The document summarizes how to search for the best evidence to answer clinical questions. It discusses creating an effective search strategy including developing search terms from a clinical question. It describes searching Medline and finding systematic reviews. It also explains using the Clinical Queries filter to locate primary studies and resources for appraising evidence quality.

1. BDent3 – Searching for the Best Evidence – an Update Westmead hospital 22 nd of August 2007 Jeremy Cullis Faculty Liaison Librarian (Dentistry) Dentistry Library University of Sydney Email: [email_address] Blog: http:// www.dentistrylibrary.blogspot.com

2. Searching for the Best Evidence - an update By the end of the session you will know: How to create an effective search strategy How to locate systematic reviews Use the Medline Clinical Queries filter to locate primary studies for your type of question Where to locate resources to help you appraise articles.

3. Searching for the Best Evidence - an update Creating a search Strategy is one of the most important steps What is your clinical question? What are the three or four key concepts in your question? Are there any similar words (synonyms) that describe each of the key concepts? Are there any specific keywords that could limit your search? How are you going to combine these keywords together to search? [Search Strategy, Internet for Dentistry and Oral Health Available at: http://www.vts.intute.ac.uk/acl/tutorial?sid=1139338&op=preview&manifestid=210&itemid=12066 , Accessed 16 th of August, 2008]

4. Searching for the Best Evidence - an update Creating a Search Strategy: Question Formulation: In patients with tooth discolouration would home bleaching compared to placebo lead to whiter teeth? [taken from Asking Questions, Centre for Evidence-based Dentistry, Available at: http://www.cebd.org/?o=1029 , Accessed: 17/08/07] Population: Patients with tooth discolouration Intervention: Home bleaching Comparison: Placebo Outcome: Whiter teeth

5. Searching for the Best Evidence - an update Any synonyms? Tooth discolouration or dental fluorosis Home bleaching or peroxide Try keyword searches for abbreviations etc to add to your searches

6. Searching for the Best Evidence - an update Combining your searches. Use AND to combine different concepts Example: Tooth discolouration AND bleaching Use OR to combine like concepts Example: peroxide OR tooth bleaching

7. Searching for the Best Evidence - an update Search Medline Remember to: Use Subject Headings (consider using keywords to expand your search) Search for one concept at a time Check the Tree Display for narrower headings Look for other relevant subject headings Use the correct logic to combine searches Use the limits – especially useful for locating primary studies.

8. Searching for the Best Evidence - an update Find a systematic review: Search Medline then use the EBM Reviews Limit First term: Tooth discolouration Second term: home bleaching

9. Searching for the Best Evidence - an update Image: Ovid Medline: http://gateway.tx.ovid.com.ezproxy2.library.usyd.edu.au/gw1/ovidweb.cgi ? New+Database=Single|17&S=CDLLFPBMJNDDKDEONCJLACPJANPPAA00: Viewed 17/8/07

10. Searching for the Best Evidence - an update Image: Ovid Medline: http://gateway.tx.ovid.com.ezproxy2.library.usyd.edu.au/gw1/ovidweb.cgi ? New+Database=Single|17&S=CDLLFPBMJNDDKDEONCJLACPJANPPAA00: Viewed 17/8/07

11. Searching for the Best Evidence - an update To find a Primary Study, use the Ovid Medline Clinical Queries Limits to limit your subject search. Limits for the Four question types: Therapy Diagnosis Aetiology Prognosis 3 Levels of emphasis for each question: Specificity (Narrowest) Optimised Sensitivity (Broadest)

12. Searching for the Best Evidence - an update Image: Ovid Medline: http://gateway.tx.ovid.com.ezproxy2.library.usyd.edu.au/gw1/ovidweb.cgi ? New+Database=Single|17&S=CDLLFPBMJNDDKDEONCJLACPJANPPAA00: Viewed 17/8/07

13. Searching for the Best Evidence - an update If the using the Therapy [specificity] Clinical queries Limit doesn’t result in relevant articles try the Therapy [optimised] then the Therapy [sensitivity] filters to expand your results Image: Ovid Medline: http://gateway.tx.ovid.com.ezproxy2.library.usyd.edu.au/gw1/ovidweb.cgi ? New+Database=Single|17&S=CDLLFPBMJNDDKDEONCJLACPJANPPAA00: Viewed 17/8/07

