Searching for Evidence on the Web: 5 Steps for Nursing Researchers

1. Janet G Schnall, MS, AHIP Ellen Howard, MLS Information Management Librarian Head, KK Sherwood Library Health Sciences Libraries Harborview Medical Center University of Washington, Seattle, WA Seattle, WA schnall@u.washington.edu ehh@u.washington.edu Searching for Evidence on the Web: 5 Steps for Nursing Researchers

3. #1 Clarify the Topic&Create a Plan

4. Clarify the Topic Why do you care? What do you already know, including other people who have done work in this area? Consider using a stepwise process, e.g. PICO, to clarify your information needs & to create a question that can be answered

5. PICO Patient population: For which group do you need information? Intervention (or Exposure): What medical event do you need to study the effect of? Comparison: What is the evidence that the proposed intervention produces better or worse results than no intervention, or a different type of intervention? Outcomes: What is the effect of the intervention?

6. Create a Plan Time Line Outline Background searches Obtaining literature Analysis/research Writing

7. What can be �shared�? Literature searching: once you clarify your topic you can explain it to a librarian who can work with you & create a focused search Sometimes this takes several iterations because you will discover new information and ideas. You may need to revise your research question. You need to think critically about the search.

8. Document Retrieval Your librarian can advise you as to the most efficient way you can get the documents you need

9. Use Your Valuable Time Wisely Learn to work with the librarian so that you spend your time thinking about your topic and doing the research. Let the librarian spend the time searching and locating needed documents.

10. #2Search for Evidencein a Database

11. What is evidence-based practice? Evidence based medicine is 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 means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett DL et al. Evidence based medicine: what it is and what it isn't. BMJ 1996 Jan 13; 312 (7023): 71-2. Evidence-based practice uses the results of scientific studies whenever possible and expert opinion and extensive experience when data are lacking. Evidence-based practice uses the results of scientific studies whenever possible and expert opinion and extensive experience when data are lacking.

12. Databases PubMed pubmed.gov NLM Gateway gateway.nlm.nih.gov/gw/Cmd CINAHL(fee) cinahl.com

13. PubMedpubmed.gov Includes MEDLINE (1950�s to present) Indexes 5,000 biomedical journals Covers all aspects of biosciences and healthcare 75% of citations have abstracts Updated 5x/week

18. PubMed Strategies for Evidence-Based Citations PubMed publication type limits Randomized Controlled Trial Meta-Analysis Practice Guideline Clinical Trial PubMed Clinical Queries and Systematic Reviews

19. PubMed Limits

22. Advantage to short clips: 40 seconds to 3 � minutes long easy to rerecord, update � example, MeSH Browser not MeSH Database change, easy to rerecord. Worth the time, since reaches more people, on and off site Usage stats: Advantage to short clips: 40 seconds to 3 � minutes long easy to rerecord, update � example, MeSH Browser not MeSH Database change, easy to rerecord. Worth the time, since reaches more people, on and off site Usage stats:

23. Advantages of PubMed Free Links to publisher�s sites for full-text journals Or, can order full-text journal articles Clinical Queries/Systematic Reviews section limits retrieval to evidence-based citations

24. NLM Gatewaygateway.nlm.nih.gov Provides "one-stop shopping" for many of NLM's databases Offers citations, full text, video, audio, and images Accesses: PubMed NLM Catalog - catalog information for books, serial titles, audiovisuals TOXLINE� Special - toxicology citations DART� - Developmental and Reproductive Toxicology MedlinePlus� - consumer health information ClinicalTrials.gov - information for the public about clinical trials DIRLINE� - Directory of Health Organizations Genetics Home Reference� - consumer info for genetic conditions Household Products Database HSRProj - health services research projects OMIM - Online Mendelian Inheritance in Man HSDB� - Hazardous Substances Data Bank AND MORE�

26. CINAHLcinahl.com Cumulative Index to Nursing and Allied Health Literature Provides coverage from 1982 to date, of nursing and 17 allied health disciplines literature 1700+ journals indexed including virtually all English-language nursing journals Can easily search for Research articles

29. E-Journals Check with your library for access to full-text e-journals For UW Affiliates: use the Proxy service to access full-text e-journals from off-campus healthlinks.washington.edu/howto/connect

