EBP Database Basics for Fibromyalgia Treatment

EBP & Database Basics
Roy Brown, MLIS
Education and Research Librarian
Tompkins-McCaw Library, VCU Libraries

CONFIDENCE IN YOUR
SEARCHING SKILLS

Objectives:
By the end of this class you will :
• Be aware of the process for doing effective research & where
it falls in the practice of EBP
• Understand the difference between keyword and subject
heading searching
• Know how to use Boolean operators & limits
• Be able to identify appropriate databases for different information
needs
Effective Searching = Less Time & Reading

• In order to keep up with what’s new in the literature, you
would have to read 43 articles a day for 365 days a year!!
Why do you need to search efficiently?

WHAT IS EVIDENCE
BASED PRACTICE?

Patient
Values
Clinical
Data/
Knowledge
Research
Evidence
Optimal
Decision
• What does the patient
want?
• What are they willing to
do?
• What does your
experience tell you?
• What has been the
experience of your
colleagues?
What does the
research say?

Evidence Based Practice Inquiry Process
Box 4
Focus
the
question
Box 6
Adequate
evidence?
Box R2
Assign /
Find
mentor
Box R3
IRB
proposal
Box R4
Data
collection
Box R5
Data
analysis
Box 7
Disseminate
Box R6
Impact
and/or
outcome
Box 1
Initial
question
Box 2
Unit
or
department
resource
Box E2
Assess
translation
of evidence
into
practice
setting
Box E3
Create
action
plan
and
implement
change
Box E4
Evaluate
outcome
and/or
impact
Box E1
Finalize team
membership
and schedule
conferences
Box E5
Report
results
to
decision-
makers
Box E6
Adopt
change
and
identify
next steps
Box R1
Contact Research
Advisory Council
or
Group (If Applicable)
Box 6
Appraisal
of
literature
Box 3
Assemble
initial
project
team
If answer is yes,
proceed to EBP
Project.
If answer is no,
proceed to research
project
Box 5
Consult
Librarian
Adapted from VCUHS Nursing Inquiry Process Diagram

Levels of Evidence Practice
Guideline

Practice Guideline
Advantages
Created by panels of experts
Based on professional published
literature
http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html
Statement produced by a panel of experts that outlines current best
practice to inform health care professionals and patients in making
clinical decisions.
 Where Can They Be Found?
o PubMed
o CINAHL
o National Guidelines Clearinghouse
Disadvantages
 Slow to change or be updated
 Not always available, espeically
on controversial topics
 Recommendations might be
affected by the type of
organization creating the
guideline

Review Articles
Review Articles
• Provide Overview of a field or subject
• Synthesize Previous Research
• Useful when you need background information and additional references
Systematic Review
• Evidence based search and review of the literature on a topic by an
established method.
Meta-Analysis
• A systematic method that takes data from a number of independent studies
and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health
Consumers)

Research Articles
• Present new and original scientific findings
• Explain research methodology and provide data
Randomized Controlled Trials (RCT’s)
Cohort Studies
Case-Controlled Studies
Studies that randomly assign individuals to
an intervention group or to a control group,
in order to measure the effects of the
intervention.
Study in which a particular outcome, such as
death from a heart attack, is compared in groups
of people who are alike in most ways but differ
by a certain characteristic
Study that compares patients who have a disease
or outcome of interest (cases) with patients who
do not have the disease or outcome (controls),
and looks back retrospectively to compare how
frequently the exposure to a risk factor is present
in each group to determine the relationship
between the risk factor and the disease.
Types of Research Articles
Cause & Effect

Selecting the Right Resource
• Research Guides
• Nursing Research Guide
• Important Databases
• PubMed/Medline (Free)
• CINAHL
• APA PsycNet/PsychInfo
• Cochrane Library
• TRIP Database (Free)
• National Guidelines
Clearinghouse (Free)
• PubMed Health (Free)
• Medline Plus (Free)
Practice
Guideline
http://guides.library.vcu.edu/nursing