14. Searching for the Best Evidence - an update Example: Image: Ovid Medline: http://gateway.tx.ovid.com.ezproxy2.library.usyd.edu.au/gw1/ovidweb.cgi ? New+Database=Single|17&S=CDLLFPBMJNDDKDEONCJLACPJANPPAA00: Viewed 17/8/07

15. Searching for the Best Evidence - an update Image: The Cochrane Library http://http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME , Viewed: 20/8/07 Free Stuff:

16. Searching for the Best Evidence - an update Image: EviDents, http://medinformatics.uthscsa.edu/EviDents/ viewed 20/9/07 * PubMed search interface Free stuff:

17. Searching for the Best Evidence - an update Articles – Dentistry EBP (All available online) : Sutherland, SE 2001, 'Evidence-based dentistry: Part I. Getting started .' Journal of the Canadian Dental Association , vol. 67, no. 4, pp. 204-6. Sutherland, SE 2001, 'Evidence-based dentistry: Part II. Searching for answers to clinical questions: how to use MEDLINE ', Journal of the Canadian Dental Association , vol. 67, no. 5, pp. 277-80. Sutherland, SE & Walker, S 2001, 'Evidence-based dentistry: Part III. Searching for answers to clinical questions: finding evidence on the Internet ', Journal of the Canadian Dental Association , vol. 67, no. 6, pp. 320-3. Sutherland, SE 2001, 'Evidence-based dentistry: Part IV. Research design and levels of evidence', Journal of the Canadian Dental Association , vol. 67, no. 7, pp. 375-8. Sutherland, SE 2001, 'Evidence-based dentistry: Part V. Critical appraisal of the dental literature: papers about therapy ', Journal of the Canadian Dental Association , vol. 67, no. 8, pp. 442-5. Sutherland, SE 2001, 'Evidence-based Dentistry: Part VI. Critical Appraisal of the Dental Literature: Papers About Diagnosis, Etiology and Prognosis ', Journal of the Canadian Dental Association , vol. 67, no. 10, pp. 582-5.

18. Searching for the Best Evidence - an update Articles – EBM Guyatt, GH, Sackett, DL & Cook, DJ 1993, 'Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group', JAMA , vol. 270, no. 21, pp. 2598-601. ---- 1994, 'Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group', JAMA , vol. 271, no. 1, pp. 59-63. Jaeschke, R, Guyatt, G & Sackett, DL 1994, 'Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group', JAMA , vol. 271, no. 5, pp. 389-91. Jaeschke, R, Guyatt, GH & Sackett, DL 1994, 'Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group', JAMA , vol. 271, no. 9, pp. 703-7. Laupacis, A, Wells, G, Richardson, WS & Tugwell, P 1994, 'Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group', JAMA , vol. 272, no. 3, pp. 234-7. Levine, M, Walter, S, Lee, H, Haines, T, Holbrook, A & Moyer, V 1994, 'Users' guides to the medical literature. IV. How to use an article about harm. Evidence-Based Medicine Working Group', JAMA , vol. 271, no. 20, pp. 1615-9. Oxman, AD, Sackett, DL & Guyatt, GH 1993, 'Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group', JAMA , vol. 270, no. 17, pp. 2093-5.

19. Searching for the Best Evidence - an update Books Hackshaw, AK, Paul, EA & Davenport, ES 2006, Evidence-based dentistry : an introduction , Blackwell Munksgaard, Oxford. Call no. 617.6 123 Clarkson, J 2002, Evidence based dentistry for effective practice , Martin Dunitz, London. Call no. 617.6 92 Greenhalgh, T 2006, How to read a paper: the basics of evidence-based medicine, 3 rd edition, Blackwell Publishing, Oxford. Call no. 616 248 Websites New Zealand Dental Association 2005, Evidence-based Dentistry , viewed 17th of August, 2007 < http:// www.nzda.org.nz /pub/?id=69 >. Tools The Cochrane Library http://www.nicsl.com.au/Cochrane/ viewed 21 st August, 2007 The Forsyth Institute, Center for Evidence-based dentistry, EviDents , viewed 20 th of August, 2007 < http:// medinformatics.uthscsa.edu/EviDents />

20. Searching for the Best Evidence - an update Thanks! Any questions? Jeremy Cullis Faculty Liaison Librarian (Dentistry) Dentistry Library University of Sydney Email: [email_address] Blog: http:// www.dentistrylibrary.blogspot.com