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How to practice EBM:
Finding the Evidence




Owen Coxall, Tatjana Petrinic & Nia Wyn Roberts
Bodleian Health Care Libraries
Session objectives


 Formulate a focused question
 Turn a focused question into a
  search
 Search TRIP & PubMed
Formulate a focused
question

Patient / Problem / Population
Intervention
Comparison
Outcome
Focused question

P: Pregnant smokers
I: nicotine replacement
C: N/A
O: cessation

Is nicotine replacement therapy an
effective and safe smoking
cessation treatment in pregnant
women?
Quick search

   TRIP
    www.tripdatabase.com

   PubMed Clinical Queries
    www.pubmed.gov
Hands-on
   Formulate a focused question
    ◦ Use your own question or one of the
      examples in your pack
    ◦ Record the search terms you’re using

 Run a quick search on TRIP
  www.tripdatabase.com
 Run a quick search on PubMed
  Clinical Queries www.pubmed.gov
Run a full search strategy
Why bother?


 Too few results
 Too many results
 Irrelevant results
 Submitting a funding proposal
 Writing a guideline
 Conducting a systematic review
Combine terms with
OR
Smoking OR tobacco – either term can be
present



      smoking
                      tobacco
Combine terms with
AND
Smoking AND cessation – both terms must
be present




      smoking         cessation
Quick tips
   Take a common word stem and look
    for spelling variations e.g.
    ◦ smok* - will retrieve papers smoking,
      smoker, smokers… but also smoked
      salmon

   Phrase searching
    ◦ Use double quote marks if you want
      words to appear next to each other e.g.

     “smoking cessation”
Develop a search strategy

1.   pregnan*
2.   smoking or smoker*
3.   nicotine replacement OR
     nicotine patch*
4.   cessation OR stop* OR quit*
5.   1 AND 2 AND 3 AND 4
Perform a search on PubMed
Searching tips: PubMed

Subject searching - use MeSH
  ◦ Subject headings added to articles
    on Medline
  ◦ Search the MeSH Database
 Finding similar articles – use the
  ‘Related articles’ link
Hands-on
   Take your focused question:

    ◦ Run further searches on PubMed
      http://www.pubmed.gov
Help
   Finding the Evidence tutorials:
    ◦ EBM web-site – EBM tools – Finding the Evidence
      http://www.cebm.net

   PubMed
    ◦ Short online tutorials
    ◦ Quick guides to PubMed – basics, MeSH search and
      MyNCBI
      http://www.nlm.nih.gov/bsd/disted/pubmed.html

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Searching session - CEBM Oxford - Spring 2012

  • 1. How to practice EBM: Finding the Evidence Owen Coxall, Tatjana Petrinic & Nia Wyn Roberts Bodleian Health Care Libraries
  • 2. Session objectives  Formulate a focused question  Turn a focused question into a search  Search TRIP & PubMed
  • 3. Formulate a focused question Patient / Problem / Population Intervention Comparison Outcome
  • 4.
  • 5. Focused question P: Pregnant smokers I: nicotine replacement C: N/A O: cessation Is nicotine replacement therapy an effective and safe smoking cessation treatment in pregnant women?
  • 6. Quick search  TRIP www.tripdatabase.com  PubMed Clinical Queries www.pubmed.gov
  • 7. Hands-on  Formulate a focused question ◦ Use your own question or one of the examples in your pack ◦ Record the search terms you’re using  Run a quick search on TRIP www.tripdatabase.com  Run a quick search on PubMed Clinical Queries www.pubmed.gov
  • 8. Run a full search strategy Why bother?  Too few results  Too many results  Irrelevant results  Submitting a funding proposal  Writing a guideline  Conducting a systematic review
  • 9. Combine terms with OR Smoking OR tobacco – either term can be present smoking tobacco
  • 10. Combine terms with AND Smoking AND cessation – both terms must be present smoking cessation
  • 11. Quick tips  Take a common word stem and look for spelling variations e.g. ◦ smok* - will retrieve papers smoking, smoker, smokers… but also smoked salmon  Phrase searching ◦ Use double quote marks if you want words to appear next to each other e.g. “smoking cessation”
  • 12. Develop a search strategy 1. pregnan* 2. smoking or smoker* 3. nicotine replacement OR nicotine patch* 4. cessation OR stop* OR quit* 5. 1 AND 2 AND 3 AND 4
  • 13. Perform a search on PubMed
  • 14. Searching tips: PubMed Subject searching - use MeSH ◦ Subject headings added to articles on Medline ◦ Search the MeSH Database  Finding similar articles – use the ‘Related articles’ link
  • 15. Hands-on  Take your focused question: ◦ Run further searches on PubMed http://www.pubmed.gov
  • 16. Help  Finding the Evidence tutorials: ◦ EBM web-site – EBM tools – Finding the Evidence http://www.cebm.net  PubMed ◦ Short online tutorials ◦ Quick guides to PubMed – basics, MeSH search and MyNCBI http://www.nlm.nih.gov/bsd/disted/pubmed.html

