Pediatric Fellowship Course Seminar Series 2013

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Pediatric Fellowship Course Seminar Series 2013. Health Sciences Library Resources: Searching Questions and Identifying Research February 11, 2014 Janice Lester, MLS Reference and Education Librarian - LIJ Health Sciences Library. Objectives/Outcomes for this session: .
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Pediatric Fellowship Course Seminar Series 2013 Health Sciences Library Resources: Searching Questions and Identifying Research February 11, 2014 Janice Lester, MLS Reference and Education Librarian - LIJ Health Sciences Library Objectives/Outcomes for this session: 1. Identify a clear structured searchable question. 2. Execute an appropriate search strategy to search the literature for specific types of study designs based on the topic. 3. Determine appropriate resources to answer background or foreground information questions. Session Timeline: 7:30-7:45Learning Objectives and Creating a Searchable Question 7:45-8:00Finding Library Resources and the Evidence Pyramid 8:00 – 8:30Effective PubMed Search Techniques and Q&A Tips When Searching
  • Be Methodical
  • Leave yourself adequate time to search…But don’t spend too much time doing it
  • Document where you searched, what you searched and when you searched
  • Store all of your citations in the same place (EndnoteWeb or Zotero)
  • Seek help when you need it, but do not wait until the last minute
  • Steps of Basic Research 1. Create an answerable research question 2. Break your research question into searchable components 3. Choose the database 4. Generate subject headings and synonyms 5. Execute your search and select limiters 6. Analyze your search results, modifying and re-executing searches as needed 7. Review the Articles Background Versus Foreground:Experience Determines Need Background Questions - About conditions Foreground Questions - About choices Create an Answerable Research Question based on your Hypothesis Know the difference between background and foreground questions. Background Questions: Ask for general knowledge about a condition or thing. Have two essential components:
  • A question root (who, what, when, etc.) with a verb
  • A disorder, test, treatment, or other aspect of healthcare
  • Foreground Questions: Ask for specific knowledge to inform clinical decisions or actions.
  • Usually have 3 or 4 essential components
  • Patient and/or problem
  • Intervention
  • Comparative intervention (not always needed)
  • Clinical outcome
  • Break your research question into searchable components Hypothesis PICO
  • Patient/Population – Includes age, race, sex, geography
  • Problem – Current health concern
  • Intervention – Exposure of interest
  • Comparison – Alternate exposure (if any)
  • Outcome – What is the desired outcome? Does this mean that every research question can/should be answered this way?
  • Creating the Question Hypothesis Create one sentence (elevator statement) that epitomizes what concept you are looking to search which includes PICO elements. Does giving Prophylactic Acetaminophen to infants (age 2 months) after immunizations decrease sleep duration compared to a placebo? What are our PICO Elements? Bad Question Hypothesis What is the best way to treat children with asthma?
  • Best how? Fewer asthma attacks? Less severe attacks? A treatment that is cheaper? Fewer side effects? Fewer adverse reactions with other medications?
  • What type of asthma? Chronic? Exercised Induced?
  • How are we diagnosing asthma and who is doing it?
  • Best compared to what? What type of treatment are we considering?
  • Is there a more specific age group that we are addressing?
  • Are we measuring any of these concerns? If so, how?
  • Good Question Hypothesis Among young children with acute asthma exacerbation, is a single dose of IM dexamethasone comparable to five days of oral prednisolone for resolution of asthma symptoms? More detail is usually better; not always possible, but generally better. Selecting and Searching the Databases Hypothesis Wait a minute… Where did you say the databases are again? Accessing EMIL from Hypothesis Healthport Access through LIJMC/CCMC Hypothesis Finding e-textbooks on EMIL Hypothesis by subject – eg. Pediatrics Finding journals and books by subject Hypothesis Finding journals – e-Journal portal 360 Link-search by Hypothesis Pubmed or DOI Pediatric Care Online Hypothesis ACP Journal Club summarizes the best new evidence for internal medicine from over 130 clinical journals accessible through ‘E-journal portal’ on EMIL
  • Example of a Point of Care - Evidence Based Clinical Database
  • Available Remotely
  • Tutorials Available
  • Can be accessed through mobile devices
  • Locating DatabasePubmed and OvidSP PubMed Database is Useful For the Following:
  • When searching for the newest information (pre-pub)
  • Very obscure cases [bot fly]
  • Special types of articles (case reports, trials)
  • Articles that have been corrected or retracted
  • Limiting by specific factors, like females and age
  • Seeking Higher Levels of Evidence and specific search filters
  • Access DatabasePubMed Through HealthportNot the Internet Tutorials Back to Our Clinical Questions… Database Find all of the searchable elements of the sentence. Then look up the appropriate subject headings and two synonyms (usually). If you can’t find the exact subject heading, do the best you can. If you need more than 2 synonyms, add them. Our Question Database Will providing patient education reduce admissions for head trauma caused by parental abuse or neglect of children? PICO PATIENT = Children PROBLEM = Parental abuse INTERVENTION = Patient Education COMPARATIVE = No Action (In other Situations Watchful Waiting/Placebo) OUTCOME = Reduce Head Trauma Admissions How to find Subject Headings and Synonyms Database
  • MeSH Database
  • Pearl Growing
  • Abstract view of PubMed results or other articles
  • Synonym generation
  • Plurals
  • Hyphenation
  • Different Spellings (British)
  • Narrow MESH Headings
  • Synonyms – Why you should use them Database BUT 2476 Results In a PubMedGeneral Search 2000-2014: Nosebleed – 3745 Results Nose Bleed – 3748 results Nosebleeds – 120 results Epistaxis (MeSH) – 2385 results Generate Subject Headings and Synonyms Database Will providing patient education reduce admissions for head trauma caused by parental abuse or neglect of children? PICO Children = This is a limiter so we do not necessarily need a Subject term- It depends on the database. Parental abuse = Child Abuse OR child neglect OR infant abuse OR child maltreatment Patient Education= Patient Education as Topic OR parent education OR education of patient OR patient education Head Trauma= Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome PubMed Database Regular PubMed can be searched two ways:
  • Creating one large search.
