The document outlines effective strategies for searching medical databases using the PICO framework to address health-related information requests. It details various free and subscription-based tools like PubMed, Trip Database, Embase, and CINAHL, and describes their specific features and types of literature they provide. The document emphasizes the importance of using high-quality evidence and understanding levels of evidence when conducting these searches.

1. Searching Medical Databases MLIS 9320 March 23, 2010 Robin Featherstone, BA, MLIS Clinical Medicine Librarian Allyn & Betty Taylor Library [email_address] Presentation available at: http://www.slideshare.net/featherr

2. Agenda Sources of Medical Evidence (EBM) & PICO Free Tools PubMed Trip Database Subscription databases EMBASE (Ovid) CINAHL (Ebsco)

3. Level of Evidence Pyramid Qualitative Studies Trip searches both

4. PICO P: Patient, population or problem I: Intervention or exposure C: Comparison (optional) O: Outcome

5. PICO Example A patron calls the desk and asks if you have any information about jet lag. They travel frequently and would like to know more about prevention methods. Have you heard of using melatonin? They’ve also read that exercise can be used to prevent symptoms. What does the medical literature say?

6. Use PICO to identify keywords for your search P: Patient with jet lag I: Melatonin C: Exercise O: Prevention of symptoms

7. FREE TOOLS

8. PubMed/MEDLINE Freely accessible database of biomedical literature from the US National Library of Medicine What you’ll find: Citations for: Primary research articles, review articles, Cochrane reviews Academic, scientific literature written for clinicians, researchers, chemists, biologists, etc... What you won’t find: Plain language materials Clinically appraised topics Evidence grading

9. Key Features in PubMed Medical Subject Headings (MeSH) Limits Single Citation Matcher Clinical Queries Topic Specific Queries

10. PubMed Exercises What are the MeSH headings for “tranquilizers?” Find an article published in the journal Psychopharmacology by J.M. Nichols in 1993 Find articles on therapies for Intermittent Explosive Disorder (IED) Find a randomized controlled trial on chocolate cravings

11. Trip Database Freely available clinical search tool from the UK that identifies high quality clinical evidence What you’ll find: What you won’t find: Sophisticated search interface Comprehensive coverage of the medical literature Evidence Based Synopses Systematic Reviews Guidelines Clinical Q&A Primary Research eTextbooks Patient Information News

12. Key features in Trip : http://www.tripdatabase.com/ Allows filtering by level of evidence Conclusions of systematic reviews available in the citation If available, results will include images Links available to Medline articles

13. Trip Exercises http://www.tripdatabase.com/ Run a search for bipolar disorder. Limit your results to only the highest quality evidence. Identify Canadian guidelines. Locate images of hip replacements Answer the question: Is tea tree oil effective in treating dermatological conditions?

14. SUBSCRIPTION TOOLS

15. EMBASE (Ovid) Subscription database (Ovid) What you’ll find: Citations for: Primary research articles, review articles, Cochrane reviews Academic, scientific literature written for clinicians, pharmacists, researchers, etc... European focus Good coverage of drug information What you won’t find: Plain language materials Clinically appraised topics Evidence grading

16. Key Features in EMBASE : Guided search in Ovid EMTREE (Subject Headings) Limits Routes of drug administration

17. EMBASE Exercises: Find citations on use of gabapentin for patients with fibromyalgia Find citations on intracameral administration of lidocaine

18. CINAHL (Ebsco) Subscription database (Ebsco) Nursing and allied health literature What you’ll find: Citations for: Primary research articles (mix of qualitative and quantitative), review articles, opinion papers, editorials, letters Allied health information for nurses, physiotherapists, occupational therapists, etc... What you won’t find: Clinically appraised topics Evidence grading

19. Key Features in CINAHL CINAHL Headings (Subject Headings) Search history Combining your searches

20. CINAHL Exercises Find citations about hydrotherapy for patients with arthritis Limit your results to research articles only Find citations about depression following mastectomy Limit to Quality of Life Studies

21. Summary Use PICO when answering health-related information requests Be conscious of the levels of evidence – aim for the highest level which still answers the patrons needs PubMed and Trip as high-quality free resources EMBASE (Ovid) for drug-related questions CINAHL (Ebsco) for allied health questions

22. Challenge Exercise A patron asks you to help her find a recent article (just published) about beta blockers versus calcium-channel blockers in preventing stroke. She remembers that the article discussed blood pressure variability.

23. QUESTIONS