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Finding Current Best Evidence
(Penelusuran Bukti Ilmiah)
Nawang PurwantiMedical LibrarianPerpustakaan FK-UGM
Workshop Evidence-Based Practice for Doctors
SEA ORCHID Indonesia/HOGSI
Malang, 4 April 2008
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Background
Access
* Information overload - over 2 millions health
research papers published every year* MEDLINE indexes less than 25% of biomedicaljournals
*50% of health research is unpublished
*Best electronic searches identify less than 50%
RCTs Busy cliniciansproblems of keeping up-to-
date with current best evidence for the care ofpatients
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Objectives
To provide relevant information and tips informulating answerable clinical questions
To introduce the Cochrane database andPubMed as Evidence-Based Practiceresources
To show how to use the database to find
the best evidence
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Elements of EBP
Your
ClinicalExpertise
EachIndividual
Patient
The BestAvailableEvidence
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The 5 steps of EBP
Ask a clear clinical question
Search for the evidence
Appraise the evidence
Apply the results to clinical practice
Evaluate the impact on practice
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Stages in searching best evidence
1. Identify types of clinical questions
2. Formulate an answerable clinical question
PICO method3. Choose search terms
4. Develop a search strategyuse of searchingtools
5. Where to search
6. Find research evidence
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Clinical questionscentral issues in clinical work
Therapy orInterventiontreatments to patients that
- do more good than harm
- are worth the efforts and costs of using them
Prognosispatients likely clinical course over atime and complications of the disorder
Etiologycauses or risk factors of disease
Diagnosis - possible causes of patients clinicalproblems
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FROM QUESTION TO SEARCH STRATEGY
Describe each PICO element, using synonymswhere appropriate
Begin with the central element/concept Define the type of question
Use the tools of each particular databaseeg descriptors/subject headings/MeSH, filters
Add other elements of the question to limit
retrieval Examine relevant records for additional terms
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Ask a clinical question
Is ibuprofen or paracetamol betterat reducing pain and fever inchildren?
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PICO method
P : Children with pain and fever
I : Ibuprofen
C : Paracetamol
O : Reduction in pain and/or fever
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Reformatted clinical question
P: In children with pain and fever
I: is ibuprofen
C: compared with paracetamol
O: more effective at reducing pain or fever?
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From Question to Search Terms
Search Terms Alternatives
Patient
Intervention
Comparison
Outcomes
ChildPainFever
Ibuprofen
Children, infant, infants
Febrile
Paracetamol AcetaminophenPainFever Febrile
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Points to remember when choosing searchterms
Search terms are specific
They belong to a controlled language, as
found in MeSH (medical subject heading orthesaurus)
MeSH available in both the Cochranedatabase and PubMed
Always consult MeSH or thesaurus to identifyappropriate search terms
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Searching tools
Boolean operators
AND, OR and NOT
Truncation
Grouping/Nesting
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Searching tools - Boolean Operators AND -narrowing
warna
A AND B
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Searching tools - Boolean Operators OR -broadening
AOR B
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Searching tools - Boolean Operators NOT -excluding
A NOT B
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Searching tools - Truncation
Symbol of truncation *
Exampleschild* = child, or
children
childcare
childhood
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Searching toolsGrouping/nesting
Symbol of grouping ( )
Examples
(fever OR febrile)
(paracetamol OR acetaminophen)
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Bringing them together
Children with
pain and fever
Paracetamol Ibuprofen
The answer
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Search Phrase
Search Terms
Patient (child* OR infant*) AND (pain OR(fever* OR febrile))
Intervention ibuprofen
Comparison (paracetamol OR acetaminophen)
(child* OR infant*) AND (pain OR (fever* OR febrile))AND ibuprofen AND (paracetamol OR acetaminophen)
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Why bother?
Search Phrase
Pubmed
3/27/08
(child* OR infant*) AND pain OR (fever* OR febrile) ANDibuprofen AND (paracetamol OR acetaminophen)
(child* OR infant*) AND pain OR (fever* OR febrile)
AND ibuprofen
(child* OR infant*)
(child* OR infant*) AND pain OR (fever* OR febrile)
PubMed Clinical Queries Systematic Reviews
1884467
166801
457
225
13
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What to look for?
The paper where someone trustworthy
has already answered yourquestion
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Primary & Secondary Research
Primary research research undertakento address a question
Secondary research researchundertaken to find the existing primaryresearch that addresses a question
reviews (systematic, narrative) and meta-analyses
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Narrative vs Systematic Reviews
Narrative review
Opinion with illustrations from the literature
Cannot appraise Not trustworthybecause potential sources of bias
cannot be assessed
Systematic review
Rigorous research methodology
Objective review of all the evidence
Can be appraised like other research
Trustworthy because potential sources of biascan be assessed
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What type of research to look for?
If your question is about: Look for a systematic review
or
Intervention / Therapy Randomised Controlled Trial(RCT)
Diagnosis / Screening:
- Accuracy Cohort studies
- Health outcomes RCT
Prognosis Longitudinal cohort studies
Aetiology / Risk factors RCT, cohort or case-controlstudies
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Where to search?
The Cochrane Library(www.thecochranelibrary.com)
collection of databases of high quality information
about healthcare interventions, includingsystematic reviews.
PubMed Clinical Queries (www.pubmed.gov)
specialised MEDLINE search engine with built-insearch filters designed to find high quality studies in
four study categories: therapy, diagnosis, aetiology and prognosis
systematic reviews
http://www.thecochranelibrary.com/http://www.pubmed.gov/http://www.pubmed.gov/http://www.thecochranelibrary.com/8/2/2019 EBMmalang_dokter
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www.thecochranelibrary.com
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www.pubmed.gov
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Other sources
National Guideline Clearinghouse (NGC) - apublic resource for evidence-based clinicalpractice guidelines
(www.guideline.gov)
Canadian Medical Association - voluntaryassociation of physicians that advocates onbehalf of its members and the public for accessto high quality health care, and provides
leadership and guidance to physicians.)(www.cma.ca)
BMJ Clinical Evidence(http://clinicalevidence.bmj.com)
ACP Journal Club (www.acpjc.org)
http://www.guideline.gov/http://www.cma.ca/http://clinicalevidence.bmj.com/http://www.acpjc.org/http://www.acpjc.org/http://clinicalevidence.bmj.com/http://www.cma.ca/http://www.guideline.gov/8/2/2019 EBMmalang_dokter
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www.guideline.gov
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www.cma.ca
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cma clinical practice guidelines
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BMJ Clinical Evidence
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ACP Journal Club
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Conclusion
Use PICO method to formulate clinicalquestions
Consult and use terms available in MeSH to getthe appropriate search terms
Develop search strategy using search toolsprovided
Activate search history (if available) to helprevise search
Practice makes perfect. Asah ketrampilandengan banyak berlatih. Selamat mencoba.
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Searching practice
Go to www.thecochranelibrary.comand www.pubmed.gov
Use the sample search phrase (child* ORinfant*) AND (pain OR (fever* OR febrile)) ANDibuprofen AND (paracetamol OR
acetaminophen) and find out the result
How do they differ?
http://www.thecochranelibrary.com/http://www.pubmed.gov/http://www.pubmed.gov/http://www.thecochranelibrary.com/