2. Outline
• Search Strategy
• Pulling Keywords from Your PICO Question
• Boolean, Truncation, and Wild Cards
• Hierarchy of Evidence and Study Design
• National Guidelines Clearinghouse
• Cochrane Database of Systematic Reviews
• PubMed (MEDLINE)
• CINAHL
3. Choosing Appropriate Evidence
Higher Percentage of
Quality Meta‐ the Literature
analyses
Systematic
reviews
Randomized
controlled trials
Prospective blind
comparisons
Cohort studies
Case‐control studies
Case series and case reports
Animal and laboratory research
Will Olmstadt, MS, MPH
4. PICO
• Patient or problem ‐ How would I describe a group of
patients similar to mine?
• Intervention ‐ Which main intervention, prognostic
factor, or exposure am I considering?
• Comparison ‐ What is the main alternative to compare
with the intervention?
• Outcome ‐ What can I hope to accomplish, measure,
improve or affect?
Will Olmstadt, MS, MPH
5. The Search Strategy
• Develop PICO question
• Identify keywords and terms from PICO
• Identify standardized subject headings
• Combine subject headings and keywords
to narrow or broaden your search
• Evaluate your search results
• Revise the search in light of your results
6. Pulling Keywords from Your
PICO Question
• What are the main topics of your PICO?
• Brainstorm – what other words could you
use to describe your topic?
• What are some synonyms for the words
you’ve come up with?
7. Evaluate the Search Results
Don’t be afraid if you have zero (0) or thousands of results,
play around with search strategies – you wont break
anything!
– Read the titles and abstracts of “hits” in your search
to get a feel for their relevance
– Identify relevant MeSH and Keywords used to index
particularly relevant “hits”
– If your search yields too many or too few hits,
modify it and try again
8. Revise the Search in Light of
your Results
• Narrow the search by combining search
terms and applying limits
• Broaden the search if the results are too
limited by removing keywords and limits
10. Boolean
strawberry AND AND chocolate
Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from
http://www.ithaca.edu/library/course/expert.html.
11. Boolean
strawberry OR OR chocolate
Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from
http://www.ithaca.edu/library/course/expert.html.
12. Boolean and Nesting
(strawberry OR NOT chocolate
Strickland, Jennifer and Henderson, John R. (October 10, 2005). Boolean Logic. Retrieved September 22, 2007, from
http://www.ithaca.edu/library/course/expert.html.
13. Truncation and Wild Cards
• Truncation is a searchable shortened form of a word.
– adolescen* will include
• adolescence
• adolescent
• adolescents, etc…
• Wild card characters are useful because of alternate spellings and
other quirks in the English language.
– behavio?r, will include
• behaviour
• behavior
– Wom*n, will include
• women
• woman
15. National Guidelines Clearinghouse
• http://www.guideline.gov/
• Freely accessible database of evidence‐based clinical
practice guidelines and related documents.
• Initiated by the AHRQ in partnership with the American
Medical Association and America's Health Insurance
Plans.
• Now maintained by the Agency for Healthcare Research
and Quality (AHRQ) and the U.S. Department of Health
and Human Services.
• If you have developed a good practice guideline
consider submitting it to the NGC
19. NGC
Pros
– Freely accessible practice guidelines that
have undergone rigorous acceptance
standards by the AMA, AHIP, AHRQ, and the
U.S. Department of Health and Human
Services
Cons
– Limited content
– Limited search capabilities
20. Cochrane Database of
Systematic Reviews
• http://www.cochrane.org/
• “Gold Standard” for systematic reviews
• Free database, but requires paid subscription to access
most content
22. Cochrane Search
Example
Question: Does the use of Echinacea really prevent the common cold?
You are only
interested in
Cochrane Reviews
23. Cochrane Search Example cont…
You are only
interested in
Cochrane Reviews
Click “Record” to
view details of review
and access full text if
available.
24. Cochrane Systematic
Reviews
Pros
– Compiled through rigorous standards
– Review process has already been done so
you don’t have to
Cons
– Limited content
– Limited search capabilities
– Access to most full‐text content requires paid
subscription
25. PubMed (MEDLINE)
• www.pubmed.gov
• Created and maintained by the National
Institute of Health (NIH) and the National
Library of Medicine (NLM)
• 17 million citations back to 1950s
• Free database of citations with some
content available for free
26. MeSH = Medical Subject Headings
Choose MeSH from
Pull Down Menu
34. PubMed - Limits cont…
For the most clinically applicable articles, limit to “Humans,” “English,” and “Type of Article”
35. PubMed – Limit to Type of Article
Tier 1 Tier 2
• Clinical Trial
• Meta‐Analysis • Clinical Trial, Phase I
• Practice Guideline • Clinical Trial, Phase II
• Clinical Trial, Phase III
• Randomized Controlled • Clinical Trial, Phase IV
Trial • Comparative Study
• Controlled Clinical Trial
• Review • Research Support, N.I.H., Extramural
• Research Support, N.I.H., Intramural
• Guideline • Research Support, Non‐U.S. Gov't
• Research Support, U.S. Gov't, Non‐P.H.S.
• Multicenter Study • Research Support, U.S. Gov't, P.H.S.
38. PubMed - Send To From “Send to” drop
down menu, choose
“E‐mail”
You can email your results to yourself and your colleagues.
39. PubMed - Search History
Don’t forget to save your search history!
40. PubMed (MEDLINE)
PubMed advantages PubMed disadvantages
– Free to search – Still have to appraise articles
– No username/password once located
– Searches same content as
Ovid MEDLINE
– Links to free full‐text
sometimes available
49. CINAHL – Displaying
Results
Scroll all the way to the bottom. Choose the number of results that
Choose “Detailed” to see as much will allow you to look at all your
information in one glance about results in one continuous list.
each article.
BERNARD BECKER MEDICAL
LIBRARY
50. CINAHL – Your Folder
Add articles you want to look
at, save, or request to your
folder.
51. CINAHL – Your Folder cont…
Look at your saved citations in the
Folder View.
52. CINAHL – Your Folder
From here you can print, email,
save, and export to a citation
managers.
53. CINAHL – Emailing
A nice option when you are
emailing your results is that you
can choose to have them
formatted into the citation style
you will need later.
54. CINAHL
CINAHL advantages CINAHL disadvantages
– Nursing and allied health – Subscription product
content – Content is limited compared
– Includes content MEDLINE to MedLine
does not – EBP limiters are limited
– Searching CINAHL is expected
in many evidence settings
– CINAHL headings
55. Good Database Searching Rules
Following these rules will improve your results…
1. Use standardized subject headings like MeSH and CINAHL Subject Terms.
2. Apply Limits like “English” and “Humans.”
3. Limit “Publications Types” to
– Meta‐analysis
– Practice Guidelines
– Randomized Controlled Trials
– Reviews
4. Keep a copy of your search history.
5. If it takes you longer then 20 minutes – ask your librarian for help.
56. Library Locations
• 660 S. Euclid • St. Louis Children’s Hospital
314‐362‐7085 Lauren Yaeger, 314‐454‐2768
Susan Fowler, 314‐362‐8092 yaegerl@wustl.edu
Pg: 314‐360‐1069
fowler@wustl.edu
• BJ North, Rothschild
Medical Library
Reka Kozak, 314‐454‐7208
kozakr@wustl.edu
