2.  General Rules
 Resources
 Customized Search Engines
 Search at the point of care
 Alert Services
 Search strategy
 Tips for searching

3.  EBM tools proliferating
 Deciding on “right” tool(s) is difficult as
products vary in
 Complexity
 Content
 Accessibility
 Intended audience.

4.  Keep it simple
 Resources they can access:
 Free is better
 Subscribed by their institute
 Accessible at the point of care
 You need to select from among
sources, not to include all of them
 Select a framework

5. I. Primary Research Sites
PubMed
Ovid
SUMSearch
Google Scholar
Medline II. Sites to assist in interpreting
the data (EBM toolkits):
 University of Alberta EBM
site
 University of Toronto EBM
site
 New York Academy of
Medicine EBM Initiative
 Society of General Internal
Medicine site
III. Sites with “Ready Synthesized
Data”
National Guideline Clearing House
Cochrane Database
Bandolier
ACP Journal Club
PIER
Society of General Internal Medicine
Website

6. •National Guideline Clearinghouse
•PubMed
•Agency for Healthcare Research and
Quality (AHRQ)
•Health Services/Technology Assessment
Text

7. •www.guideline.gov
•A public resource for evidence-based practice
guidelines.
•Conduct a keyword search OR browse by
disease/condition, treatment/intervention
•Homepage contains weekly news updates on
recently submitted guidelines that have either been
reviewed or are new to the database
•FDA Advisories – on recent changes or alerts on
prescription drugs

9. www.pubmed.gov
•A free, public database of clinical/biomedical abstracts
•Includes over 4,800 journals
•Provided by the National Library of Medicine (NLM) &
the National Institutes of Health (NIH)
•Can search on any medical topic in this database
•Provides a tutorial & help section to guide you through a
PubMed search.
•Can begin with general keywords OR use the Medical
Subject Headings

10. •Limits tab is very helpful when searching the
database. Use it and become familiar with it.
What publication dates? Historical or recent?
Only in the last 5 years
What language?
What journal subset?
•Contains Subsets of Journals: good for
narrowing your journal selections

11. •Clinical Queries feature:
for searching evidence-based literature –
RCTs and clinical reviews – built-in
search feature that limits search results.
•Simplifies method entering your
keywords, selecting category (therapy,
diagnosis, prognosis, etc.) and scope –
PubMed will do the rest……

14. •Cochrane Reviews
•DynaMed
•Up-To-Date
•InfoRetreiver
•Clinical Evidence

15. www.cochrane.org
•Updated collection of EBM Databases
•based on the best available information about
healthcare interventions
•They explore the evidence for & against the
effectiveness & appropriateness of treatments
(medications, surgery, education, etc) in specific
circumstances.
•Published on a quarterly basis & made available both
on CD-ROM & the Internet
•Can browse & search abstracts of reviews free of
charge

16. •Cochrane reviews relevant to reproductive
health can also be found in the WHO
Reproductive Health Library, which is available
free of charge to health workers in developing
countries by e-mailing RHL@who.ch.
•The premier resource for systematic reviews
(and RCTs) is the Cochrane Library, which
should be searched first.
•The Cochrane Library contains the following
components for searching for systematic
reviews.
1. Cochrane Database of Systematic Reviews
(CDSR)
2. Database of Reviews of Effectiveness (DARE)
3. Health Technology Assessment Database (HTA)

19. Is there a Cochrane Review?
Is there a non-Cochrane Review?
Are there any trials?

25. Level of Evidence labels

29. On the left is the outline – a very good way to navigate through the topic review.
FOCUS here to find answers to the questions or problems.

30. •Tripdatabase
•Google Custom Search

36.  Desktop computer
 Cochrane Library
 Up-to-Date
 Dynamed
 Clinical Evidence
 Stat!-Ref
 InfoRetriever
 Handheld computer
 InfoRetriever
 PDR, Lexi-Comp Drug Database, 5-min. Clinical Consult
 Low tech
 Wall charts, pocket cards, and bulletin boards
 Pearl books

38.  Daily InfoPoem,
 BMJ update,
 Pub Med.

40. should have a systematic &
structured approach to achieve a
high degree of comprehensiveness
and to avoid bias in selection of
studies.

41. 1. Formulate clinical question(s)
2. Search for guidelines, If no relevant guidelines
3. Search for systematic reviews using:
- the internet
- the Cochrane Library
- other databases
4. Search for primary studies using:
- the Cochrane Library
- Medline and EMBASE
- CINAHL, BNI and MIDIRS
- Science Citation Index
- other databases

42. •National Guidelines Clearinghouse:
www.guideline.gov/index.asp
•Turning Research Into Practice (TRIP):
http://www.tripdatabase.com/
•RCOG: http://www.rcog.org.uk/
•Guidelines in O&G:
http://archive.uwcm.ac.uk/uwcm/lb/pep/maternal/index.html
•http://matweb.hcuge.ch/matweb/endo/cours_4e_mreg/obstetrics
_guidelines.htm
•National Electronic Library for Health: http://www.nelh.nhs.uk/
•OMNI: http://omni.ac.uk/ (click advanced search and specify:
Practice Guidelines in Resource Type)
•CMA Infobase: http://www.cma.ca/cpgs/
•Guidelines and Guidelines in Practice:
http://www.eguidelines.co.uk/

43. If no relevant reviews are located on the Cochrane Library
the next step is to search alternative sources that
summarise and appraise systematic reviews.
These include the journals
1. The internet service TRIP should be searched,
as it covers both UK and US evidence-based
reviews as well as guidelines.
2. ACP Journal Club and Evidence Based Medicine,
which are also searchable on the electronic database
Best Evidence.
3. Clinical Evidence published by the BMJ is a high-
quality text that should also be searched; it
summarises the results of reviews and other levels of
evidence to answer specific clinical questions.
4. Medline and EMBASE will also need to be searched
for increased comprehensiveness.

44. Search Cascade

45.  Decide the TYPE of question (Rx, Dx, Px,
…)
 Chose the right database for the type of
question, e.g.,
 Intervention: Cochrane Library, PubMed, …
 Diagnostic: Common Diagnostic Strategies (in
BE), or PubMed: Clinical Queries
 Prognosis, Etiology: PubMed: Clinical Queries

46. •Combining Terms - AND
Use AND to combine similar concepts &
to narrow your search results
sleep deprivation AND ICU
•Use simple search terms
• Check spelling
• Use quotation marks around exact
phrases
• Use search limits

47.  (Population OR synonym 1 OR …) AND
 (Intervention OR synonym 1 OR …) AND
 (Comparator OR synonym 1 OR …) AND
 (Outcome OR synonym 1 OR …) AND
 FILTER (for best study type)

48.  AND = both terms
 OR = either term
Use OR to join terms to broaden search
results
ICU OR Intensive Care Unit
 NOT = not this term
 (ADJacent, NEAR, … = AND + close)
* George Boole (a man) is claimed to have invented “logic”

49.  If you want
 cheese AND fruit
 Which do you ask for?
 cheese AND (apple OR pear OR melon)
 (cheese AND apple) OR pear OR melon
 What does PubMed do with if AND and OR?
 Cheese AND apple OR pear
 (Look at DETAILS tab)

50.  Search on Title only
Eg [ti]
(Others are [au] - author; [so], [yr], …)
 ‘Related Articles’ button
(PubMed)
 Previously identified study (PubMed)
Look for the MeSH terms
MeSH browser

51. Thank you
Aboubakr elnashar