30. Open Access Journal Sites BioMed Central www.biomedcentral.com Independent publishing house providing immediate free access to peer-reviewed biomedical research Includes BMC Nursing PubMed Central pubmedcentral.gov National Library of Medicine's free digital archive of biomedical and life sciences journal literature Biomed Central: Not free sections: Images.md and Faculty of 1000 UW faculty can publish for free because institutional member -------------- July 14, 2004: U.S.House Appropriations Committee recommends that NIH provide free public access to research articles resulting from NIH-funded research. The Report calls on NIH to offer access to authors' final manuscripts (as accepted for journal publication) and supplemental materials via PubMed Central six months after publication. If the grantee used NIH funds to pay any publication charges (e.g., page or color charges, or fees for digital distribution), PMC access would be immediate. The Report instructs NIH to inform the Committee by December 1, 2004 how it intends to implement the policy. Needs to pass in Senate� -------------- BRITISH PARLIAMENTARY PANEL ENDORSES OPEN ACCESS TO SCIENTIFIC LITERATURE By Lila Guterman of the Chronicle of Higher Education In a much-anticipated report scheduled to be released today, the Science and Technology Committee of Britain's House of Commons endorsed open access to research results and criticized the scientific-publishing industry for the escalating prices of its journals. The report comes just days after a U.S. Congressional committee recommended requiring free access to papers based on research financed by the National Institutes of Health (The Chronicle, July 19). http://chronicle.com/prm/daily/2004/07/2004072002n.htm Biomed Central: Not free sections: Images.md and Faculty of 1000 UW faculty can publish for free because institutional member -------------- July 14, 2004: U.S.House Appropriations Committee recommends that NIH provide free public access to research articles resulting from NIH-funded research. The Report calls on NIH to offer access to authors' final manuscripts (as accepted for journal publication) and supplemental materials via PubMed Central six months after publication. If the grantee used NIH funds to pay any publication charges (e.g., page or color charges, or fees for digital distribution), PMC access would be immediate. The Report instructs NIH to inform the Committee by December 1, 2004 how it intends to implement the policy. Needs to pass in Senate� -------------- BRITISH PARLIAMENTARY PANEL ENDORSES OPEN ACCESS TO SCIENTIFIC LITERATURE By Lila Guterman of the Chronicle of Higher Education In a much-anticipated report scheduled to be released today, the Science and Technology Committee of Britain's House of Commons endorsed open access to research results and criticized the scientific-publishing industry for the escalating prices of its journals. The report comes just days after a U.S. Congressional committee recommended requiring free access to papers based on research financed by the National Institutes of Health (The Chronicle, July 19). http://chronicle.com/prm/daily/2004/07/2004072002n.htm

31. Order Articles Online for a Fee Document Services/University of Washington https://healthlinks.washington.edu/hsl/docservices/services.html Loansome Doc https://healthlinks.washington.edu/hsl/docservices/lds-na.html Allows you to order full-text articles after searching PubMed

32. EBP and Guidelines Resources PubMed Clinical Queries/Systematic Reviews www.ncbi.nlm.nih.gov/entrez/query/static/ clinical.shtml Cochrane Library (fee): gold standard www.cochrane.org National Guideline Clearinghouse guideline.gov TRIP (Turning Research into Practice) www.tripdatabase.com

37. TRIP Databasewww.tripdatabase.com Metasearch engine Performs a simple search of more than 75 databases Finds evidence based resources Searches Cochrane, National Guideline Clearinghouse, Bandolier, etc.

