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Searching with PICO and Alternative question formulation framework OT
- 1. Searching the literature in Occupational Therapy Jill Boruff, MLIS, AHIP Associate Librarian Liaison to the School of Physical and Occupational Therapy jill.boruff@mcgill.ca
- 2. Objectives 1. Recognize the importance of question formulation and searching in the EBP cycle 2. Demonstrate how to design a search strategy from a case scenario using a question formulation framework 3. Use MeSH and keywords to search effectively in MEDLINE 4. Locate the library resources available at McGill
- 3. Outline of today’s workshop 1. How MEDLINE works when searching subject headings and keywords 2. Discussion of the question formulation framework and how to use it in practical situations to search MEDLINE
- 4. http://www.redorbit.com/media/uploads/2013/0 6/KidMathShapes_062513-617x416.jpg How MEDLINE works
- 5. Discussion 1. Why do we search? 2. Why do we use subject-specific databases?
- 6. Evidence-Based Practice Cycle Appraising the Evidence Incorporating evidence into decision-making Evaluating the Process Formulating The Clinical Question Searching the Evidence
- 7. Using MEDLINE on Ovid
- 8. Find this article! Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71, 7101180010. https://doi.org/10.5014/ajot.2017.023234
- 11. IDEA 1 IDEA 2 IDEA 3 Which ideas best represent this article?
- 12. Boolean Logic connectors AND = every reference contains both (or all) of the search terms specified. OR = every reference contains at least one of the search terms
- 13. What are we searching? IDEA 1 _____________ OR _____________ IDEA 2 _____________ OR _____________ IDEA 3 _____________ OR _____________
- 15. No Keywords for Carpal Tunnel Syndrome Subject Headings
- 18. When to search keywords Reason Example When the database does not have controlled vocabulary Google, Scopus, Web of Science When subject headings do not fully capture the idea you are searching Yoga/ but you want specifically “hot yoga” or “bikram yoga” When there is more than one name for an idea Transcutaneous Electric Nerve Stimulation/ or tens.mp. When the idea is new and there is not a subject heading for it yet or the subject heading is new Constraint-induced movement therapy
- 19. “controlled vocabulary” Database will search descriptor field Should be the focus of the article because the process involves humans Different in each database, but standardized across articles “natural language” Database will search multiple fields May not be the focus of the article Necessary if subject heading does not exist for your term
- 20. Do a search in MEDLINE Mrs. Bélanger is a 52-year-old L-handed self-employed hairdresser who has been diagnosed with bilateral carpal tunnel syndrome last week. The symptoms slowly started over the past year but she delayed consulting since the symptoms had not significantly interfered with her work until more recently. She described numbness on the median nerve territory bilaterally but more significant in the L hand. You also noticed some muscle atrophy in the L thenar eminence. She lives alone in an apartment in Montreal and enjoys bowling, playing cards and swimming. You know that splints are the standard of care but you would like to see if muscle stretching exercises would help as well.
- 21. Discussion 1. What did you find? 2. Did everyone find the same information? Is this important?
- 22. http://www.flickr.com/photos/32595 872@N02/4195880838/ Formulating the clinical question and how to use it http://www.flickr.com/photos/32595872 @N02/4195880838/
- 23. Evidence-Based Practice Cycle Appraising the Evidence Incorporating evidence into decision-making Evaluating the Process Formulating The Clinical Question Searching the Evidence Start here!
- 24. Clinical Question What is it and why do we use it? A question that is “directly relevant to the problem at hand… [and] phrased to facilitate searching for a precise answer.” From: Richardson, WS. Wilson, MC. Nishikawa J. Hayward, RS. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club. Nov-Dec 1995. “ To benefit patients and clinicians, such questions need to be both directly relevant to patients’ problems and phrased in ways that direct your search to relevant and precise answers.” Centre for Evidence-Based Medicine. (n.d.). Asking focused questions. Centre for Evidence-Based Medicine. Retrieved from http://www.cebm.net/asking-focused-questions/.
- 25. Clinical Question • Directly relevant to the patient’s problem: Mother comes with her child with autism in your office There is a specific issue you would like to address • Phrased to facilitate searching for a relevant and precise answer: “Is occupational therapy effective in treating children with autism?” “Does sensory integration improve social behaviour in children with autism?”
- 26. Types of studies Systematic Reviews Randomized Controlled Trials Case-Control studies Cohort Studies Case Reports
- 27. Best evidence for your question Question Best Evidence Therapy •Systematic reviews / meta-analyses •Randomized controlled trials Diagnosis •Diagnostic validation studies •Prospective studies / blind comparison to a gold standard Prevention •Systematic reviews / meta-analyses •Randomized controlled trials •Cohort studies, case control studies Prognosis •Inception cohort studies •Case control studies •Case series Cost-effectiveness •Economic analyses For more information: http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036068
- 28. A framework for search question Elements Answer Patient or Population Intervention Comparison Outcome Type of question Answerable clinical question
- 29. A framework for search question Elements Answer Problem Population Patient stakeholder Professional stakeholder Type of question Answerable clinical question Elements Answer Intervention Context Outcome measure Time
- 30. Elements Answer Patient or Population Intervention Comparison Outcome Type of question Answerable clinical question: Mr. Frank Richards is a left-handed 26 year old who sustained a fracture to the 5th metacarpal of his left hand in a bar fight. The fight happened last night while he was working as a bouncer. Should you fabricate a cast or an orthosis for Mr. Richards to facilitate fracture healing? Adult male with metacarpal fracture Orthosis Cast Fracture healing Therapy In adult males with a metacarpal fracture, is a cast or an orthosis most effective for facilitating fracture healing?
