Finding the evidence

The EBM steps

Patient encounter

Formulate clinical questions

Searching the evidence

Appraising the evidence

Applying the evidence

Outline

Which database/search engine?

Getting started

Tips & tricks

Databases in clinical medicine
Which database should I use?

Database Address Remarks Accessibility

Database of choice for Free citations &

Pubmed http://www.cochrane.org/
beginning search abstracts

More European, non-english, & Subscription

Embase http://www.embase.com/
drug therapy journals required

Covers Pubmed & Embase Subscription

Scopus http://www.scopus.com/
articles since 1996 required

Cochrane http:// Collection of systematic review/ Free abstract/

library www.thecochranelibrary..com/ meta-analysis summary
Getting started

Define your topic:

as completely and succinctly as possible

what are you looking for: clinical question (PICO)

what are you not looking for

Determine keywords

Enter keywords into database search engine

Use modifiers as needed

Keywords

Extracted from the clinical question

Most users submit 1.5 keywords per search, not enough for
an eective query.

Recommended maximum is 6 to 8 carefully chosen words,

preferably nouns and objects.

Search engines consider articles (the, a, an) and pronouns

clutter.

Avoid verbs: treatment rather than treating

Determining keywords: practical example

A mother came into your practice bringing her 5 year old child with fever.
She asked you about the most eective drug for relieving fever. She was
using acetaminophen but thought that it did not help her child so much.
Her friend suggested using the combination of acetaminophen and
ibuprofen. What is your suggestion?

Clinical question:

In children with fever, does the combination of acetaminophen and

ibuprofen is better than acetaminophen alone in shortening the duration
of fever?
Extracting keywords

Patients/
Intervention Comparison Outcomes
Problems
6
acetaminophen 1
children with acetaminophen duration of
and ibuprofen
4 fever 2 alone fever
combination
5
3
pediatric alternate paracetamol febrile
Entering keywords

Combining keywords: Boolean basics

(named after George Boole, the 19th-century mathematician)

Powerful technique to narrow or expand your search to a reasonable

number of results, and increase the chance of those results being
useful.

Simple & eective. The three most commonly used Boolean commands
(or "operators") are AND, OR and AND NOT.
The Boolean basics fever AND acetaminophen

AND means "I want only

documents that contain
both/all words.

fever acetaminophen

OR means "I want

documents that contain
either word; I don't care
which."

fever OR acetaminophen
Use OR to string together
synonyms
The Boleean basics

AND NOT (NOT, BUT NOT)

means "I want documents fever AND acetaminophen NOT adult
that contain this word, but
not if the document also
contains another word."

AND NOT only applies to the

fever adult acetaminophen
word or phrase that
immediately follows it.

Before you apply AND NOT,

see what results you get
from a simpler search
General structure

(Intervention OR synonym 1 OR ) AND

(Comparator OR synonym 1 OR ) AND

(Outcome OR synonym 1 OR ) AND

(Population OR synonym 1 OR ) AND

Our example

Keywords:

Acetaminophen (paracetamol), ibuprofen, combination (alternate), fever,

duration, child (pediatric)

Combining keywords:

(acetaminophen OR paracetamol) AND ibuprofen AND (combination OR

alternate) AND fever AND (child OR pediatric)
Search in the Pubmed

Entering
keywords
Search in Pubmeds: limits
Type of studies

Question Best study design

Intervention Randomized controlled trial (RCT)

Etiology and risk factor RCT

Cohort study

Case-control study

Frequency and rate Cohort study

Cross-sectional study

Diagnosis Cross-sectional study with random or

consecutive sample

Prognosis and prediction Cohort/survival study

Search in Pubmed: Clinical Queries

Check the question

type

Check the
emphasis
Our example
Quick tips

Use nouns as query keywords.

Spell carefully and consider
alternate spellings
Never use articles ("a," "the"),
pronouns ("he", "it"),
conjunctions ("and", "or") or Avoid redundant terms
prepositions ("to", "from")

Use 6 to 8 keywords per query Check the "Help" function of the

particular search engine

Where possible, combine

keywords into phrases by using
quotation marks, as in "solar
system"
Conclusions

A successful Internet search can take several tries.

But remember: it's estimated that there are between 200 and 800 million
documents online- with no master system for organizing this information!

No wonder eective searches take knowhow, patience and ingenuity

Thank You

LEARN THROUGH PLAY

TRY ALL BUTTONS
MAKE LOTS OF MISTAKES
HAVE FUN
Exercise

Four-year old boy diagnosed with bacterial meningitis is admitted to your

ward. Serology tests indicate the infection with H. influenzae. After taking
blood samples for haemoculture, you decide to treat your patient with
antibiotics. You know that in some cases bacterial meningitis can lead to
partial or total hearing loss, and you think you have read somewhere that
treatment with dexamethasone can reduce the risk of hearing loss.

You prescribed Azithromycin for pharyngitis to a preschool child. His

mother wants to know about the harmful eects of Azithromycin.

Mother of a 16-year old boy comes to your general practice oce and
asks you about the adverse eects of ecstasy. She heard that it can
damage brain functions. She thinks that her son is using ecstasy and she
is really concerned about his health. She asks you for some evidence
about the adverse eects of ecstasy to convince him to stop using it.