Searching for and finding the Evidence

Searching for & finding the
evidence
Grainne McCabe, Mercer Library, RCSI
gmccabe@rcsi.ie
RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

In this session we will cover.....
• 5S approach to searching for the evidence
– clinical summaries; systematic reviews;
– primary studies
• Grey literature
• Database search process
– Scoping topic; identifying search terms; testing searches; saving
searches; setting up alerts
• Complex search strategy (from Cochrane Library)
– “unpick” the elements of the search: keywords / subject
headings
– Display it on the CINAHL database
Image: http://commons.wikimedia.org/wiki/File:Magical_books.jpg

Evidence-based healthcare
The practice of evidence based medicine
means integrating individual clinical expertise with
the best available external clinical evidence from
systematic research.
Source: Sackett, D.L. et al. (1996) Evidence based medicine: what it is and
what it isn't. BMJ 312, 71-2.

Strategy
Systematic
Criteria
Explicit
Reliable
Reproducible
Documented
Searches

Where do YOU go to search for the evidence?
• Google?

CLINICAL SUMMARIES
DynaMed / UptoDate /
Clinical Evidence
Cochrane Library
MEDLINE / CINAHL /
databases for primary studies
Grey literature
Evidence Based Medicine
Evidence Based Nursing
ACP Journal Club
B Haynes EBM v11 Dec 2006

Summaries - evidence-based digests
• Designed for use at point-of-care: wards, family practice
• Summarise the evidence
• Continually updated
• However....may not deal with all aspects of a topic or
with very specialised topics
• Each clinical summary has a different emphasis

Armstrong, DG . Basic principles of wound management. UptoDate [updated
28 Jan 2014 cited 24 Apr 2014]. Available from http://www.uptodate.com

Syntheses – systematic reviews
What is a systematic review?
• Identifies, appraises and synthesizes the evidence that
meets pre-specified eligibility criteria to answer a given
research question.
• Explicit methods are used, aimed at minimizing bias, and
producing more reliable findings.

Studies – primary journal articles
• Databases: a selection
– Medline - PubMed, Ovid Medline, Ebsco Medline .....
– CINAHL – Nursing & Allied Health
– PsycInfo – psychology & psychiatry
– Embase – particularly good for pharmacology topics, European
studies
– Web of Science
• Good for conference abstracts
• Citation searching

Studies – grey literature
• OpenGrey (System for Information on Grey Literature in
Europe) www.opengrey.eu
• NLM (Nat Lib Med) www.nlm.nih.gov/nichsr/db.html
– Databases:
• Health Services & Sciences Research Resources
• Health Services Research & Health Care Technology
• Health Services Research Projects
• Health Services Technology Assessments
– LocatorPlus – NLM catalogue
•Reports
•Official
Publications
•Conference
Papers
•Dissertations
•Patents

Studies – grey literature
• Institutional repositories: digital collections of scholarly
output from academic and professional organisations
OpenDOAR (www.opendoar.org) International
Bielefeld Base (www.base-search.net) European
CORE (http://core.kmi.open.ac.uk/search) UK
RIAN (http://rian.ie/) Irish
• Websites of relevant professional organisations
– EWMA; American Professional Wound Care Association; Wound
Management Association of Ireland

Theses & Dissertations
• Repositories – see previous slide
• Networked Digital Library of Theses & Dissertations
(NDLTD) (http://www.ndltd.org/home)
• DART-Europe E-theses portal (http://www.dart-
europe.eu/basic-search.php)

Scoping the topic – background searches
• Overview – places your work in the context of research
already published
– Size of the literature
– Identify gaps
– Types of studies / research designs
– Spread of publications
– Testing the search strategy on a group of documents – look for
other search terms / subject headings
– What is missing from your search results?
– What is included which is peripheral to your research?

