches will be in these patients.
This is different from etiology/harm how?
Execute Your Search
Execute your search and select limiters if needed
Select the appropriate filter Advanced search building and limiters May depend on Database.
Analyze Your Search Results
This may be the point where you discover that you either have too many results or too few (or off topic results).
Too Many - Apply more or stricter limiters, look for higher levels of evidence or make search terms more specific.
Too Few (or off topic) – Remove any limiters, execute a general PubMed search, add search terms or generalize search terms (think drug class as opposed to specific drug)
Read the Abstracts/Review Articles
At this point you should be able to discover some basic information about the results by looking at the titles and abstracts. Look to see what type of results you have, and whether it suits your purpose.
Does this mean that you have found everything ever written because you searched in Pubmed?
Of course not.
In most cases, if you are doing searching that is clinical or research based you will not be doing yourself a disservice simply searching Pubmed. If, on the other hand, you are writing a literature review, systematic review, or meta-analysis you may also need to search grey literature, which includes conference proceedings, institutional publications, white papers, unpublished trials, and foreign language journals.
New ResourcesVisual DXWeb Of Knowledge
Visual DX Differential Builder-by lesion
Web of Knowledge
Journal Citation Reports will
organize journals by impact factor
Journal Citation Reports
Web of Scienc
e
Cited 18 times
Web of Science
Web of Science- Citation Map
Web of Science- Citation map – Backward and Forward
Perceptions can be Deceiving
References
Straus SE. Evidence-based medicine: How to practice and teach EBM. Edinburgh: Elsevier/Churchill Livingstone; 2005.
Guyatt G. JAMA's users' guides to the medical literature: A manual for evidence-based clinical practice. New York: McGraw-Hill Medical; 2008.
Moyer V. Weighing the evidence: PICO questions: What are they, and why bother? AAP Grand Rounds 2008 Jan; 19(1): 2.
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