The Search Process Search Steps
2.
5. Evaluate
the Results
6. Good Results = Use the Data
• Bad = Start Over
3. Choose the appropriate
database(s) or resource for
your topic
4. Perform the
Search
1. Problem/ Construct
Question
Image: http://evidencebasedhealth.blogspot.com/
Formulate Your Search
Strategy
• Synonyms for Search Terms
• Subject Heading vs. Keyword
• Boolean Operators & Limits

Starting Your Search……..Step 1
Starts with a
Problem or Need
for Information

The Problem……….
• Helping a patient to deal
with the pain/issues of
fibromyalgia
• Improve Quality of Life
Question - Brings Focus to Search of the Literature

Formulate Your Question
Question
Is therapeutic touch or guided
imagery more effective when
treating a patient with
fibromyalgia?
P I C O T T

Type of Question/ Best Type of Study
Type of Question Best Type of Study
Therapy
How to select treatments to offer patients that do more
good than harm and that are worth the efforts and costs of
using them
Randomized Control Trial (RCT)
Prevention
How to prevent a disease or condition
RCT/ Cohort Study / Case Control
Prognosis
How to estimate the patient's likely clinical course over
time and anticipate likely
complications of disease
Cohort Study/ Case Control/ Case Series or Case Report
Diagnosis
How to select and interpret diagnostic tests
Blind RCT Compared to the Gold Standard
(best treatment/test for diagnosis)
Etiology/Harm
How to identify causes for disease
RCT/ Cohort Study /Case Control
Cost analysis
Economic costs of all facets of a intervention or disease
treatment
Economic Analysis
Search Process Checklist

PICO & Breaking Search Into Concepts
Main Concepts
Break Search in Groups/Concepts
20
Fibromyalgia | Guided Imagery & Therapeutic Touch
These concepts will be used to search the databases
Find Synonyms/ Related Terms for Concepts
P I C O T T
Patient with
Fibromyalgia
Therapeutic
Touch
Guided
Imagery
Alleviating
the
symptoms of
Fibromyalgia
Therapy
RCT

What are some alternative terms…
• Guided Imagery
• Fibromyalgia
• Therapeutic Touch

Fibromyalgia Therapeutic Touch Guided Imagery

"Fibromyalgia"[Majr] OR
"Fatigue Syndrome,
Chronic"[Majr]
OR "Diffuse Myofascial
Pain Syndrome" OR
"Fibromyalgia" OR
"Fibromyalgia-
Fibromyostitis
Syndrome" OR "Chronic
Fatigue Syndrome" OR
"Chronic Fatigue and
Immune Dysfunction
Syndrome" OR
"Postviral Fatigue
Syndrome"
"Massage"[Mesh]) AND
"Therapeutic
Touch"[Mesh:NoExp]
OR “Therapeutic Touch”
OR “Laying-on-of-
Hands” OR “Reiki” OR
“Massage” OR Zone
Therap* OR Bodywork*
OR Reflexology
("Imagery
(Psychotherapy)"[Mesh]
OR Imagery OR
"Guided Imagery" OR
"Directed Reverie
Therapy" OR Hypnoses
OR Mesmerism) OR
"Hypnosis"[Mesh:NoExp
]

Background Information
• Good Sources:
1. Point-of-Care Tools
2. Government Sites
3. Google Scholar
Term/Concept Mining

Google vs. Google Scholar
 main purpose of is to
hunt for text in Web
pages
 Displays results based
on Page Rank
 Does not really cover
information contained in
library catalogs, official
government documents,
phone books, etc.
• Indexes the full text of
scholarly literature across an
array of publishing formats
and disciplines
• Includes most peer-
reviewed online journals of
Europe and America's
largest scholarly publishers
• Tends to put weight on
citation counts when
displaying search results
Falagas, M. E., Pitsouni, E. I., Malietzis, G. A., & Pappas, G. (2008). Comparison of PubMed, scopus, web of science, and google scholar: Strengths and weaknesses The FASEB Journal :
Official Publication of the Federation of American Societies for Experimental Biology, 22(2), 338-342. doi:10.1096/fj.07-9492LSF
Vine, #., & Rita. (2006). Google scholar Journal of the Medical Library Association, 94(1), 97–9.
Wikipedia contributors.Google search Retrieved, 2012,

