1. developed for the Indiana University School of Nursing Library Database searching for Evidence Based Practice (EBP) Revised January 2008 IUPUI University Library Randi L. Stocker, MLS

2. Develop a searchable question • Search relevant databases, such as CINAHL, Medline, and others. • Stocker, R. (2008). Finding articles and systematic reviews related to nursing [web page]. http://www.ulib.iupui.edu/prod/subjectareas/nursing/indexes • Evaluate citations for potential relevance • Read summaries to make sure responses are relevant to your practice, if not may need to go back to step 1 Clinician database competencies:Steps to a more efficient search Steps:

3. Develop a Searchable question Two Search Methods PICO (most common) P – Patient or problem I – Intervention C – Comparison O – Outcome What is the effect of _________________________________ Intervention / Predictor Variable On _________________________________ Given Characteristic / Outcome For _________________________________ Specific group of patients / Patient Characteristics Alternate Template for Searching Alternate template: Thede, L. Q., Pierce, S., & Allen, M. (2003). Other Facets of Informatics: A wide Impact. In L. Q. Thede (Ed.), Informatics and Nursing: Opportunities & Challenges (2nd ed., pp. 243 - 258.). Philadelphia: Lippincott.

4. Select search tools • Databases oriented to different practitioners: • Nurses, Physicians, Psychologists, Educators, (& patients) • Databases focusing on specific types of research: • Guidelines, Systematic Reviews, Registers of studies, etc. • Design search strategy that optimizes value of selected databases & their features • Select Subject Headings • Select Limits • Review results; modify search Search Strategy Planning

5. Each article is coded with relevant official Subject Headings. (The coding is based on what the authors’ write.) • Different authors use different terminology. • To avoid misinterpretations or oversights in searches all articles are coded using that database’s “official” subject headings for that a given concept. Example: • If the author used any of the following phrases, the article would be coded with the official MeSH term, “Breast Neoplasms” • Used for: breast cancer, breast neoplasm, breast tumor, or breast tumors WHEN articles enter Medline or CINAHL:

6. The “Official” lists of subjects used in CINAHL and Medline are similar, but not identical. • Medlne’s official list of Subject Headings is known MeSH (Medical Subject Headings). • CINAHL uses many MeSH headings, but, over time, has added many additional Subject Headings WHEN articles enter Medline or CINAHL: • Additional topics indexed in CINAHL include: • Research methodology and instruments • Theories and models, • Nursing concepts such as “wellness”

7. MEDLINE & CINAHL Indexing Practices* * Allen M. (2006).

8. Each concept is coded only at the most specific level Example – Article focuses ONLY on Male Breast Cancer? It is onlycoded with the phrase: “Breast Neoplasms, Male” one detail about article coding: • MeSH “Subject Tree” for Breast Neoplasms • (used in both the Medline & CINAHL databases) • All MeSH subject headings : • Diseases category: Neoplasms: • Neoplasms by Site: • Breast Neoplasms • Breast Neoplasms, Male • Carcinoma, Ductal, Breast

9. Problem – Searching “Breast Neoplasms” using Ovid will only retrieve articles coded at that level . in the subject tree. It will miss the articles that ONLY discuss “Male Breast Neoplasms.” Solution – Select the Explode option to retrieve results using the selected term plus all of its more specific terms. Then “Breast Neoplasms” with Explode turned on also includes: “Breast Neoplasms, Male” “Carcinoma, Ductal, Breast” Using “explode” to retrieve articles • MeSH “Subject Tree” for Breast Neoplasms • (as used in both the Medline & CINAHL databases) • All MeSH subject headings : • Diseases category: Neoplasms: • Neoplasms by Site: • Breast Neoplasms: (EXPLODED) • Breast Neoplasms, Male • Carcinoma, Ductal, Breast

10. Selecting “Explode” in an Ovid database

11. Problem – Searching “Breast Neoplasms” will retrieve articles that mention them, regardless of whether the they are just mentioned in passing or are a major focus of the article Solution – Select the Focus option to retrieve only those results where “Breast Neoplasms” is a major focus of the article. Using “Focus” to limit to major emphasis CINAHL results (as of 1/24/2008) Breast Neoplasms= 16028 articles Breast Neoplasms (Exploded) = 16102 articles Breast Neoplasms (Exploded & Focused) = 12613 articles

12. Selecting “focus” in an Ovid database

13. CINAHL and MeSH terms are arranged in hierarchies, referred to as trees • “Exploding” subject headings adds terms below the selected term in the hierarchy • (PubMed automatically explodes subject headings and subheadings, unless user changes this default setting) Subject headings are selected for both major and minor mentions of a concept • Use “Focus” to retrieve only those articles that concentrate on that concept References: Allen, M. (2007). MEDLINE and CINAHL Indexing Practices. http://www.pegallen.net/Documents/Indexing.pdf Subject Headings -- Summary

14. Primary Research • Individual studies • Abstracts and commentaries • Need to evaluate and synthesize findings • Research is sometimes limited to specifics and results do not always apply • Evidence Summaries – Synthesis • Systematic Reviews: Integrative Reviews; Meta-Analysis • Critical Appraisal with implications for practice • Translation Literature Types of search findings For ebp

15. Proven practices, not new findings • Practice guidelines • Care plans • Critical paths • Protocols • Standards • Clinical innovations Translation Literature

16. Translation Literature • Are they evidence-based? • Just because it’s a gold standard doesn’t mean that it is common knowledge • Look for Evidence Summaries • Systematic reviews; Meta-analyses; Critical appraisals • What’s new? • Primary Research • Research Abstracts • Research in progress • Propose new research? Start with the quality-filtered resources

17. IUPUI Resources for Nursing ebp - pyramid

18. Think about question • Use of official Subject Headings • EBP filters • Explode, Indexing, Focusing • Other limits? Sample Search: What should we do to prevent pressure ulcers in our elderly patients? EBP search demonstration* *Allen, M. (2006).

19. What is the effect of Nursing care/interventionsIntervention (Predictor Variable) On Preventing pressure ulcers Given Characteristic (Outcome) For Elderly________________ Specific group of patients (Patient Characteristics) EBP Search Strategy* Sample Search: What should we do to prevent pressure ulcers in our elderly patients? *Allen, M. (2006).

20. Summary: EBP Search strategy

21. Useful Limits for Evidence-Based Searching* [PT] = Publication Type; [MH] = MeSH Subject Heading; [sb] = Subheading *Allen, M. (2006).

22. Accessing core databases • COCHRANE Reviews • Ovid • Wiley Interscience • CINAHL • MEDLINE • others MEDLINE • Ovid • PubMed • EBSCOhost • others CINAHL • EBSCOhost • Only source for CINAHL Plus • Ovid through 2008 • others

23. Questions? Read more about it: • Allen, M. (2006). Teaching clinicians to fish: Library skills for EBP [PowerPoint show]. • http://www.pegallen.net/Documents/TeachingClinician2FishWeb.pps • Allen, M. (2007). MEDLINE and CINAHL indexing practices [Handout]. • http://www.pegallen.net/Documents/Indexing.pdf