- 31. Elements Answer Problem Population Patient stakeholder Professional stakeholder Type of question Answerable clinical question Elements Answer Intervention Context Outcome measure Time Mr. Frank Richards is a left-handed 26 year old who sustained a fracture to the 5th metacarpal of his left hand in a bar fight. The fight happened last night while he was working as a bouncer. Should you fabricate a cast or an orthosis for Mr. Richards to facilitate fracture healing? Metacarpal fracture Orthosis Fracture healing In adult males with a metacarpal fracture, is a cast or an orthosis most effective for facilitating fracture healing? Therapy 26 year old male Fight; work as a bouncer Yesterday (24 hour period)
- 32. What are we searching? IDEA 1 Metacarpal fracture IDEA 2 Orthosis IDEA 3 Casts IDEA 4 Fracture healing AND
- 33. Evidence-Based Practice Cycle Appraising the Evidence Incorporating evidence into decision-making Evaluating the Process Formulating The Clinical Question Searching the Evidence Move to the next step
- 35. Back to our first search Mrs. Bélanger is a 52-year-old L-handed self-employed hairdresser who has been diagnosed with bilateral carpal tunnel syndrome last week. The symptoms slowly started over the past year but she delayed consulting since the symptoms had not significantly interfered with her work until more recently. She described numbness on the median nerve territory bilaterally but more significant in the L hand. You also noticed some muscle atrophy in the L thenar eminence. She lives alone in an apartment in Montreal and enjoys bowling, playing cards and swimming. You know that splints are the standard of care but you would like to see if muscle stretching exercises would help as well.
- 36. Elements Answer Patient or Population Intervention Comparison Outcome Type of question Answerable clinical question: Mrs. Bélanger is a 52-year-old L-handed self-employed hairdresser who has been diagnosed with bilateral carpal tunnel syndrome last week. The symptoms slowly started over the past year but she delayed consulting since the symptoms had not significantly interfered with her work until more recently. She described numbness on the median nerve territory bilaterally but more significant in the L hand. You also noticed some muscle atrophy in the L thenar eminence. She lives alone in an apartment in Montreal and enjoys bowling, playing cards and swimming. You know that splints are the standard of care but you would like to see if muscle stretching exercises would help as well. Adult female with carpal tunnel syndrome Stretching exercises with splints Splints Reduced numbness Therapy In adult females with carpal tunnel syndrome, is stretching with splinting more effective than splinting alone in reducing numbness?
- 37. Mrs. Bélanger is a 52-year-old L-handed self-employed hairdresser who has been diagnosed with bilateral carpal tunnel syndrome last week. The symptoms slowly started over the past year but she delayed consulting since the symptoms had not significantly interfered with her work until more recently. She described numbness on the median nerve territory bilaterally but more significant in the L hand. You also noticed some muscle atrophy in the L thenar eminence. She lives alone in an apartment in Montreal and enjoys bowling, playing cards and swimming. You know that splints are the standard of care but you would like to see if muscle stretching exercises would help as well. Elements Answer Problem Population Patient stakeholder Professional stakeholder Type of question Answerable clinical question Elements Answer Intervention Context Outcome measure Time Carpal tunnel syndrome IN adult females with carpal tunnel syndrome, is stretching with splinting more effective than splinting alone in reducing numbness? Therapy Adult female Occupational therapist Splint; Stretching exercises Work Reduced numbness Increase in severity over the last year
- 38. What are we searching? IDEA 1 Carpal tunnel syndrome/ IDEA 2 Muscle stretching exercises/ OR Stretch*.mp. IDEA 3 Splints/ OR Splint*.mp. IDEA 4 Outcome AND
- 40. When is this framework useful? • To identify your clinical question • To select the best resource(s) or study design to answer your question • To focus your search on the most important elements
- 41. Database Subject areas Publication types included Dates covered Controlled vocabulary Medline / PubMed Biomedicine and health care Journal articles, editorials 1946 to present Yes EMBASE Biomedicine, rehabilitation, pharmacology Journal articles, editorials, conferences 1947 to present Yes CINAHL Nursing and allied health Journal articles, editorials, trade magazines 1937 to present Yes PsycInfo Psychological, social, behavioral, and mental health Journals articles, books, book chapters 1806 to present Yes Database comparison
- 42. Reviewing what we learned
- 43. Reviewing what we learned 1. The importance of question formulation and searching in the EBP cycle 2. Using the question formulation framework to refine your question and focus your search 3. Designing a search strategy from a case scenario: • use subject headings and keywords according to your needs • choosing the type of study you are looking for
- 44. Need Help? Osler Library of the History of Medicine • Located in the McIntyre Medical Building • Reserve materials, holds, and ILL pick-up available • Study space Schulich Library of Science and Engineering • Located on lower campus • Library service hours with librarian on duty: Monday to Friday, Sunday • Non-reserve materials for Life Sciences • Extended hours for study • My office!