Step 2: Formulate Your Search Strategy

Keyword
• Also called natural language searching
• Search for words or phrases found in title, abstract, or
other parts of articles
• Keyword searching used for
• New terminology
• Rare terms
• Other terms that have no related subject heading
• Spelling variations
• Truncation - Train*
• Trained, Trainer, Training, etc.
• Grouping Using “Guided Imagery”
• Use Quotation Marks
• Without Quotes – AND Terms Together
Perspective
Synonyms

All searched when searching by
keyword

All Places that are searched when
doing a keyword search in PubMed

Pepsi Coke
Pop
Soda Soda
Pop
Subject Headings/ Controlled Vocabulary
• Controlled Vocabulary – Thesaurus
• Help to return results that directly
apply to subject of the search
• Hierarchy – Tree Structure
• Broad –Specific
• Minor / Major Heading
• Major Heading - Focuses your search
results to returning articles that
specifically address the topic
• PubMed – have stars beside them
• CINAHL – Divided into Major & Minor
Headings
• Scope Note – Term Definition
Soft
Drink

May need to move backward in order to move
forward……

Searched when searching with Subject
Headings/ Controlled Vocabulary

Subject heading field in PubMed

"Fibromyalgia"[Majr] OR
"Fatigue Syndrome,
Chronic"[Majr]
OR "Diffuse Myofascial
Pain Syndrome" OR
"Fibromyalgia" OR
"Fibromyalgia-
Fibromyostitis
Syndrome" OR "Chronic
Fatigue Syndrome" OR
"Chronic Fatigue and
Immune Dysfunction
Syndrome" OR
"Postviral Fatigue
Syndrome"
"Massage"[Mesh]) AND
"Therapeutic
Touch"[Mesh:NoExp]
OR “Therapeutic Touch”
OR “Laying-on-of-
Hands” OR “Reiki” OR
“Massage” OR Zone
Therap* OR Bodywork*
OR Reflexology
("Imagery
(Psychotherapy)"[Mesh]
OR Imagery OR
"Guided Imagery" OR
"Directed Reverie
Therapy" OR Hypnoses
OR Mesmerism) OR
"Hypnosis"[Mesh:NoExp
]
Good Search – Combination of Subject
Headings and Keywords

Boolean Operators - AND
• Combines concepts
• Relationship
• Retrieves records that
contain BOTH terms
entered
Soda Pop Weight
Gain

Boolean Operators - OR
• Combines synonyms or
like concepts
• No Relationship
Necessary
• Retrieves records that
contain EITHER term
entered
Coke Pepsi

When Searching………..
Combining Terms Together
Group 1
Combine
Terms with OR
Group 2
Combine Terms
with OR
AND AND
Group 3
Combine Terms
with OR

When Searching………..
Combining Terms Together
Fibromyalgia
(SH/KW)
OR
Chronic
Fatigue
Syndrome
(SH/KW)
Therapeutic
Touch (SH/KW)
OR
Massage (KW)
AND AND
Guided
Imagery
(SH/KW)
OR
Hypnotism
(KW)

Ways to Expand Your Results Ways to Focus Your Results
• Explode Your Terms
• Keyword Searching
• Look At Related or Citing
Articles
• Major Concept/Subject
• Subheadings
• Limits
Keep in Mind……

Keep in Mind……
Break Your Search into Concepts –
Don’t Marry Early/ Let Them Date!!!!
Start Your Search Broad and Then Focus –
Don’t Put Blinders on the Horse Too Soon !!
Be sure to come up with alternative or
related terms for your topic
Always search in at least two databases.

