Searching Ovid for an answer

Question from scenario

65-year-old male had been waking frequently at night due to urgency to void. His urologist has diagnosed Benign Prostatic Hyperplasia (BPH). In reviewing the literature alpha-antagonists also called alpha-blockers are prescribed. The patient is getting more irritable at home and is suffering from concentration problems at his high–tech job. The physician is concerned with patient compliance with his medication.

•P• I•C•O

====

65 year old male withBenign Prostatic Hyperplasia

finasteride

terasozin

most efficacious relief of BPH symptoms

PICO

• Keywords describe the main idea of your topic/concept

• Keywords are located in the Title, Author, Subject/Descriptor, Abstract, and Journal fields

• Use keyword searching when articles have not been indexed with subject headings

• Negative - Have to use synonyms (all the ways an author may have expressed and/or spelled the topic)

Ex: back pain OR back pains OR backache ORbackaches OR back ache OR back aches, OR pain, back etc.

• Negative - More articles, tends to be less relevant

Keyword Searching

How to get to Ovid

Mouse over Databases

Databases

Click on Ovid

Libraries’ home pagewww.ttuhsc.edu/libraries

Click Continue

Main Search Page

“benign prostatic hyperplasia”

Click Search

Results in thefirst search set

finasteride

Click Search

Results in thesecond search set

Click Searchfinasteride

Select sets to Combine

Click And

Boolean Logic - AND

finasteridebenign

prostatichyperplasia

AND

Results of theAND combination

terazosin

Click Search

Results of thethird search set


Click And


Results have narrowed to a

manageable number of articles

Click Display to view articles

Search Results

Articles with answer to

PICO question

EBM Journal Article Literature Databases

Note that the results are sorted by database – in this case the Cochrane Database of Systematic

Reviews

Scrolling through the results

there areresults from

ACP Journal Club

results from Database of

Reviews of Effects(DARE)

and results from Cochrane Central

Register of Controlled Trials

Cochrane Databaseof Systematic

Reviews

What is a Systematic Review?

From: Cochrane Collaboration at http://www.cochrane.org/resources/glossary.htm

Systematic reviewA review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.

Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies.

Meta-analysisThe use of statistical techniques in a systematic review to integrate the results of included studies. Sometimes misused as a synonym for systematic reviews, where the review includes a meta-analysis.

Systematic Reviews assess randomized trials and provide a comprehensive summary of the available evidence.

Over 800 international journals are searched to locate articles.a

Systematic Reviews contain all known reference to trials on a particular intervention.

Evidence is assessed with explicit quality criteria to minimize bias ensure reliability.

Trials that meet assessment criteria can be combined to produce a more statistically reliable result.

Data from studies are often combined statistically to increase the power of the findings of numerous studies, which on their own may be too small to produce reliable results.

Authors, who participate with the Cochrane Collaboration, appraise andsynthesize evidence from as many relevant scientific studies as possible.

Click EBM Topic Review

The EBM Topic Reviewis a methodological

summary of thecomplete systematic

review article

Topic reviews are prepared by an author team including subject experts, peer reviewers, librarians, methodologists,

and copy and content editors.

Article as PDF

96 pages

complete article

Search strategy done for this review.

Subject heading used in the search.

ACP Journal Club

Study categories include:aa

Prevention or treatment Diagnosis Prognosis Etiology Economics Clinical prediction guides Differential diagnosis

ACP Journal Club is a joint online journal:ACP Journal Club by the American College of PhysiciansEvidence-Based Medicine by the British Medical Journal Group

Over 100 clinical journals are screened for original studies that are methodologically sound & clinically relevant.

Information summarized in structured abstracts

include:aA

Study SelectionData Extraction

ResultsConclusions

Information summarized in structured abstracts

include:

Study SelectionData Extraction

ResultsConclusions

ACP Journal Club includes brief commentaries on:aaa

ContextClinical applications of

findings

DARE includesOver 3000 abstracts

of systematic reviews thathave been quality assessed

Reviews answer questionsabout specific interventions

Authors’ conclusionsCritical commentary

Implications

Cochrane Central

Register ofControlled Trials

Click Complete Reference

CCRT does not contain full text.Access full text through Gold Rush.

The Cochrane Central Register ofControlled Trials

3/5th’s records are from PubMedRelevant records from Embase

Other published and unpublished sources Reports from conference proceedings

The Cochrane Central Register ofControlled Trials

also searchable by PubMed’sMedical Subject Headings

Subject Heading searchesyield easier and more

accurate search results

Keywords VS Subject Headings

Subject headings:• Also called controlled vocabulary words (thesaurus) – links your

synonyms and different spellings to one word or phrase

• Standardized set of terms usually identified and defined by subject indexers

• Articles have been indexed and given subject headings

• Finds less articles but are more relevant

• Negative – May miss articles not indexed

Advanced Searching Techniques

Advanced Searching Techniques

By entering an asterisk at the end of part of a word, the computer searches for any suffix of that word:

Example: gene* can yieldgenes

generation

genetic

genetics

This is called truncation.

