CONDUCTING A SMART SEARCH

1. CONDUCTING A SMART SEARCH

2. Overview • Derive Search Terms from Clinical Scenario through PICO • Define “Searching Smarter” • Understand Evidence Pyramid • Where to Start? Using Search Resources Effectively • Resources

3. PICO Drives the Search Terms

4. Use These Search Tips for Best Results • Begin with PICO! • Truncate words to pick up variant endings. • Type in all variations of a word. • Limit to Publication Types: Meta-analysis, Practice Guideline, RCT, etc. • Use ‘specificity’ as a text word in diagnosis searches. Limit using MeSH terms including: Treatment Outcome, Prognosis; or Sensitivity and Specificity . • Less is more.

5. Searching Smarter Many sources of “evidence-based articles” are available for review in preparing your project. However, the first articles to search for are evidence-based medicine reviews that are: Relevant to family medicine Highly focused From a source that uses a structured or systematic methodology to develop the recommendation Consist of recent evidence (last 3-5 years) Patient-oriented, outcomes-based studies

6. Searching Smarter We have identified the following high-quality, Best Evidence Sources that synthesize the current evidence available for a particular topic or clinical question and give specific recommendations. While you are certainly welcome to use other sources, we suggest beginning with these. These sources will provide a strength of recommendation based on the Strength of Recommendation Taxonomy, (SORT) used in the HelpDesk Answers. Best Evidence Sources (freely available): FPIN Clinical InquiriesFPIN HelpDesk AnswersFPIN Priority Updates from the Research LiteratureU.S. Preventive Services Task ForceSystematic Evidence Reviews from AFP, Annals of FM, JABFM, & JFPBest Evidence Sources (fee based): Cochrane Database of Systematic ReviewsClinical Evidence

7. …Let the Evidence Pyramid Be Your Guide As you move up the pyramid, the amount of available literature decreases, but increases in relevance to the clinical setting. Meta-Analysis Look for quality articles, over quantity Systematic Reviews Randomized Control Trials Cohort Studies Case-Control Studies Case Series Expert Opinion

8. Evidence Reviews • A Systematic Reviewis a literature review focused on a single question which tries to identify, appraise, select and synthesis all high quality research evidence relevant to that question. • Meta-analyses are systematic reviews that combine the results of several studies using quantitative statistics. • A Structured Reviewdiffers from a systematic review only in the extent of the studies included (i.e. some may limit to english-only, primary care, etc.) • Evidence Summaries or Synopses attempt to summarize the current state of knowledge, including knowns and unknowns, based on a thorough search of the medical literature.

9. Evidence Reviews • FPIN Clinical Inquiries https://mospace.umsystem.edu/xmlui/handle/10355/2789High quality evidence reviews that answer clinical questions posed by primary care physicians • FPIN HelpDesk Answers https://mospace.umsystem.edu/xmlui/handle/10355/7251Good quality reviews of the evidence focused on a clinical question • FPIN PURLs https://mospace.umsystem.edu/xmlui/handle/10355/5400 • AHRQ Evidence Reports www.ahrq.gov/clinic/epcix.htmEvidence summaries published by the US Agency for Healthcare Research and Quality • Cochrane Database of Systematic Reviews www3.interscience.wiley.com"Gold Standard" for high quality, selected topics in treatment and some prevention.(fee based) • Clinical Evidence www.clinicalevidence.comHigh quality systematic reviews of selected therapy topics. (fee based)

10. Evidence Guidelines • USPSTF Guidelines www.ahrq.gov/clinic/prevenix.htmThe US Preventive Services Task Force systematically reviews published literature with a focus on screening and prevention. • Institute for Clinical Systems Improvement (ICSI) www.icsi.orgHigh-quality, guidelines from within the US that include graded recommendations. • National Institute for Health and Clinical Excellence http://guidance.nice.org.uk/ High-quality, guidelines from the National Health Service (England). • Scottish Intercollegiate Guidelines Network (SIGN) http://www.sign.ac.uk/new.html High-quality, guidelines from the National Health Service(Scotland).

11. Search Resources Recommended Search Tools • FPIN Search: https://mospace.umsystem.edu/xmlui/handle/10355/2787Includes PURLs, Clinical Inquiries, HDAs, and some eMedRef not always available through the TRIP Database. • TRIP Database www.tripdatabase.comThis MetaSearch will simultaneously search all journals and guidelines previously discussed. Be careful to sift carefully and refer to this list of sources to prioritize the articles found. Focus on Evidence Based Synopses, Systematic Reviews, and Guidelines. If you do not find what you need, TRIP will also provide the Medline result for your search terms. Look in the Medline Articles: Systematic Reviews section for filtered results. • Use the new TRIP Search Wizard based on PICO at: http://tripdatabase.com/search/wizard

12. Additional Resources • Medical Librarian at your Hospital/University • Dartmouth Biomedical Libraries - Finding Good Answers to Clinical Questions: http://www.dartmouth.edu/~biomed/resources.htmld/guides/FindingGoodAnswers.pdf • Videos on Pubmed Searches: • http://www.youtube.com/watch?v=OjORvR-sIKE • http://www.youtube.com/watch?v=XGTV4nU3v28&feature=related • Video on how to search on Cochrane • http://www.youtube.com/watch?v=xN4fBin7Yl0&feature=related