Eskind Biomedical Library Resources and Services

Cardiovascular Perfusion Technology

Elizabeth Frakes, MLISRachel Walden, MLIS August 2015

Objectives • Searching the Biomedical Literature• PICO• Boolean Operators• Controlled Vocabulary

• Eskind Biomedical Library Resources and Services• CINAHL• Digital Library• Acorn• UpToDate• Clinical Key• Micromedex

Why do we Search the Medical Literature?

Patient

Clinical

Education

Research

BestPractices

Levels of Evidence

EBM Definition

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”

- Dave Sackett

Patient Concerns

Clinical Expertise

Best Research Evidence

= Evidence Based Medicine

EBM

• Clinical problem• Formulate a clinical

question• Find best evidence• Validity of evidence• Determine results• Apply to patient

• Assess• Ask

• Acquire• Appraise• Appraise• Apply

Asking the Question: PICO• Patient, Population or Problem • What are the characteristics of the patient or population? • What is the condition or disease you are interested in?

• Intervention or exposure • What do you want to do with this patient (e.g. treat,

diagnose, observe)? • Comparison • What is the alternative to the intervention (e.g. placebo,

different drug, surgery)? • Outcome • What are the relevant outcomes (e.g. morbidity, death,

complications)?

http://healthlinks.washington.edu/ebp/pico.html

Question

What is the efficiency of ECMO to treat respiratory failure in

newborns and babies?

Clinical Question

Patients: Newborns and Babies

Problem: Respiratory Failure

Intervention: Extracorporeal Membrane Oxygenation

Comparison: None

Outcome: Survival, condition improvement

Boolean Logic

In the context of database searching, Boolean logic refers to the logical relationships among search terms.

• The Boolean operators AND, OR, NOT can be used to combine search terms in PubMed and other databases.• Boolean operators must be entered in uppercase

letters in most databases.

Source: http://www.nlm.nih.gov/bsd/disted/pubmedtutorial/020_350.html

AND

BOTH terms included in any results.

If a record has only one of the two terms, it will not be retrieved.

If the record has neither term, it will not be retrieved.

What does this do to the amount of records retrieved?

AND

OR

‘OR’ will retrieve articles if either concept is included.

What does OR do to the amount of records retrieved?

NOT

Excludes any results containing the term

Records containing both will not be retrieved.

What does NOT do to the amount of records retrieved?

NOT

Using AND“AND” groupings contain terms for different

ideas/concepts and can combine OR groupingsTerm AND (Term OR Term) where each represents a

different concept

“respiratory failure” AND “extracorporeal membrane oxygenation”

(“respiratory failure” OR “respiratory insufficiency”) AND “extracorporeal membrane oxygenation”

Using OR“OR” groupings contain terms for the same

idea/concept and are usually put in parenthesis

(term OR term OR term) where all terms are difference ways of

representing the same concept

(“respiratory failure " OR "respiratory insufficiency” OR “respiratory depression”)

Using NOT

“NOT” statements are usually put last and is often used to get rid of a common subgroup

“respiratory failure” NOT “respiratory paralysis”

Controlled Vocabulary• A controlled vocabulary is an established list of standardized

terminology for use in indexing and retrieval of information. • It ensures that a subject will be described using the same preferred

term each time it is indexed and this will make it easier to find all information about a specific topic during the search process.*

• Examples:• Medical Subject Headings (MeSH)• CINAHL Headings• PsycInfo Thesaurus

*http://stats.oecd.org/glossary/detail.asp?ID=6260

Example: many words can be used to represent the concept "people who teach" teachers faculty instructors professors tutors educators lecturers, etc.

in a controlled vocabulary one of these will be chosen to represent the concept

MeSH = Faculty Faculty, Dental Faculty, Medical Faculty, Nursing, etc.

