General Rules

Resources

Customized Search Engines

Search at the point of care

Alert Services

Search strategy

Tips for searching

EBM tools proliferating

Deciding on “right” tool(s) is difficult as

products vary in

Complexity

Content

Accessibility

Intended audience.

Keep it simple

Resources they can access:

Free is better

Subscribed by their institute

Accessible at the point of care

You need to select from among

sources, not to include all of them

Select a framework

I. Primary Research Sites

PubMed

Ovid

SUMSearch

Google Scholar

Medline II. Sites to assist in interpreting

the data (EBM toolkits):

University of Alberta EBM

site

University of Toronto EBM

site

New York Academy of

Medicine EBM Initiative

Society of General Internal

Medicine site III. Sites with “Ready Synthesized

Data”

National Guideline Clearing House

Cochrane Database

Bandolier

ACP Journal Club

PIER

Society of General Internal Medicine

Website

•National Guideline Clearinghouse

•PubMed

•Agency for Healthcare Research and

Quality (AHRQ)

•Health Services/Technology Assessment

Text

•www.guideline.gov

•A public resource for evidence-based practice

guidelines.

•Conduct a keyword search OR browse by disease/condition, treatment/intervention

•Homepage contains weekly news updates on

recently submitted guidelines that have either been

reviewed or are new to the database

•FDA Advisories – on recent changes or alerts on

prescription drugs

www.pubmed.gov

•A free, public database of clinical/biomedical abstracts

•Includes over 4,800 journals

•Provided by the National Library of Medicine (NLM) &

the National Institutes of Health (NIH)

•Can search on any medical topic in this database

•Provides a tutorial & help section to guide you through a

PubMed search.

•Can begin with general keywords OR use the Medical

Subject Headings

•Limits tab is very helpful when searching the

database. Use it and become familiar with it.

What publication dates? Historical or recent?

Only in the last 5 years What language? What journal subset?

•Contains Subsets of Journals: good for

narrowing your journal selections

•Clinical Queries feature:

for searching evidence-based literature –

RCTs and clinical reviews – built-in

search feature that limits search results.

•Simplifies method entering your

keywords, selecting category (therapy,

diagnosis, prognosis, etc.) and scope –

PubMed will do the rest……

•Cochrane Reviews

•DynaMed

•Up-To-Date

•InfoRetreiver

•Clinical Evidence

www.cochrane.org

•Updated collection of EBM Databases

•based on the best available information about

healthcare interventions

•They explore the evidence for & against the

effectiveness & appropriateness of treatments

(medications, surgery, education, etc) in specific

circumstances.

•Published on a quarterly basis & made available both

on CD-ROM & the Internet

•Can browse & search abstracts of reviews free of

charge

•Cochrane reviews relevant to reproductive

health can also be found in the WHO

Reproductive Health Library, which is available

free of charge to health workers in developing

countries by e-mailing RHL@who.ch.

•The premier resource for systematic reviews

(and RCTs) is the Cochrane Library, which

should be searched first.

•The Cochrane Library contains the following

components for searching for systematic

reviews. 1. Cochrane Database of Systematic Reviews

(CDSR)

2. Database of Reviews of Effectiveness (DARE)

3. Health Technology Assessment Database (HTA)

Is there a Cochrane Review? Is there a non-Cochrane Review?

Are there any trials?

Level of Evidence labels

On the left is the outline – a very good way to navigate through the topic review.

FOCUS here to find answers to the questions or problems.

•Tripdatabase

•Google Custom Search

Desktop computer Cochrane Library

Up-to-Date

Dynamed

Clinical Evidence

Stat!-Ref

InfoRetriever

Handheld computer InfoRetriever

PDR, Lexi-Comp Drug Database, 5-min. Clinical Consult

Low tech Wall charts, pocket cards, and bulletin boards

Pearl books

Daily InfoPoem,

BMJ update,

Pub Med.

should have a systematic &

structured approach to achieve a

high degree of comprehensiveness

and to avoid bias in selection of

studies.

1. Formulate clinical question(s)

2. Search for guidelines, If no relevant guidelines

3. Search for systematic reviews using:

- the internet

- the Cochrane Library

- other databases

4. Search for primary studies using:

- the Cochrane Library

- Medline and EMBASE

- CINAHL, BNI and MIDIRS

- Science Citation Index

- other databases

•National Guidelines Clearinghouse:

www.guideline.gov/index.asp

•Turning Research Into Practice (TRIP):

http://www.tripdatabase.com/

•RCOG: http://www.rcog.org.uk/ •Guidelines in O&G:

http://archive.uwcm.ac.uk/uwcm/lb/pep/maternal/index.html

•http://matweb.hcuge.ch/matweb/endo/cours_4e_mreg/obstetrics

_guidelines.htm

•National Electronic Library for Health: http://www.nelh.nhs.uk/

•OMNI: http://omni.ac.uk/ (click advanced search and specify:

Practice Guidelines in Resource Type)

•CMA Infobase: http://www.cma.ca/cpgs/

•Guidelines and Guidelines in Practice:

http://www.eguidelines.co.uk/

If no relevant reviews are located on the Cochrane Library

the next step is to search alternative sources that

summarise and appraise systematic reviews.

These include the journals

1. The internet service TRIP should be searched,

as it covers both UK and US evidence-based

reviews as well as guidelines. 2. ACP Journal Club and Evidence Based Medicine,

which are also searchable on the electronic database

Best Evidence.

3. Clinical Evidence published by the BMJ is a high-

quality text that should also be searched; it

summarises the results of reviews and other levels of

evidence to answer specific clinical questions.

4. Medline and EMBASE will also need to be searched

for increased comprehensiveness.

Search Cascade

Decide the TYPE of question (Rx, Dx, Px,

…)

Chose the right database for the type of

question, e.g.,

Intervention: Cochrane Library, PubMed, …

Diagnostic: Common Diagnostic Strategies (in

BE), or PubMed: Clinical Queries

Prognosis, Etiology: PubMed: Clinical Queries

•Combining Terms - AND

Use AND to combine similar concepts &

to narrow your search results

sleep deprivation AND ICU

•Use simple search terms

• Check spelling

• Use quotation marks around exact

phrases

• Use search limits

(Population OR synonym 1 OR …) AND

(Intervention OR synonym 1 OR …) AND

(Comparator OR synonym 1 OR …) AND

(Outcome OR synonym 1 OR …) AND

FILTER (for best study type)

AND = both terms

OR = either term

Use OR to join terms to broaden search

results

ICU OR Intensive Care Unit

NOT = not this term

(ADJacent, NEAR, … = AND + close)

* George Boole (a man) is claimed to have invented “logic”

If you want

cheese AND fruit

Which do you ask for?

cheese AND (apple OR pear OR melon)

(cheese AND apple) OR pear OR melon

What does PubMed do with if AND and OR?

Cheese AND apple OR pear

(Look at DETAILS tab)

Search on Title only

Eg [ti]

(Others are [au] - author; [so], [yr], …)

‘Related Articles’ button

(PubMed)

Previously identified study (PubMed)

Look for the MeSH terms

MeSH browser

Thank you Aboubakr elnashar