  • Doing smaller searches and adding them together later. (Child Abuse OR child neglect OR infant abuse OR child maltreatment) AND (Patient Education as Topic OR parent education OR education of patient OR patient education) AND (Craniocerebral Trauma OR head injuries OR head trauma OR head injury OR shaken baby syndrome) PubMed Clinical Queries can also be searched both ways, but the second way tends to be a little more difficult.
  • Database Filter and Study Design Database Before you search the PICO elements of your clinical question, it’s important to know:
  • What TYPE of question are you asking?
  • What is the best STUDY DESIGN to search for to find evidence to answer your clinical question?
  • What Kind Of Question is This? Database As a physician, you would like to know the prevalence of headaches three and 12 months after mild, moderate or severe traumatic brain injury (TBI) in children ages 5 to 17. Which of the following clinical query filters would you want to apply to receive the most relevant and specific results?
  • Etiology
  • Therapy
  • Prognosis
  • Diagnosis
  • Clinical prediction guidelines
  • The prognosis filter in DatabasePubmed Clinical Queries automatically applies a specific search strategy (prognos*[Title/Abstract] OR (first[Title/Abstract] AND episode[Title/Abstract]) OR cohort[Title/Abstract]) to the search terms entered in order to retrieve article and study types that best address the concept of prognosis. In this case we are interested in following the course of the disease (TBI) to see what the outcome and frequency of headaches will be in these patients. This is different from etiology/harm how? Execute Your Search Database
  • Execute your search and select limiters if needed
  • Select the appropriate filter Advanced search building and limiters may depend on Database.
  • Limit DatabaseYour Search Analyze Your Search Results Database This may be the point where you discover that you either have too many results or too few (or off topic results).
  • Too Many - Apply more or stricter limiters, look for higher levels of evidence or make search terms more specific.
  • Too Few (or off topic) – Remove any limiters, execute a general PubMed search, add search terms or generalize search terms (think drug class as opposed to specific drug)
  • Read the Abstracts/Review Articles Database At this point you should be able to discover some basic information about the results by looking at the titles and abstracts. Look to see what type of results you have, and whether it suits your purpose. Does this mean that you have found everything ever written because you searched in Pubmed? Of course not. Database In most cases, if you are doing searching that is clinical or research based you will not be doing yourself a disservice simply searching Pubmed. If, on the other hand, you are writing a literature review, systematic review, or meta-analysis you may also need to search grey literature, which includes conference proceedings, institutional publications, white papers, unpublished trials, and foreign language journals. New Resources Database
  • Visual DX
  • Web Of Knowledge
  • Visual DX Differential Builder-by lesion Database Web of Knowledge Database Journal Citation Reports will organize journals by impact factor Journal Citation Reports Database Web of Science Database Cited 18 times Web of Science Database Web of Science- Citation map – Backward and Forward Database Web of Science- Citation Map EMIL Mobile Database EMIL MOBILE provides 24 hour mobile access (iPhone, iPads, Android…) to all library resources. Over 10,000 medical journals, nursing literature, evidence based databases, literature search requests and many other resources are available. To access EMIL Mobile: go to Healthport via RAP, enter your Universal ID/password and click on EMIL. See handout For NSLIJ owned devices contact [email protected] Perceptions can be Deceiving Database References Database Straus SE. Evidence-based medicine: How to practice and teach EBM. Edinburgh: Elsevier/Churchill Livingstone; 2005. Guyatt G. JAMA's users' guides to the medical literature: A manual for evidence-based clinical practice. New York: McGraw-Hill Medical; 2008. Moyer V. Weighing the evidence: PICO questions: What are they, and why bother? AAP Grand Rounds 2008 Jan; 19(1): 2.
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