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