Concepts
• Break the topic into concepts
– Is zyban effective in smoking cessation? Two principal
concepts. Search for each separately, then combine
OR
• Use the PICO framework:
– Patient / population / problem
– Intervention: cause, prognostic factor, treatment
– Comparison (if appropriate)
– Outcome
• May need to look beyond PICO

Identifying search terms
• Using key papers
– Find on the database
– What words/phrases (keywords) & subject headings are used?
• Adapting other people’s strategies:
• Be critical
• Amend for your topic

Wound cleansing for pressure ulcers
ACTIVITY:
Wound Cleansing:
– think of different ways of describing this concept
– Include solutions used in wound cleansing
Pressure Ulcers:
– think of different ways of describing this concept

Wound Cleansing Pressure Ulcers

Appendix 5. EBSCO CINAHL search strategy
S28 S22 and S27
S27 S23 or S24 or S25 or S26
S26 TI (bed sore* or bedsore* ) or AB (bed sore* or bedsore*)
S25 TI decubitus or AB decubitus
S24 TI (pressure ulcer* or pressure sore*) or AB (pressure ulcer* or pressure sore*)
S23 (MH ”Pressure Ulcer“)
S22 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20
or S21
S21 TI ( wash* or scrub* or swab* or shower* or bath* or soak* or irrigat* or whirlpool ) or AB ( wash* or scrub* or swab* or
shower* or bath* or soak* or irrigat* or whirlpool )
S20 TI ( wound clean* or wound cleans* ) or AB ( wound clean* or wound cleans* )
S19 (MH ”Hydrotherapy+“)
S18 (MH ”Bathing and Baths“)
S17 (MH ”Irrigation+“)
S16 AB ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or
disinfectant* or antiseptic* or detergent* or soap* or hydrogen peroxide or benzoyl peroxide or gentian violet or eusol or dakin* or
permanganate or water or alcohol*1 or solution* )
S15 TI ( normal saline or hypochlorit* or iodophor* or povidone or iodine or chlorhexidine or hibitane or betadine or antiseptic* or
S14 (MH ”Solutions+“)
S13 (MH ”Alcohols+“)
S12 (MH ”Water+“)
S11 (MH ”Gentian Violet“)
S10 (MH ”Hydrogen Peroxide“)
S9 (MH ”Soaps“)
S8 (MH ”Detergents+“)
S7 (MH ”Disinfectants“)
S6 (MH ”Antiinfective Agents, Local+“)
S5 (MH ”Povidone-Iodine“)
S4 (MH ”Chlorhexidine“)
S3 (MH ”Saline Solution, Hypertonic“)
S2 (MH ”Sodium Hypochlorite“)
S1 (MH ”Sodium Chloride+“)
Moore ZEH, Cowman S. Wound
cleansing for pressure ulcers.
Cochrane Database of Systematic
Reviews 2013, Issue 3. Art. No.:
CD004983. DOI:
10.1002/14651858.CD004983.pub3

Subject Headings (added by indexers) v Keywords (authors’ words)

S9 (MH ”Soaps“)
Wound
Cleansing
solutions –
subject
headings (MH)

S16 AB ( normal saline or hypochlorit* or iodophor*
or povidone or iodine or chlorhexidine or hibitane
or betadine or antiseptic* or disinfectant* or
antiseptic* or detergent* or soap* or hydrogen
peroxide or benzoyl peroxide or gentian violet or
eusol or dakin* or permanganate or water or
alcohol*1 or solution* )
S15 TI ( normal saline or hypochlorit* or iodophor*
or povidone or iodine or chlorhexidine or hibitane
or betadine or antiseptic* or disinfectant* or
antiseptic* or detergent* or soap* or hydrogen
peroxide or benzoyl peroxide or gentian violet or
eusol or dakin* or permanganate or water or
alcohol*1 or solution* )
Wound
Cleansing
solutions –
title /
abstracts

S21 TI ( wash* or scrub* or swab* or
shower* or bath* or soak* or irrigat* or
whirlpool ) or AB ( wash* or scrub* or swab*
or shower* or bath* or soak* or irrigat* or
whirlpool )
S20 TI ( wound clean* or wound cleans* ) or
AB ( wound clean* or wound cleans* )
Wound
Cleansing
methods –
subject
headings
title/abstract

S22
S1 or S2 or S3 or S4 or S5 or S6 or S7 or
S8 or S9 or S10 or S11 or S12 or S13 or
S14 or S15 or S16 or S17 or S18 or S19
or S20 or S21
All wound cleansing
searches combined
into one set

