The document outlines the steps for conducting a research literature review in health informatics, emphasizing systematic approaches to formulating research questions, selecting databases, and applying screening criteria. It provides practical exercises for identifying relevant search terms, subjects, and methodologies while stressing the importance of synthesizing results and evaluating study quality. The guide aims to support researchers in effectively finding and managing literature related to their specific research topics.

1. Strategies for Answering Research Questions Introduction to Health Informatics April 8, 2010 Robin Featherstone, BA, MLIS Clinical Medicine Librarian Allyn & Betty Taylor Library [email_address] Presentation available at: http://www.slideshare.net/featherr

2. Objectives To provide an overview of the steps involved with conducting a research literature review To familiarize you with a variety of medical databases

3. Level of Evidence Pyramid Qualitative Studies Trip searches both

4. What’s a Research Lit Review? A research literature review is a systematic, explicit and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars, and practitioners.* * Fink, A. (2005). Conducting Research Literature Reviews . London: Sage.

5. 7 tasks in the Research Lit Review Selecting research questions Selecting your sources Choosing search terms Running your search Applying practical screening criteria Applying methodological screening criteria Synthesizing the results

6. Selecting research questions

7. Scenario You’re applying for a grant to support your research on high blood pressure in patients with diabetes. In pairs, discuss some possible research questions related to this topic. Note: this is just a suggested topic; please feel free to discuss another topic of interest to you.

8. How questions influence search results Relevancy Retrieval (# of search results) Broad Questions Narrow Questions High = lots of articles Low = very few articles High = directly relevant articles Low = mostly irrelevant articles

9. Exercise Select an appropriately narrow question for your research lit review and write it on your concept map. Example: Does ambulatory BP readings improve detection rates for high blood pressure in patients with type 1 diabetes?

10. Selecting your sources

11. Lit reviews depend on data from seven sources Online public bibliographic databases (i.e., MEDLINE) Private bibliographic databases (i.e., EMBASE) Specialized bibliographic databases (i.e., Cochrane Database of Systematic Reviews) Manual or “hand searches” of references lists “ Grey literature” (i.e., conference proceedings) Web reports Experts

12. Exercise Select a source from Ovid for your first search & indicate your choice on your concept map Ovid MEDLINE Ovid EMBASE Ovid AMED If searching EMBASE or AMED, please use the link on Taylor Med Info User name: uwotraining Password: training

13. Why do I have to select a database first? Your database will determine: Your subject headings Your operators (i.e., truncation symbols)

14. Different databases have different subject headings Tips: Complete a concept map for each database that you search Select subject headings that are the closest match for your concept Pay attention to “explode” commands – some databases will search related headings by default, others will not Database Subject Headings Medline MeSH EMBASE EMTREE CINAHL CINAHL Headings Cochrane Library MeSH Web of Science N/A Scopus N/A AMED AMED Subject Headings

15. Choosing search terms

16. Breaking down your question Break you question into concepts Identify subject headings for each concept Identify keywords for each concept

17. Exercise: Identify Concepts Identify concepts for your research question. Write each concept at the top of the columns on your concept map Example: Research question: Does ambulatory BP readings improve detection rates for high blood pressure in patients with type 1 diabetes? Concepts: #1: High Blood Pressure #2: Type 1 Diabetes #3: Ambulatory BP Readings

18. Exercise: Identify Subject Headings Search your database to find subject headings and enter them in the rows below your concepts + = explode Concepts: #1: High Blood Pressure #2: Type 1 Diabetes #3: Ambulatory BP Readings Subject Heading: Hypertension Diabetes Mellitus, Type 1 + Blood Pressure Monitoring, Ambulatory Subject Heading: Hypertension, Malignant

19. Exercise: Identify keywords Think of synonyms for your concepts. These will be words that appear in the title or abstract fields. Tip: use a “target article” to help identify keywords Concepts: #1: High Blood Pressure #2: Type 1 Diabetes #3: Ambulatory BP Readings Subject Heading: Hypertension Diabetes Mellitus, Type 1 + Blood Pressure Monitoring, Ambulatory Subject Heading: Hypertension, Malignant Keyword: ((high OR elevated) ADJ ( blood pressure OR bp).tw. ((type 1 OR insulin?dependent OR juvenile?onset OR sudden?onset) AND diabet$).tw. ((ambulatory OR self OR home) AND monitor$ AND blood pressure).tw. Keyword: hypertensi$.tw. IDDM.tw.

