Revised January 2008
IUPUI University Library
Randi L. Stocker, MLS
developed for the Indiana University School of Nursing
1. Develop a searchable question
2. Search relevant databases, such as CINAHL, Medline, and others.
• Stocker, R. (2008). Finding articles and systematic reviews related to nursing [web page]. http://www.ulib.iupui.edu/prod/subjectareas/nursing/indexes
3. Evaluate citations for potential relevance
• Read summaries to make sure responses are relevant to your practice, if not may need to go back to step 1
Steps:
PICO (most common)
P – Patient or problemI – Intervention C – Comparison O – Outcome
What is the effect of
_________________________________Intervention / Predictor Variable
On _________________________________ Given Characteristic / Outcome
For _________________________________Specific group of patients /
Patient Characteristics
Alternate Template for Searching
Alternate template: Thede, L. Q., Pierce, S., & Allen, M. (2003). Other Facets of Informatics: A wide Impact. In L. Q. Thede (Ed.), Informatics and Nursing: Opportunities & Challenges (2nd ed., pp. 243 - 258.). Philadelphia: Lippincott.
Two Search Methods
• Select search tools• Databases oriented to different practitioners:
• Nurses, Physicians, Psychologists, Educators, (& patients)
• Databases focusing on specific types of research: • Guidelines, Systematic Reviews, Registers of studies, etc.
• Design search strategy that optimizes value of selected databases & their features• Select Subject Headings• Select Limits
• Review results; modify search
Each article is coded with relevant official Subject Headings. (The coding is based on what the authors’ write.) Different authors use different terminology. To avoid misinterpretations or oversights in
searches all articles are coded using that database’s “official” subject headings for that a given concept.
Example: If the author used any of the following
phrases, the article would be coded with the official MeSH term, “Breast Neoplasms”
Used for: breast cancer, breast neoplasm, breast tumor, or breast tumors
The “Official” lists of subjects used in CINAHL and Medline are similar, but not identical. Medlne’s official list of Subject Headings is
known MeSH (Medical Subject Headings). CINAHL uses many MeSH headings, but, over
time, has added many additional Subject Headings
Additional topics indexed in CINAHL include:• Research methodology and
instruments• Theories and models, • Nursing concepts such as “wellness”
(in 2006) MEDLINE CINAHL
Journal titles 4,800+ 1,800+
Other formats Search NLM gateway
Many, including web
Subject Headings
MeSH - biomedical
MeSH-based 7,427 same + 4,987 unique
Subheadings Yes; as many as needed
Yes; up to 3 per heading
Publication types
Format/type of article
Adds features included in item
Cited references No Yes, 1993 - * Allen M. (2006).
Each concept is coded only at the most specific level
Example –
Article focuses ONLY on Male Breast Cancer? It is only coded with the phrase:
“Breast Neoplasms, Male”
MeSH “Subject Tree” for Breast Neoplasms (used in both the Medline & CINAHL
databases)
All MeSH subject headings :• Diseases category: Neoplasms:
• Neoplasms by Site:• Breast Neoplasms
• Breast Neoplasms, Male • Carcinoma, Ductal, Breast
Problem – Searching “Breast Neoplasms” using
Ovid will only retrieve articles coded at that level . in the subject tree. It will miss the articles that ONLY discuss “Male Breast Neoplasms.”
Solution – Select the Explode option to retrieve results using the selected term plus all of its more specific terms.
Then “Breast Neoplasms” with Explode turned on also includes:
“Breast Neoplasms, Male” “Carcinoma, Ductal, Breast”
MeSH “Subject Tree” for Breast Neoplasms
(as used in both the Medline & CINAHL databases)
All MeSH subject headings :• Diseases category: Neoplasms:
• Neoplasms by Site:• Breast Neoplasms:
(EXPLODED)• Breast Neoplasms,
Male • Carcinoma, Ductal,
Breast
Problem – Searching “Breast Neoplasms” will
retrieve articles that mention them, regardless ofwhether the they are just mentioned in passing orare a major focus of the article
Solution – Select the Focus option to retrieve only those results where “Breast Neoplasms” is a major focus of the article.