S27 S23 or S24 or S25 or S26
S26 TI (bed sore* or bedsore* )
or AB (bed sore* or bedsore*)
S25 TI decubitus or AB
decubitus
S24 TI (pressure ulcer* or
pressure sore*) or AB (pressure
ulcer* or pressure sore*)
Pressure ulcers:
Subject headings;
title / abstracts
All combined into
one set (S27)

S28 S22 and S27 Final set -
All results have to
discuss wound
cleansing (S22) AS
WELL AS pressure
ulcers (S27)

Putting that into practice!
https://www.flickr.com/photos/shindotv/3835365695/in/photolist-dQEffh-bKSERv-cL7gTW-P7XEF-ayTAnE-7Frdi-cL7gJs-bB8RAe-
9nXSy4-9nXSqX-5W6qxG-6QVfAK-7DUk5-fKow7d-2xQ9VT-czfWj7-9hhbsY-9he4ax-9he44P-hWT88P-cNX7ZA-4b5Zk7-
7odfak-3DEACY-75txKd-4dyNMq-cNX7Xy-8gAKm1-8iedyK-dYVCmw-85Rwed-aupZZW-61cUps-6T2aCS-sUnH-67TuU9-8K

CINAHL – the basics
In this search,
we are looking
for articles
which discuss
medication
adherence
amongst
asthma
sufferers
Leave Search
Options /
Limits till later

AND =
both ASTHMA
as well as
MEDICATION
ADHERENCE
have to be in
the results

Could we have missed some
results?
In this approach, we will think
of different ways to describe
medication adherence
Separate
searches

OR =
Either
COMPLIANCE
or else
ADHERENCE
has to be in
the results

S28 S22 and S27
S27 S23 or S24 or S25 or S26
or S21
S9 (MH ”Soaps“)
CD004983. DOI:
10.1002/14651858.CD004983.pub3
Back to the
advanced
search...

CINAHL search
S24 TI (pressure ulcer* or pressure sore*) or AB (pressure ulcer* or
pressure sore*)
Keyword
search:
Authors’ words

Keyword
search:
Authors’ words

S26 TI (bed sore* or bedsore* ) or AB (bed
sore* or bedsore*)
Keyword
search:
Authors’ words

Click on
“Pressure Ulcer”
for more
information

Deep Tissue Injury &
Heel Ulcer are narrower
headings
Tick EXPLODE box to
include them

An abbreviated version for demo purposes -
the full strategy should be run (S1-S21)

Record your searches
Reproducible & documented
• Set up personal accounts
• Save searches
• Set up alerts - email advising you of new results
• Set up alerts for journal table of contents
• Image: http://commons.wikimedia.org/wiki/File:Power_of_Words_by_Antonio_Litterio.jpg

S28 S22 and S27
S27 S23 or S24 or S25 or S26
or S21
S9 (MH ”Soaps“)
CD004983. DOI:
10.1002/14651858.CD004983.pub3
You may be asked to
record number of
results also....

Limits
• Vary from database to database
• “Weaken” the evidence?
• Examples:
– Publication date
– Language
– Age group
– Type of publication: review; randomised controlled trial; letter to
the editor/editorial; clinical query (studies relating to
therapy/diagnosis/aetiology/prognosis)
• Use with caution

Translating searches into other databases
• Each platform (eg EBSCO, OVID): different structure
– EBSCO (eg CINAHL, Medline): default search is keyword
– OVID (eg Medline, PsycInfo): default search is subject heading
– PubMed (Medline): default search is a combination of both
• Subject headings vary / or no headings at all
– More detailed nursing subject headings on CINAHL
– Web of Science doesn’t use subject headings – you rely on
authors’ words
• KNOW the database structure
• Take your time!

Sources of help.....
• Cochrane Handbook for Systematic Reviews of
Interventions
– www.cochrane-handbook.org
• Centre for Reviews and Dissemination, University of
York. Systematic Reviews: CRD’s guidance for
undertaking reviews in health care
– www.york.ac.uk/inst/crd/index_guidance.htm
• Your Librarian

Thank you!
Grainne McCabe
Mercer Library, Royal College of Surgeons in Ireland
www.rcsi.ie/library
gmccabe@rcsi.ie

Searching for and finding the Evidence

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