20. Some key operators in Ovid Note: These are recommended operators for research lit reviews. There are many, many more operators... Use Ovid‘s Help menu to locate them. Operator Command $ Truncation (finds alternate endings) ? Wildcard (finds alternate spellings) .tw. Text Word (tells Ovid to search for your term in the Title or Abstract fields) () Parentheses control the order of search operations Adj Adjacency operator (can be followed by a number) tells Ovid terms must appear adjacent to one another AND all terms must appear in results OR any terms will appear in results

21. Running your search

22. Running your search(es) Start with your first concept Search for the subject headings first Then search keywords Combine these synonymous searches with OR using your search history Repeat for your second, third, and subsequent concepts Finally, combine large search results set with AND

23. Running your search(es) Search #2 = Search #3 = Search #4 = Search #5 = #1 OR #2 OR #3 OR #4 Search #1 = Concept 1 Search #6 = Search #7 = Search #8 = Search #9 = Concept 2 Search #10 = #6 OR #7 OR #8 OR #9 Search #11 = #5 AND #10 Results

24. Evaluate your results Too many citations? Adjust your search strategy by adding another concept or selecting a more narrow concept Reduce the number of search terms Too few? Adjust your search strategy by removing a concept Add more search terms Irrelevant citations? Remove broad terms

25. Applying practical & methodological screening criteria

26. Screening Two kinds: practical and methodological Why? Use practical screening to identify a broad range of potentially useful studies Use methodological screening to identify the best available studies

27. Practical Screening Criteria – some examples Date of publication only studies conducted between 2005 and 2010 Participants or subjects only children 6 to 12 years of age Publication language only materials written in English Research design only clinical trials

28. Exercise: Practical Screens Use limits to apply some practical screens to your combined search result set Apply by using “limits” (may also be called “search options”)

29. Methodological Screening Criteria - some questions to ask Is the study’s research design internally & externally valid? Are the data sources used in the study reliable & valid? Are the analytic methods appropriate? Are the results meaningful in practical & statistical terms?* *Fink, A. (2005). Conducting Research Literature Reviews . London: Sage.

30. Next steps

31. Saving and Managing Results Save your search history Create an account with Ovid, Ebsco, etc.. Export results to a citation manager (EndNote, RefWorkds, etc...) Remove duplicates using the citation manager Share with your research team Apply methodological screens Evaluate results and exclude studies which don’t meet your criteria

32. Moving to another source Retain as much of your original strategy as possible Recognize that subject headings and operators* will be different (or non-existent) Keep track of your search terms using a new concept map * Check help menus for lists of operators

33. Exercise Please complete the same search in one or more of the following databases: MEDLINE (Ovid) EMBASE (Ovid) Cochrane Library (Wiley) CINAHL (Ebsco) SCOPUS (Elsevier) Web of Science (ISI) PsycINFO (CSA) AMED (Ovid)

34. Hand searching and final steps Locate the reference lists for selected articles* Identify new articles that have cited your articles* Identify key journals and “hand search” their issues - http://www.journaltocs.hw.ac.uk/ Test your search strategy by checking to see if a few “target articles” appear in the results * Use Web of Science or Scopus

35. Synthesizing the results Tip: Use a synthesis matrix – http://www.ncsu.edu/tutorial_center/writespeak/download/Synthesis.pdf

36. Use your results to... Describe current knowledge about your research topic Support the need for and significance of new research Explain research findings Describe the quality of a body of research* *Fink, A. (2005). Conducting Research Literature Reviews . London: Sage.

37. Level of Evidence Pyramid Qualitative Studies Trip searches both

38. Recap Research lit reviews are: systematic, explicit and reproducible Appropriate research questions are narrow... But not too narrow! Break your question into concepts Identify synonyms and subject headings for each concept Combine synonym searches with OR Combine concept searches with AND Apply practical and methodological screens Send search results to a citation manager Move to the next source or database retaining as much of your strategy as possible Use your lit review to summarize knowledge, assess research and support new research initiatives

39. QUESTIONS