Other search techniques:

Can use Boolean OR to combine synonyms

Example: alpha-antagonists or alpha-blockers

or

alpha-antagonists

alpha-blockers

Possible search strategies for the

other PICO questions

Assignment

Reading AssignmentBuilding Focused, Well-Articulated Clinical Questions What makes a clinical question well built? First, the question should be directly relevant to the problems at hand. Next, the question should be phrased to facilitate searching for a precise answer. To achieve these aims, the question must be focusedand well articulated for all 4 parts of its 'anatomy' (known as PICO): 1) the Patient, population or problem being addressed

What are the characteristics of the patient or population?

What is the condition or disease? 2) the Intervention being considered which could include:exposure, diagnostic test, prognostic factor, therapy, patient perception What do you want to do with this patient? Treat, diagnose, observe?3) the Comparison intervention or exposure, when relevant

relevant most often when looking at therapy questions

What is the alternative to the intervention? Placebo, different drug, surgery?

4) the clinical Outcomes of interestWhat are relevant clinical outcomes of interest to

youand your patient? Morbidity, death,

complications?

Asking focused, four-component questions takes practice. Doing it well requires that you have insight into what you do not know, coupled with curiosity and a willingness to learn. Also, knowing how questions arise, where they come from, and how to recognize and articulate them can help you refine your skills.How do clinical questions arise? During a patient encounter, the clinician may be uncomfortable making a decision until more is known. It is recommended that you quietyour emotions while turning your implicit knowledge gaps into explicit questions.Most clinical questions arise from the following six aspects of clinical work: 1) Clinical evidence: how to gather clinical findings properly & interpret them soundly.2) Diagnosis: how to select and interpret diagnostic tests.3) Prognosis: how to anticipate the patient's likely course.4) Therapy: how to select treatments that do more good than harm.5) Prevention: how to screen and reduce the risk for disease.6) Education: how to teach yourself, the patient, and the family what is needed.

How can you recognize and formulate clinical questions as they occur? First, pay careful attention to the questions that spontaneously occur to you. Listen for the 'question behind the question.' Next, try saying your questions out loud or writing them down with all four components included. Then build your question in two steps, starting with the 'location,' such as 'my question is about therapy,' Ask yourself what type of clinical scenario would you like to consider: Therapy?

Prognosis? Diagnosis? Harm?Then, articulate all four PICO components explicitly. See the example below.What if too many questions arise? Select from the many questions the few that are most important to answer right away. Ask yourself, "What is the most important issue for this patient now? What issue should I address first? Which question, when answered, will help me most?

PICO Example:

Patient or Problem: 65-year-old man with a stroke & moderate carotid stenosis

Intervention: ASA (acetylsalicylic acid)Comparison Intervention: PlaceboOutcome: Stroke

becomes a focused, well-built question.

Focused, Well-Built Question:In a 65-year-old man with a stroke and moderate

carotid stenosis, can ASA decrease the risk of another stroke compared with no treatment? Additional PracticeIf you would like additional practice formulating articulate questions using a web tutorial go to:http://www.cebm.utoronto.ca/practise/formulate/Answering Clinical QuestionsAfter the patient care problem(s) has been articulated into a focused, well-built question, the next step is to search the literature. A variety of EBM resources will be explored in the library teaching sessions.

Taken from: The well-built clinical question: a key to evidence-based decisions by W. Scott Richardson, MD, et al. in ACP Journal Club. 1995; 123 (Nov-Dec): A-12. Centre for Evidence-Based Medicine, University Health Network, University of Toronto Libraries, (2004). Practising EBM. Retrieved May 8, 2007, from Practising EBM: FormulatingAnswerable Clinical Questions Web site: http://www.cebm.utoronto.ca/practise/formulate/ University of Washington Health Sciences Libraries, (1994-2007). Construct Well-Built Clinical Questions Using PICO. Retrieved May 9, 2007, from HealthLinks, Toolkits, Care Provider, Evidence Based Practice Web site: http://healthlinks.washington.edu/ebp/pico.html

rev.2 05/09/07

Create a PICO using the PICO Worksheet

Assessment

1) Using the PICO formulation helps to organize issues of research in clinical cases.

TrueFalse

2) The “I” in the PICO formula stands for IDEA. True False

Assessment

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