- 45. Boruff, Cavalcante, Kloda, 2017 http://libraryguides.mcgill.ca/poth jill.boruff@mcgill.ca
Editor's Notes
- Introduce yourself;
- State the objectives of this lesson; State your expectations for students' participation and the importance of searching for their academic and professional practices.
- http://www.redorbit.com/media/uploads/2013/06/KidMathShapes_062513-617x416.jpg
- Question 1: (to look for evidence to support our practices) Question 2: (focused on our specific needs; they contain the most updated knowledge) Discussion about database search Ask them the first question and have a whole-class discussion. Then move on to the second question. Let at least 3 students talk.
- Cycle of "decision making" Present the cycle of literature search. Ask them if they have ever seen that. Explain each point and emphasize the importance of a good search for a good practice.
- Finding MEDLINE/OVID database If you find it useful, give some information regarding the database itself.
- Give them some time to find the article.
- Discuss the elements of the article Quickly go over the information about the article, and focus on the Title, MeSH SH, and abstract.
- Ask them to read the abstract and give 3 ideas that are representative of that article If possible, write the 3 ideas in the PPT presentation (bubbles). Discuss different ways of describing each idea
- Explain the role of AND/OR logic connectors Emphasize that they fundamentally work in our favor to find the best type of evidence (OR expands our search, AND filters our search).
- Show them how to connect the different ideas to find articles.
- Importance of subject headings: No key word for Carpal Tunnel syndrome Focus: If you used FOCUS on Carpal Tunnel, you wouldn’t have gotten this article
- Explode: Must explode upper extremity, easy way to get all parts; keyword would need to search each word Focus: or focus on these terms
- Importance of subject headings: If you searched “splint” or “splints” as keyword, you would not have gotten this article
- Give them some examples of when keywords are useful If possible, ask them if they ever had similar situations.
- Summarize the ideas that you already discussed
- Propose a search based on the given scenario
- Discuss their findings Let at least 3 students share their findings, so that we can see diversity of results. Discuss why they found different information and whether this is important.
- http://www.flickr.com/photos/32595872@N02/4195880838/ Clarify your thoughts Fill gaps in your knowledge There is so much research out there that you will never be able to keep up with all of that reading—want to keep up with your practice Write questions to help us find the best evidence when searching.
- Importance of clinical question Go back to the cycle and explain that to solve problems better, we need to better formulate questions to search.
- What is a clinical question and why do we use it? Focus on the importance of clinical questions for their own professional practice. It is not a theoretical exercise; it is rather a very practical issue.
- How it relates to their professional practice Emphasize that phrasing it correctly will enhance the chances of getting relevant information.
- Explain different types of studies Explain why SR and RCTs are the best type of evidence.
- Introduce a framework for clinical question: PICO Ask them whether they are familiar with it, and whether they use it during their studies. Also, explain each element with the help of the students, if possible.
- Introduce a framework for clinical question. Ask them whether they are familiar with it, and whether they use it during their studies. Also, explain each element with the help of the students, if possible.
- Find each element in the example As the students identify the PICO elements, write them either on the slides or on the board.
- Find each element in the example As the students identify the elements in this framework, write them either on the slides or on the board.
- Discuss the subject headings for this search For each PICO element, show how the subject headings look like and their logic connectors. Comment on the absence of output for the search
- Mention how limits could be used if large number Verify if all students found the same article Check the search items and logic connectors in case anyone did not find the same article. Discuss: we were lucky to find only one article (RCT), but what if we had not found it or if we wanted a systematic review? We would need to expand our search. Ask them possible ways to expand the search, and how it would look like in the database search. If time allows, let them do a new search and discuss the results.
- Discuss the PICO elements in the scenario Emphasize the idea that the example contains much information that are not relevant for the PICO framework.
- Mention l Show the PICO elements and have them do the search by themselves. Discuss the results.
- Mention l Show the framework elements and have them do the search by themselves. Discuss the results, and check which elements they used to their search.
- Discuss the subject headings for this search For each PICO element, show how the subject headings look like and their logic connectors. Comment on the absence of output for the search
- Mention limits Show the search box and the most relevant article that they were supposed to find.
- These databases all have subject headings, or controlled vocab Have to look for them in some databases—but some databases are very helpful and suggest subject headings to you!
- Recognize the importance of question formulation and searching in the EBP cycle Demonstrate how to design a search strategy from a case scenario Use MeSH and keywords to search effectively in MEDLINE Locate the library resources available at McGill