CINAHL results (as of 1/24/2008)Breast Neoplasms = 16028 articlesBreast Neoplasms (Exploded) = 16102 articlesBreast Neoplasms (Exploded & Focused) = 12613 articles
CINAHL and MeSH terms are arranged in hierarchies, referred to as trees• “Exploding” subject headings adds terms below
the selected term in the hierarchy• (PubMed automatically explodes subject headings
and subheadings, unless user changes this default setting)
Subject headings are selected for both major and minor mentions of a concept• Use “Focus” to retrieve only those articles that
concentrate on that concept
References:Allen, M. (2007). MEDLINE and CINAHL Indexing
Practices. http://www.pegallen.net/Documents/Indexing.pdf
• Primary Research• Individual studies• Abstracts and commentaries• Need to evaluate and synthesize
findings• Research is sometimes limited to
specifics and results do not always apply
• Evidence Summaries – Synthesis• Systematic Reviews: Integrative
Reviews; Meta-Analysis• Critical Appraisal with implications for
practice• Translation Literature
• Proven practices, not new findings• Practice guidelines• Care plans• Critical paths• Protocols• Standards• Clinical innovations
1. Translation Literature• Are they evidence-based? • Just because it’s a gold standard
doesn’t mean that it is common knowledge
2. Look for Evidence Summaries• Systematic reviews; Meta-analyses;
Critical appraisals
3. What’s new?• Primary Research• Research Abstracts• Research in progress• Propose new research?
• Think about question• Use of official Subject Headings• EBP filters• Explode, Indexing, Focusing• Other limits?
Sample Search:What should we do to prevent pressure ulcers in our elderly patients?
*Allen, M. (2006).
What is the effect of
Nursing care/interventions Intervention (Predictor Variable)
On Preventing pressure ulcersGiven Characteristic (Outcome)
For Elderly________________Specific group of patients(Patient Characteristics)
What should we do to prevent
pressure ulcers in our elderly
patients?
Sample Search:
*Allen, M. (2006).
Subject Headings
Limits
CINAHLversion of the search
Pressure UlcerPressure Ulcer/ nursing; prevention & controlLimit to Nursing Journals subset?
Evidence Based Practice (Specific Interest Category) Systematic Review (Publication Type)ResearchAged <65-79> & <80 and Over>Clinical Queries
MEDLINEversion of the search
Pressure Ulcer/ nursing; prevention & controlLimit to Nursing Journals subset?
Evidence Based Medicine ReviewsSystematic Reviews (subset)Practice GuidelinesAll Aged (65 and Over)Clinical Queries
CINAHL PubMed/MEDLINE
Translation Literature
Care Plan [PT] OR Clinical Innovations [PT] OR Critical Path [PT] OR Practice Guidelines [PT] OR Protocol [PT] OR Standards [PT] OR Algorithm [PT] OR Evidence Based Care Sheet [PT; C+ only]Optional: CEU [PT]
Practice Guideline [PT] OR Guideline [PT]Clinical Protocols [MH] OR Critical Pathways [MH] OR Decision Trees [MH] ORStandards [subheading]Systematic [sb] NOT (Clinical Trial OR Review [PT] OR Meta-Analysis [PT])
Evidence Summaries
Systematic Review [PT] Commentary [PT] with Research or Review
Systematic [sb] AND (Review [PT]) OR Meta-Analysis [PT])
Primary Research
Research [PT] Clinical Trials [PT] OR RCT [PT]Validation Studies [PT]Has abstractClinical queries ORSUMsearch Clinical queries
[PT] = Publication Type; [MH] = MeSH Subject Heading; [sb] = Subheading *Allen, M. (2006).
MEDLINE• Ovid• PubMed• EBSCOhost• others
CINAHL• EBSCOhost
•Only source for CINAHL Plus
• Ovid through 2008
• others
COCHRANE Reviews•Ovid•Wiley Interscience•CINAHL•MEDLINE•others
Read more about it:
•Allen, M. (2006). Teaching clinicians to fish: Library skills for EBP [PowerPoint show].
• http://www.pegallen.net/Documents/TeachingClinician2FishWeb.pps
•Allen, M. (2007). MEDLINE and CINAHL indexing practices [Handout].
• http://www.pegallen.net/Documents/Indexing.pdf