38. TRIP search: prevention of pressure ulcers

39. Other Databases UW Libraries Catalog MedlinePlus EthnoMed and other cross-cultural resources Micromedex (fee)

40. UW Libraries Catalogcatalog.lib.washington.edu/search~

41. MedlinePlus medlineplus.gov #1 SOURCE for basic quality consumer/patient information Includes drug information Medical Encyclopedia � full-text with illustrations Spanish version Preformulated PubMed searches Interactive tutorials Current health news There are so many places to go on the Internet for quality information. We are going to describe the very best websites here. These websites are all consumer-oriented, up to date and contain accurate information. MedlinePlus is one of the best places of many to go for basic, quality consumer health information on the Web. In most cases you can start here. Why is it one of the best? The National Library of Medicine produces it The information is reviewed and reliable. It links to governmental and non-profit organizations� Web sites. Continually updated No advertising or links to commercial sites Minimum redundancy American Customer Satisfaction Index Scores, Q1 2004 Government Web Sites: Health #1: MedlinePlus #2: MedlinePlus en espa�ol MedlinePlus is available in Spanish by clicking on the �espa�ol� link This is not a �mirror� site, all the materials here are responsive to the language, dietary, and cultural needs of the Hispanic population There are so many places to go on the Internet for quality information. We are going to describe the very best websites here. These websites are all consumer-oriented, up to date and contain accurate information. MedlinePlus is one of the best places of many to go for basic, quality consumer health information on the Web. In most cases you can start here. Why is it one of the best? The National Library of Medicine produces it The information is reviewed and reliable. It links to governmental and non-profit organizations� Web sites. Continually updated No advertising or links to commercial sites Minimum redundancy American Customer Satisfaction Index Scores, Q1 2004 Government Web Sites: Health #1: MedlinePlus #2: MedlinePlus en espa�ol MedlinePlus is available in Spanish by clicking on the �espa�ol� link This is not a �mirror� site, all the materials here are responsive to the language, dietary, and cultural needs of the Hispanic population

42. MedlinePlus Content Slide provided by Angela B. Ruffin, Head NN/LM National Network Office National Library of Medicine National Institutes of Health, HHS October 18, 2005 Senior Health: can enlarge text and view in high contrast Clinical Trials: provides easy information on clinical trials for a wide range of conditions Pre-recorded webcasts of surgical procedures Actual operations performed at medical centers in U.S. One-hour programs with printable transcripts Slide provided by Angela B. Ruffin, Head NN/LM National Network Office National Library of Medicine National Institutes of Health, HHS October 18, 2005 Senior Health: can enlarge text and view in high contrast Clinical Trials: provides easy information on clinical trials for a wide range of conditions Pre-recorded webcasts of surgical procedures Actual operations performed at medical centers in U.S. One-hour programs with printable transcripts

44. Encyclopedia includes: 4,000+ entries on diseases, tests, symptoms, injuries and surgeries an extensive library of photographs and illustrations.Encyclopedia includes: 4,000+ entries on diseases, tests, symptoms, injuries and surgeries an extensive library of photographs and illustrations.

45. Drugs, Supplements & Herbal Information page USP Advice for the Patient. New feature: Natural Standard herbal supplement database released � late Fall 2005 This is the 105 monographs in English and Spanish - written for the layperson. It is the same as on Harvard's site and Mayo clinic ( http://www.mayoclinic.com/findinformation/druginformation/index.cfm )�it�s the only appropriate one that is evidence based.�  USP Advice for the Patient. New feature: Natural Standard herbal supplement database released � late Fall 2005

46. 105 Herbs and Supplements Monographs in English & Spanish English and Spanish with pictures Includes evidence-based information on effectiveness, side effects, interactions, dosing, and pregnancy, breastfeeding. English and Spanish with pictures Includes evidence-based information on effectiveness, side effects, interactions, dosing, and pregnancy, breastfeeding.

48. Cross-Cultural Healthcare Resources EthnoMed ethnomed.org A cross-cultural medicine database containing information about cultural beliefs and medical issues pertinent to healthcare of ethnic groups in Seattle area Culture Clues depts.washington.edu/pfes/cultureclues.html Tip sheets designed to increase awareness about concepts and preferences of patients from diverse cultures SPIRAL spiral.tufts.edu Patient ed resources in East Asian languages

51. Somali Asthma Cultural Profile Foods commonly consumed Dietary beliefs Religious dietary beliefs Diet related health problemsSomali Asthma Cultural Profile Foods commonly consumed Dietary beliefs Religious dietary beliefs Diet related health problems

52. Micromedexwww.micromedex.com Clinical information on toxicology, drugs, drug interactions, and reproductive risks Provides evidence-based medical information Available on the HealthLinks Care Provider Toolkit and at most hospitals

54. #3Keep Current with Email Alert Services

55. Information Overload! 2 million articles published in biomedical journals each year considering everything of potential biomedical importance would require perusing about 6,000 articles per day� If you only read 2 articles a day, at the end of year you would be 60 centuries behind.