Notas do Editor

  1. Introduce ourselves
  2. Once we’ve gone over the objectives we should let them know that the session will be a mix or demonstration and hands-on practice. If people are sitting at the machines, say they’re welcome to follow the demonstration themselves on the PC but that we won’t be able to troubleshoot during the presentation, only during the hands-on.
  3. They should have covered question formulation in the morning session, so they should all be familiar with the concept. As a result we shouldn’t need to say much about this, apart from the fact that it’s a useful tool for structuring the search strategy.
  4. Allow the participants to read the scenario – but you might also want to talk through it a bit. You’re a community midwife running and antenatal group. Following the recent furore on television and newspapers about celebrities smoking during pregnancy one of the women asks for advice on using nicotine patches to help her give up smoking for the rest of the pregnancy. This might be an opportunity to get some interaction – ask the group to identify the PICO components before we go onto the new slide.
  5. Confirm if the participants have correctly identified the PICO elements and suggest this as a possible question to answer. At this point we might want to introduce people to the idea that different authors use different words for the same concept. Another opportunity for interaction, ask for suggestions for different terms for the 3 identified concepts: Smoking Acupuncture Cessation
  6. Explain that they will have 10 minutes to do a quick search – to find an answer to a clinical question. They should have scenarios in their workshop pack – they can use those or their own questions. Help will be at hand if they need it.
  7. Or = would bring everything up that falls in either of the 2 circles
  8. And – will only bring up material in the overlap between the 2 circles
  9. The participants might have come up with different terms but suggest these as a start off point. Explain about role of truncation * Explain that once you have lots of keywords you need to combine in different ways – OR=Broad, AND=narrow – move to next 2 slides for further illustration
  10. Bring them back to the demonstration, explaining that if they want to do more detailed or extensive searching then they need to learn other searching techniques on Pubmed and or using other databases, we’ll also show them Cochrane Library in this context. PubMed demonstration; Do the search one concept at a time – using the History to combine at the end. Use the following examples: #1 Smoker* or smoking or tobacco #2 acupuncture or acupressure #3 cessation or stop* or quit* #4 #1 and #2 and #3 Do a more specific search by restricting to title or title and abstract: use the following example: #1 Acupuncture [ti] #2 smoking [tiab] or smoker* [tiab] or tobacco [tiab] Subject searching – introduce the concept of MeSH, use the following examples: Click through to MeSH Search for Smoking – explain it searches for terms associated with smoking, pick the most appropriate term. Select Smoking Cessation and add to search box Search for Acupuncture – explain importance of checking description, illustrate with difference between acupuncture (discipline) and acupuncture therapy (treatment). Click on acupuncture therapy and show narrower terms – add to search box with and Search for Smoking cessation and acupuncture therapy Other things to demonstrate – limits, get rid of non-English publications - Related articles link - Help pages
  11. Explain that rest of session is for them to search PubMed and Cochrane a bit more – ask for help if needed