The Search Process Search Steps
2.
5. Evaluate
the Results
6. Good Results = Use the Data
• Bad = Start Over
3. Choose the appropriate
database(s) or resource
for your topic
4. Perform the
Search
1. Problem/ Construct
Question
Image: http://evidencebasedhealth.blogspot.com/
Formulate Your Search
Strategy
• Synonyms for Search Terms
• Subject Heading vs. Keyword
• Boolean Operators & Limits

Selecting the Right Resource
• Research Guides
• Nursing Leadership Institute:
Evidence Based Practice
• Important Databases
• PubMed/Medline (Free)
• TRIP Database (Free)
• National Guidelines
Clearinghouse (Free)
• PubMed Health (Free)
• Medline Plus (Free)
• CINAHL
• APA PsycNet/PsychInfo
• Cochrane Library

TRIP – TURNING RESEARCH
INTO PRACTICE

TRIP – Turning Research into Practice
Free database free clinical search engine that searches several databases at
once. Primary function is to help identify the best available evidence when it
comes to patient care.
Results
displayed by
hierarchy of
evidence
Results
displayed
chronologically
Clinical Areas
Links to
Clinical
Trials.Gov &
PubMed
Clinical
Queries

Pub Med
Clinical Queries
Tools that allow clinicians to
quickly and easily search for
relevant clinical literature on
etiology, prognosis, diagnosis and
therapy of diseases and
diagnostics.
Not intended to be
comprehensive!!
Direct Link:
http://www.ncbi.nlm.nih.gov/pubm
ed/clinical
PubMed Homepage
Click here to access but not
before performing your search
in PubMed.

Categories of Queries:
• There are five study categories or
filters to choose from based on your
clinical question:
• Etiology - information addressing
causation/harm of disease
• Diagnosis - information addressing
disease diagnosis
• Prognosis - information addressing
disease prognosis
• Clinical prediction guidelines -
data addressing the likelihood of
disease presence or absence
• Therapy - information addressing
the treatment of disease *Note:
therapy is the search default.
Two scope categories or filters
are provided:
• narrow, specific search -- will get
more precise, relevant citations but
less retrieval
• broad, sensitive search -- includes
relevant citations but probably some
less relevant; will get more retrieval
Place the last number of
your search strategy here
or you can use
combination of keywords
Study Categories/
Scope
Displays citations for
systematic reviews,
meta-analyses,
reviews of clinical
trials, evidence-based
medicine, consensus
development
conferences, and
guidelines
Study
Results

• Health Topics
• Medical Encyclopedia
• Interactive Health Tutorials
• Drugs, Supplements, & Herbal
Information
• Current Health News
• Dictionary
• Multiple Languages - links to health
information in over 40 languages
• Directories - locations and
credentials of doctors, dentists and
hospitals
http://www.nlm.nih.gov/m
edlineplus/

• Specializes in reviews of clinical
effectiveness research
• What Works in Medical Care?
• Reviews based on systematic
reviews of clinical trials
• Information partners:
• Agency for Health Care Research and Quality
(US) (AHRQ)
• Centre for Reviews and Dissemination (CRD)
• The Cochrane Collaboration (CC)
• German Institute for Quality and Efficiency in
Health Care (IQWiG)
• National Cancer Institute (NCI)
• National Institute for Health and Clinical
Excellence guidelines program (NICE)
• National Institute for Health Research (NIHR)
Health Technology Assessment Programme
(NIHR HTA)
• Oregon Health and Science University's Drug
Effectiveness Review Project (DERP)
• Department of Veterans Affairs' Evidence-
based Synthesis Program from the Veterans
Health Administration R&D (VA ESP)
http://www.ncbi.nlm.nih.gov/p
ubmedhealth/

If You Need Help……..
• Get in touch with Me…..
Roy Brown, MLIS
Education and Research Librarian
Tompkins-McCaw Library, VCU Libraries
rebrown2@vcu.edu / Ph. 804-828-1592

EBP Database Basics for Fibromyalgia Treatment

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