Library Database searching for Evidence Based Practice (EBP)

1. developed for the Indiana University School of Nursing Library Database searching for Evidence Based Practice (EBP) Revised January 2008 IUPUI University Library Randi L. Stocker, MLS

2. Develop a searchable question • Search relevant databases, such as CINAHL, Medline, and others. • Stocker, R. (2008). Finding articles and systematic reviews related to nursing [web page]. http://www.ulib.iupui.edu/prod/subjectareas/nursing/indexes • Evaluate citations for potential relevance • Read summaries to make sure responses are relevant to your practice, if not may need to go back to step 1 Clinician database competencies:Steps to a more efficient search Steps:

3. Develop a Searchable question Two Search Methods PICO (most common) P – Patient or problem I – Intervention C – Comparison O – Outcome What is the effect of _________________________________ Intervention / Predictor Variable On _________________________________ Given Characteristic / Outcome For _________________________________ Specific group of patients / Patient Characteristics Alternate Template for Searching Alternate template: Thede, L. Q., Pierce, S., & Allen, M. (2003). Other Facets of Informatics: A wide Impact. In L. Q. Thede (Ed.), Informatics and Nursing: Opportunities & Challenges (2nd ed., pp. 243 - 258.). Philadelphia: Lippincott.

4. Select search tools • Databases oriented to different practitioners: • Nurses, Physicians, Psychologists, Educators, (& patients) • Databases focusing on specific types of research: • Guidelines, Systematic Reviews, Registers of studies, etc. • Design search strategy that optimizes value of selected databases & their features • Select Subject Headings • Select Limits • Review results; modify search Search Strategy Planning

5. Each article is coded with relevant official Subject Headings. (The coding is based on what the authors’ write.) • Different authors use different terminology. • To avoid misinterpretations or oversights in searches all articles are coded using that database’s “official” subject headings for that a given concept. Example: • If the author used any of the following phrases, the article would be coded with the official MeSH term, “Breast Neoplasms” • Used for: breast cancer, breast neoplasm, breast tumor, or breast tumors WHEN articles enter Medline or CINAHL:

6. The “Official” lists of subjects used in CINAHL and Medline are similar, but not identical. • Medlne’s official list of Subject Headings is known MeSH (Medical Subject Headings). • CINAHL uses many MeSH headings, but, over time, has added many additional Subject Headings WHEN articles enter Medline or CINAHL: • Additional topics indexed in CINAHL include: • Research methodology and instruments • Theories and models, • Nursing concepts such as “wellness”

7. MEDLINE & CINAHL Indexing Practices* * Allen M. (2006).

8. Each concept is coded only at the most specific level Example – Article focuses ONLY on Male Breast Cancer? It is onlycoded with the phrase: “Breast Neoplasms, Male” one detail about article coding: • MeSH “Subject Tree” for Breast Neoplasms • (used in both the Medline & CINAHL databases) • All MeSH subject headings : • Diseases category: Neoplasms: • Neoplasms by Site: • Breast Neoplasms • Breast Neoplasms, Male • Carcinoma, Ductal, Breast

9. Problem – Searching “Breast Neoplasms” using Ovid will only retrieve articles coded at that level . in the subject tree. It will miss the articles that ONLY discuss “Male Breast Neoplasms.” Solution – Select the Explode option to retrieve results using the selected term plus all of its more specific terms. Then “Breast Neoplasms” with Explode turned on also includes: “Breast Neoplasms, Male” “Carcinoma, Ductal, Breast” Using “explode” to retrieve articles • MeSH “Subject Tree” for Breast Neoplasms • (as used in both the Medline & CINAHL databases) • All MeSH subject headings : • Diseases category: Neoplasms: • Neoplasms by Site: • Breast Neoplasms: (EXPLODED) • Breast Neoplasms, Male • Carcinoma, Ductal, Breast

10. Selecting “Explode” in an Ovid database

11. Problem – Searching “Breast Neoplasms” will retrieve articles that mention them, regardless of whether the they are just mentioned in passing or are a major focus of the article Solution – Select the Focus option to retrieve only those results where “Breast Neoplasms” is a major focus of the article. Using “Focus” to limit to major emphasis CINAHL results (as of 1/24/2008) Breast Neoplasms= 16028 articles Breast Neoplasms (Exploded) = 16102 articles Breast Neoplasms (Exploded & Focused) = 12613 articles

12. Selecting “focus” in an Ovid database

13. CINAHL and MeSH terms are arranged in hierarchies, referred to as trees • “Exploding” subject headings adds terms below the selected term in the hierarchy • (PubMed automatically explodes subject headings and subheadings, unless user changes this default setting) Subject headings are selected for both major and minor mentions of a concept • Use “Focus” to retrieve only those articles that concentrate on that concept References: Allen, M. (2007). MEDLINE and CINAHL Indexing Practices. http://www.pegallen.net/Documents/Indexing.pdf Subject Headings -- Summary

14. Primary Research • Individual studies • Abstracts and commentaries • Need to evaluate and synthesize findings • Research is sometimes limited to specifics and results do not always apply • Evidence Summaries – Synthesis • Systematic Reviews: Integrative Reviews; Meta-Analysis • Critical Appraisal with implications for practice • Translation Literature Types of search findings For ebp

15. Proven practices, not new findings • Practice guidelines • Care plans • Critical paths • Protocols • Standards • Clinical innovations Translation Literature

16. Translation Literature • Are they evidence-based? • Just because it’s a gold standard doesn’t mean that it is common knowledge • Look for Evidence Summaries • Systematic reviews; Meta-analyses; Critical appraisals • What’s new? • Primary Research • Research Abstracts • Research in progress • Propose new research? Start with the quality-filtered resources

17. IUPUI Resources for Nursing ebp - pyramid

18. Think about question • Use of official Subject Headings • EBP filters • Explode, Indexing, Focusing • Other limits? Sample Search: What should we do to prevent pressure ulcers in our elderly patients? EBP search demonstration* *Allen, M. (2006).

19. What is the effect of Nursing care/interventionsIntervention (Predictor Variable) On Preventing pressure ulcers Given Characteristic (Outcome) For Elderly________________ Specific group of patients (Patient Characteristics) EBP Search Strategy* Sample Search: What should we do to prevent pressure ulcers in our elderly patients? *Allen, M. (2006).

20. Summary: EBP Search strategy

21. Useful Limits for Evidence-Based Searching* [PT] = Publication Type; [MH] = MeSH Subject Heading; [sb] = Subheading *Allen, M. (2006).

22. Accessing core databases • COCHRANE Reviews • Ovid • Wiley Interscience • CINAHL • MEDLINE • others MEDLINE • Ovid • PubMed • EBSCOhost • others CINAHL • EBSCOhost • Only source for CINAHL Plus • Ovid through 2008 • others

23. Questions? Read more about it: • Allen, M. (2006). Teaching clinicians to fish: Library skills for EBP [PowerPoint show]. • http://www.pegallen.net/Documents/TeachingClinician2FishWeb.pps • Allen, M. (2007). MEDLINE and CINAHL indexing practices [Handout]. • http://www.pegallen.net/Documents/Indexing.pdf