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Efficient Searching of the Literature & Critical Appraisal

Efficient Searching of the Literature & Critical Appraisal. Rick Wallace March 9, 2007. Public Service Professional Librarians. Nakia Carter, MLS Maylene Qiu, MLS Rick Wallace, MLS. My Philosophy of the Literature- EBM: 6 Steps. Patient/Problem Question Search Critical Appraisal

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Efficient Searching of the Literature & Critical Appraisal

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  1. Efficient Searching of the Literature & Critical Appraisal Rick Wallace March 9, 2007

  2. Public Service Professional Librarians • Nakia Carter, MLS • Maylene Qiu, MLS • Rick Wallace, MLS

  3. My Philosophy of the Literature- EBM: 6 Steps • Patient/Problem • Question • Search • Critical Appraisal • Application • Evaluation

  4. Before You Search • You must have a patient/problem- Step #1 • You must have a searchable question- Step #2

  5. Clinical Scenario- Patient & Question • In pediatric patients with acute asthma exacerbation, does the inclusion of inhaled steroid improve outcomes such as hospitalization rates, length of stay, etc.

  6. PICO the Question • P OPULATION/ PATIENT • I NTERVENTION • C OMPARATIVE INTERVENTION • O UTCOME

  7. Our Scenario • Population- Pediatric patients w/ acute asthma exacerbation • Intervention- Inhaled steroids • Comparative- None • Outcome- Improve hospitalization rates - Generally ImprovedM&M

  8. Well-Built, ANSWERABLEClinical Question • In pediatric patients with acute asthma exacerbation (P), do inhaled steroids (I/C) improve hospitalization rates (LOS, etc.), and general morbidities (relief of symptoms, reduction of side effects, etc.) (O) ?

  9. Step #3: Searching- Two processes • Choose database • Search database

  10. Skill #1- Choice of Database(s) Search What to Search How to Search

  11. Decision- What database do I search?

  12. Secondary Literature • Evolution of the Secondary Literature InfoMastery- reduces the need for expertise in steps 3 & 4 Classic EBM- 6 steps

  13. Secondary Databases • Transparent- levels of evidence • POEMS • Pre-validated • High level of evidence- evidence pyramid • Concise summaries to reduce work

  14. Some Secondary Databases • UpToDate • Inforetriever • DynaMed • Clinical Evidence • Cochrane Database of Systematic Reviews • DARE/CCTR • FPIN • ACP Journal Club • National Guideline Clearinghouse • FirstConsult • PIER

  15. Primary Databases • PubMed (MEDLINE) • MDConsult (textbooks) • StatRef (textbooks)

  16. How to Search

  17. Secondary Database- UpToDate • Search “asthma” • Asthma exacerbation • Pediatrics-Pharmacologic Tx of Acute asthma exacerbation • Inhaled steroids

  18. Secondary Database- Inforetriever • Asthma • Managing acute asthma exacerbations (LOE = 1a) • Guideline- “Managing an acute exacerbation of asthma • Initial therapy- #3- corticosteroids

  19. Secondary Database- DynaMed • Asthma • Asthma exacerbation • Steroids (click for details) • Inhaled topical steroids…

  20. Secondary Database- Clinical Evidence • Asthma • Asthma and other wheezing disorders in children • Corticosteroids (high dose inhaled)

  21. Secondary Database- Cochrane Database of Systematic Reviews • asthma AND (child OR adolescent OR infant) AND (steroid* OR corticosteroid*) AND (inhale* OR nebulize*) AND (exacerbat*) –searched as tw • #23. Corticosteroids for hospitalised children with acute asthma • Note: we have already searched CDSR by searching other databases • Also DARE and CCTR

  22. Secondary Database- AHRQ Evidence Reports • Asthma • Use “find”

  23. Secondary Database- National Guideline Clearinghouse • asthma AND inhale* AND Exacerbate*

  24. Secondary Database- ACP Journal Club

  25. Secondary Database- FirstConsult

  26. Primary Databases • “raw”- not pre-validated • Not transparent • Not summarized- lots of work- work equation • All levels of evidence- well done RCT with 10,000 pts. versus individual case study

  27. Primary Databases- PubMed • PICO- MESH

  28. MeSH- Medical Subject Headings • What? • Thesarus used to index citations in MEDLINE • MEDLINE vs PubMed • Updated to reflect changes in medicine • Why? • Higher retrieval of relevant articles • Synonyms • Search stop words: Hepatitis A

  29. MeSH • Major/ non-major • Explosions • Sub-headings • Boolean • Tree structure • Pass out thesari

  30. PICO MeSH • Population- Pediatric patients w/ acute asthma exacerbation • Intervention- Inhaled steroids • Comparative- None • Outcome- Improve hospitalization rates; generally improved M&M • Population- Asthma/tx; All Child • Intervention- Steroids/ tx use • Comparative- none • Outcome- length of stay; outcome assessment

  31. Pearl Searching • Do a text word search • Look at the citation display • Do subject search with MeSH

  32. Example • Question: Is the development of breast cancer affected by the intake of dietary fat? • Text word search- breast cancer fat • Relevant article- • Browse MeSH- review scope note, subheadings, etc.

  33. Narrowing retrieval • Combine sets • Use Boolean AND • Limits- human, age, gender, language, publication type, date range

  34. Example • In patients with asthma do steroids affect the outcome? • Search- asthma/ drug therapy • Major Mesh, English, human, last 5 years

  35. Searching for Evidence • Use a publication type • Use a hedge • Use clinical queries filter

  36. Other • My NCBI • Related Items • Displays • Save • SFX • LoansomeDoc • Details- automatic mapping

  37. Exercises • Take a clinical scenario • PICO it • Construct a well-built clinical question • List type of clinical question • List best type of literature to answer it • Do a search – save search strategy and results- try at least one secondary database and PubMed

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