SEARCHING THE EVIDENCE

Step in EBM
• Formulate an answerable question
• Track down the best evidence
• Critically appraise the evidence
• Individualize, base clinical expertise and patient concerns
• Evaluate our effectiveness and efficiencykeep a record,
improve the process
Online Medical Information
Resource
• https://www.ncbi.nlm.nih.gov/pubmed
Learning through
• Try all buttons
• Make lots mistake
• Have fun
Step searching in PubMed
1. Formulate a focused PICO question
2. Define keyword
3. Identify the type of article that is most likely to answer your
question:therapy, diagnosis, harm, etc
4. Identify the design that is most likely to answer your
question: RCT, cohort, cross section, case control, etc
5. Always try to find systematic reviews
6. Use MeSH or Thesaurus or text word for searching
7. Combine concepts with Boolean operators(AND/OR/NOT)
8. Limiting to age, sex, language, year of publication, etc
9. Evaluate search result
10. Use ‘’Related Articles” link option
The PICO model
• P atient, P opulation, (Clinical) Problem
• I ntervention (or Indicator or Index test)
• C omparison ( be brief and spesific)
• O utcome
Type of study
QUESTION Best atudy design
Intervention Randomised controlled trial (RCT)
Etiology and risk factor RCT
Cohort Study
Case Control Study
Frequency and rate Cohort Study
Cross Section Study
Diagnosis Cross Section Study with random or
consecutive sample
Prognosis and prediction Cohort/survival study
EBM and Systematic Review
EBM (quick and dirty) Systematic Review
steps steps
Answerable question Answerable question
Search Search ++++
appraise Appraise x2
apply synthesize
apply
- Time: 90 second - Time: 6 months
- < 20 articles - < 2000 articles
- This patient survives! - This patient is dead

Find a systematic review

Search strategies for MEDLINE
• Thesaurus searching
• Texword searching
Define keywords
a. MeSH terms
• Non-Hodgkin’s Lymphoma
• Non-Hodgkin Lymphoma
• Lymphoma, Non-Hodgkin
• Lymphoma, Non-Hodgkin’s

b. Text word
• Important keyword not included in MeSH thesaurus
 MeSH=Medical Subject
Headings
• It is a thesaurus of medical terms used by
many data bases and libraries to index and
clasify medical information
• MeSH helps to overcome the issues of
US/UK English dan different terminology
applied to identical concepts
• MeSH is also known as controlled
vocabulary or keyword
• Check whether your keywords are
listed in MeSH
• Consider text word when a MeSH
term not exist for your concept
 Boolean operators
• AND
• OR
• NOT
 Sensitivity vs Specificity
• Different from terminology of statistics in diagnostic test, but
the meaning are similar
• Sensitivity
-High recall, low precision( i.e retrieves more of relevant
articles, but at the expense of picking up more unwanted
stuff)
-Likelihood of retrieving relevant items
• Specificity
-Lower recall, higher precision(i.e more of articles
retrieved will be relevant, but more of relevant stuff will
be missed)
-Likelihood of excluding irrelevant item
 How to increase sensitivity
• Expand your search using( broader terms
in)thesaurus
• Use the textword search of the database
• Use truncation and wildcard to catch spelling
variants
• Use Boolean OR to make sure you have included
all alternatives for the terms you are after
 How to increase specificity
• Use thesaurus to identify more specific headings
• Use more specific terms in textword search
• Use Boolean AND
• Limit the search by publication type, year of
publication, patient’s age etc
 Strategy of using Boolean operators:
first increase sensitivity, then spesificity
• One keyword concerning the Patient
• Another keyword concerning the Patient
• #1 OR #2
• One keyword concerning the Intervention
• Another keyword concerning the Intervention
• #4 OR #5
• One keyword concerning the Outcome
• Another keyword concerning the Outcome
• #7 OR #8
• #3 AND #6 AND #9
 General structure of search
• (Population OR synonim 1 OR…) AND
• (I ntervention OR synonim 1 OR…) AND
• (C omparator OR synonim 1 OR…) AND
• (O utcome OR synonim 1 OR…) AND
• FILTER (for best study tipe)
 Using the question to guide
searching
Scenario- you are interested in checking the hearing of elderly
patient, and have the heard that“whispered voice test’ is good.

Question
• Population -in elderly patient does (3)
• Indicator- a poor whispered voice test (1)
• Comparator- a normal whispered voice test
• Outcome- predict poor hearing (audiogram) (2)

1. underline the (root of the) key terms

2. number the order of importance from 1-4
3. think of alternate spellings, synonims and truncations
 Stepwise searching
• Search with #1 PICO item
- whisper
-Then go to clinical queries: diagnosis
- whisper* (again)
• Add #2 PICO item
-whisper AND hear* OR audiogram
 Features of commands
Feature Key Explanation
expand thesaurus Use explosion and include all subheadings to expand
your research
truncation * (or $) Analy*=analysis,analytic,analycal, analyse,etc
wildcards ? Gyn?ecology=gynaecology, gynecology
Random?*=randomisation, randomization,
randomised
Boolean AND Article must include both terms
OR Article can include either terms
NOT Excludes articles containing the term (for exp:
econom* NOT economy picks up economic and
economical but not economy
Proximity NEAR Terms must occur close to each other (for exp: within
6 word)(heart NEAR failure)
Limit variable As appropriate, restrict by publ type, yr, language or
by searching for terms in spesific parts( e.g diabet*in
ti- articles which have diabetes or diabetic in title)
Related variable “related” hyperlink
 Limits

• Type of publication
• Age group
• Gender
• Year of publication
• language
 Example: neonatal seizure
• PubMed search terms
• (“infant, newborn”[MeSH terms] OR (“Infant”[All Fields] OR
“newborn infant”[All Fields] OR “neonatal”[All Fields] AND
(“Seizures”[MeSH terms] OR “seizures” [All Fields]
• Result
5873 all
851 reviews
649 free texts
 Use spesific queries
• In PubMed, use tools
• Example: clinical queries: neonatal seizure
• ((“infant,newborn”[MeSH term] OR (“infant”[All Fields] AND
“newborn”[All Fields]) OR “Newborn infant”[All Fields]mOR
“neonatal[All Fields] AND (“Seizure”[MeSH terms] OR
“seizure”[All Fields] OR “seizure”[All Fields]) AND
Terapy/Narrow[Filter]

• 67 relevant articles, 3 review and 12 free

 Identify the type of article
• Diagnosis
• Prognosis
• Terapy
• Harm/ etiology
 Using free medical journal
(www. freemedicaljournals.com)
• Linked to many journal websites
• Journal hyperlink are sorted by:
-Free articles available(all articles are free, free after six
month, free after one year,etc)
-Subjects
• Impact factor=how many times articles in journal are cited in
the last 2 years=?
 Using BMJ search engine
(www.bmj.com)
• BMJ: all articles are free( after 6 months)
• User-friendly search optimization page(advanced search)
• Putting keywords: different boxes according to specificity
• Link all high-wire hosted journals
Saving your search results
• Abstract or full text
-Click SAVE AS…
-COPY and PASTE in word document
• PDF or abridged PDF
-Begin automatic download
-Take longer time
MOHON BIMBINGANNYA