• MeSH is a vocabulary of medical and scientific terms assigned to most documents in PubMed • Some MeSH terms are designated as Major Topic• Some MeSH terms have an additional subheading –

added with an intervening slash ('/') character• MeSH terms are Exploded- finds not only the documents

indexed under that term, but also all documents indexed using more specific terms that are included in the meaning

PubMed MeSH Database

PubMed

PubMed Field Tags

Affiliation [AD] Article Identifier [AID] All Fields [ALL] Author [AU] Author Identifier [AUID] Book [book] Comment Corrections Corporate Author [CN] Create Date [CRDT] Completion Date [DCOM] EC/RN Number [RN] Editor [ED] Entrez Date [EDAT] Filter [FILTER] First Author Name [1AU] Full Author Name [FAU] Full Investigator Name [FIR] Grant Number [GR]

Investigator [IR] ISBN [ISBN] Issue [IP] Journal [TA] Language [LA] Last Author [LASTAU] Location ID [LID] MeSH Date [MHDA] MeSH Major Topic [MAJR] MeSH Subheadings [SH] MeSH Terms [MH] Modification Date [LR] NLM Unique ID [JID] Other Term [OT] Owner Pagination [PG] Personal Name as Subject [PS]

Pharmacological Action [PA] Place of Publication [PL] PMID [PMID] Publisher [PUBN] Publication Date [DP] Publication Type [PT] Secondary Source ID [SI] Subset [SB] Supplementary Concept[NM] Text Words [TW] Title [TI] Title/Abstract [TIAB] Transliterated Title [TT] UID [PMID] Version Volume [VI]

Search Strategy with Controlled Vocabulary

("Extracorporeal Membrane Oxygenation"[Mesh] OR "ECMO"[tiab] OR "extracorporeal Membrane oxygenation"[tiab]) AND ("Respiratory Insufficiency"[Mesh] OR "respiratory failure"[tiab] OR "Respiratory Insufficiency"[tiab]) AND "infant"[MeSH Terms] AND "Treatment Outcome"[Mesh]

In Summary

1. Identify the concepts (Parse the question)2. List specific terms for each concept3. Put the terms for each concept in OR statements within

parentheses4. Combine OR statements with AND5. Add any NOT statements to the end

Library Resources & Services

CINAHLThe Cumulative Index to Nursing and Allied Health Literature

provides access to the literature of nursing and other allied health specialties such as:

patient educationoccupational and physical therapysocial servicesemergency servicessurgical technologyand related fields

limited to 8 concurrent users can be accessed on mobile devices

UpToDate

• Adult and Pediatric Emergency Medicine

• Adult Primary Care• Allery and Immunology• Anesthesiology• Cardiovascular Medicine• Dermatology• Drug information• Endocrinology and Diabetes• Family Practice and General Practice• Gastroenterology and Hepatology• General Surgery• Geriatrics

• Gynecology

• Hematology• Hospital Medicine• Infectious Diseases• Nephrology and Hypertension• Neurology• Obstetrics and Women's Health• Oncology• Palliative Care• Pediatrics• Pulmonary and Critical Care

Medicine• Psychiatry• Rheumatology• Sleep Medicine

Topics Include:

Clinical Key

Virtual Medical Library• Journals• Books• Clinical guidelines• Drug information•Multimedia resources• Patient education materials

images to use in presentations

Micromedex

• Toxicology• Drug interaction• Contraindications• Clinical effects• Dosing• Calculators• RED BOOK Online® Search

Cochrane Library

• Systematic Reviews (Cochrane Reviews)• Database of Abstracts of Reviews of Effects (Other Reviews)• Central Register of Controlled Trials (Clinical Trials)• Health Technology Assessment Database (Technology

Assessments)• NHS Economic Evaluation Database (Economic Evaluations)

Allows • Keyword and phrase searching • Boolean Operators

Embase• provides citations to the international journal literature on a

variety of drug-related topics• Including therapeutic use, physiologic effects, pharmacology,

and adverse effects

Allows • Keyword searching, and map term to subject heading• Can limit by Routes of Drug Administration• Can exclude Medline articles

Limited to 2 concurrent users.

Endnote Tutorial

Contact Information

Elizabeth Frakeselizabeth.frakes@vanderbilt.edu

Rachel Waldenrachel.l.walden@vanderbilt.edu

Eskind Biomedical Library615.936.1410http://www.mc.vanderbilt.edu/diglib/

Vanderbilt Libraries615.322.7100http://www.library.vanderbilt.edu/