56. What are Email Alert Services? Deliver current citations into your email Based on a search strategy you create In most cases, abstracts of the articles are provided May provide links to PubMed and full-text articles Why use email alerts? Keep abreast of new literature in your field Receive automatic updates View tables of contents from your home or office Some free, some via UW Why use email alerts? Keep abreast of new literature in your field Receive automatic updates View tables of contents from your home or office Some free, some via UW

57. PubMed: MY NCBI Your personal space on the NLM computer system for storing search strategies to generate updates Free registration required Recent PubMed citations sent automatically to your email

60. e-Textbooks UpToDate (fee) Concise comprehensive uptodate reviews of clinical topics in multiple specialties www.uptodate.com HealthLinks Textbooks page 500+ e-texts healthlinks.washington.edu/textbooks

64. #5 Navigate the Web Beyond Basic Google

65. Navigation Difficulties Size of the Web Lack of control or review Lack of quality standards The web contains over 4.3 billion pages of information. Combined coverage of eleven majorsearch engines is 42% of the Web. No individual search engine coversmore than 16% of the Web. Overlap between individual searchengines is low. The web contains over 4.3 billion pages of information. Combined coverage of eleven majorsearch engines is 42% of the Web. No individual search engine coversmore than 16% of the Web. Overlap between individual searchengines is low.

66. Googlegoogle.com Largest: over 8 billion pages Relevance ranking based on linkanalysis Google Advanced Search www.google.com/advanced_search?hl=en Google Scholar scholar.google.com View cached page to resurrect dead pages Includes similar pages feature Search for images Includes pdf and other file types Search within results View cached page to resurrect dead pages Includes similar pages feature Search for images Includes pdf and other file types Search within results

67. Google Advanced Search Featureswww.google.com/advanced_search?hl=en File Format, i.e. pdf Date, i.e. pages updated in last 3 months Occurrences, i.e. terms appear in title Domain, i.e. .gov, .edu Links, i.e. pages that link to the page

70. Google Scholarscholar.google.com Searches for scholarly literature, including peer-reviewed papers, theses, books, abstracts and technical reports Finds articles from academic publishers, professional societies, universities, etc. as well as scholarly articles on the web "Cited by" link identifies # that have cited the original Access to full text only available with subscription NEW: Now links to full text articles the UW subscribes to Caution: Not a reliable sole source for searching scholarly literature

71. Meta-Search Engines

72. Meta -Search Engines

73. Clusty clusty.com All the speed and functionality of Google, with clustering added Clustered results in left margin Why use clustering? Learn at a glance types of information available Uncover results that are otherwise buried

75. Dogpiledogpile.com Makes searching the web easier by returning the best results from these leading search engines: Google � Yahoo � Ask.com About � LookSmart � Search for audio, images, and multimedia formats

76. MetaCrawler Hits

78. Tips and Strategies Select one or two tools and get to know them well Read the Help Try Advanced Search options Know when NOT to search: 10 minute rule Is it worth your time? Would a phone call to a colleague or librarian be more productive? Is the information you seek likely to be on the web?

79. Evaluate Web Resources: Evaluation Strategies Evaluate using Criteria for Evaluating Web Resources Determine the type of site by analyzing Web Site Addresses A User's Guide to Finding and Evaluating Health Information on the Webwww.mlanet.org/resources/userguide.html

80. Criteria for Evaluating Web Siteshealthlinks.washington.edu/howto/navigating/criteria.pdf Authority Accuracy Objectivity Currency Coverage Design

81. Analyze the Website Address:URL (Uniform Resource Locator) edu org com gov

82. Final Thoughts Contact Your Ultimate Search Engine� a librarian! Remember key resources: PubMed CINAHL Advanced Google and Google Scholar

83. For more UW information� If you are affiliated with the UW, contact the nursing library liaison: Janet G. Schnall, MS,AHIP 206.543.7474 schnall@u.washington.edu Or, at HMC, contact the head of the KK Sherwood Library: Ellen Howard, MLS 206.341.4124 ehh@u.washington.edu

84. For more information� For non- UW affiliates, contact the National Network of Libraries of Medicine (NN/LM) for exhibits, workshops, classes, and project collaborations NN/LM 800.338.7657 Linda Milgrom 206.221.3400 lmilgrom@u.washington.edu

85. Searching for Evidence on the Web:5 Steps for Nurse Researchers PowerPoint presentation located: healthlinks.washington.edu/hsl/liaisons/schnall/hmc2007.ppt