Improving Biomedical Literature Search Skills within Evidence-Based Dentistry

Improving Biomedical Literature Search Improving Biomedical Literature Search Skills within Evidence-Based Dentistry Skills within Evidence-Based Dentistry

Vince MarianoVince MarianoCDM 3530 CDM 3530

Health Professions Division LibraryHealth Professions Division LibraryMarch 26, 2008March 26, 2008

Learning ObjectivesLearning ObjectivesTopics covered in this presentation include:Topics covered in this presentation include:

Identify and distinguish between Bibliographic Databases and Identify and distinguish between Bibliographic Databases and Evidence-Based Practice (EBP) databases Evidence-Based Practice (EBP) databases

Assessing the scope of the major dental information sourcesAssessing the scope of the major dental information sources

Overview of the Evidence-Based Practice processOverview of the Evidence-Based Practice process

Developing a search strategy which can be applied to all Developing a search strategy which can be applied to all bibliographic and full-text databasesbibliographic and full-text databases

Learn how to conduct a literature search to find the best evidence to Learn how to conduct a literature search to find the best evidence to support decision-making in clinical situations support decision-making in clinical situations

Databases Covering the Dental LiteratureDatabases Covering the Dental Literature Two types of databases encompass what is the biomedical literature, Two types of databases encompass what is the biomedical literature,

including the dental literature:including the dental literature:

Bibliographic DatabasesBibliographic Databases

These databases index and abstract the primary journal literature These databases index and abstract the primary journal literature No value-added information or additional analysis provided beyond No value-added information or additional analysis provided beyond

what is stated by the authors within each individual article/study.what is stated by the authors within each individual article/study.

Evidence Based Medicine (EBM) DatabasesEvidence Based Medicine (EBM) Databases

Contain research publications which constitute the most Contain research publications which constitute the most authoritative statements of evidence on clinical therapeutic authoritative statements of evidence on clinical therapeutic interventions. interventions.

The information in these databases appraise the quality of studies The information in these databases appraise the quality of studies and often make recommendations for practice.and often make recommendations for practice.

Contain what is referred to as “filtered” or “critically appraised” Contain what is referred to as “filtered” or “critically appraised” information & data.information & data.

PubMed/MEDLINEPubMed/MEDLINE PubMed/MEDLINE is the pre-eminent biomedical database in the PubMed/MEDLINE is the pre-eminent biomedical database in the

world, covering the fields of medicine, nursing, dentistry, world, covering the fields of medicine, nursing, dentistry, pharmacy/pharmacology, the health care system, and the preclinical pharmacy/pharmacology, the health care system, and the preclinical sciences. sciences.

PubMed/MEDLINE contains bibliographic citations and author PubMed/MEDLINE contains bibliographic citations and author abstracts from more than 4,900 biomedical journals. The database abstracts from more than 4,900 biomedical journals. The database contains over 17 million citations dating back to the mid-1800s. contains over 17 million citations dating back to the mid-1800s.

250 Journals indexed are Dentistry-specific, and PubMed contains 250 Journals indexed are Dentistry-specific, and PubMed contains approximately 500,000 dental and oral medicine articles- indexes all approximately 500,000 dental and oral medicine articles- indexes all high-impact dental journals.high-impact dental journals.

Coverage of journals is worldwide, but most records are from Coverage of journals is worldwide, but most records are from English-language sources or have English abstracts English-language sources or have English abstracts

Data Type- abstract-level coverage with some links to full-text Data Type- abstract-level coverage with some links to full-text articlesarticles

PubMed is the first database to query when starting your research PubMed is the first database to query when starting your research

EMBASE.comEMBASE.com EMBASE.com indexes over 4,800 journals from 70 countries; is updated weekly; EMBASE.com indexes over 4,800 journals from 70 countries; is updated weekly;

coverage goes back to 1974, with MEDLINE records from 1966. Database contains coverage goes back to 1974, with MEDLINE records from 1966. Database contains More than 18 million records. abstracts and citations. More than 18 million records. abstracts and citations.

The European “counterpart” to PubMed/MEDLINE. EMBASE indexes journals The European “counterpart” to PubMed/MEDLINE. EMBASE indexes journals

emanating primarily from Europe and Asia. emanating primarily from Europe and Asia.

Approximately 35% overlap of journals covered with PubMed – indexes about 1,800 Approximately 35% overlap of journals covered with PubMed – indexes about 1,800 journals which PubMed does notjournals which PubMed does not

Provides comprehensive coverage of pharmacy, pharmacology, toxicology, with detailed Provides comprehensive coverage of pharmacy, pharmacology, toxicology, with detailed subject headings for drugs – indexers use Manufacturers' and drug trade names more subject headings for drugs – indexers use Manufacturers' and drug trade names more frequently than PubMed- Excellent resource for identifying foreign drugsfrequently than PubMed- Excellent resource for identifying foreign drugs

Indexes 37 Dentistry/Stomatology specific journals Indexes 37 Dentistry/Stomatology specific journals

Data Type- Abstract-level coverage with links to Full-TextData Type- Abstract-level coverage with links to Full-Text

CINAHL – Cumulative Index to Nursing CINAHL – Cumulative Index to Nursing and Allied Health Literatureand Allied Health Literature

Covers the Nursing and Allied Health Literature from 1937-present.Covers the Nursing and Allied Health Literature from 1937-present. Dental Hygiene is the primary dental specialty coveredDental Hygiene is the primary dental specialty covered Data Type – Abstract-level coverage with some full-text articles Data Type – Abstract-level coverage with some full-text articles

ISI Web of ScienceISI Web of Science

Web interface to the Web interface to the

• Science Citation Index ExpandedScience Citation Index Expanded• Social Sciences Citation IndexSocial Sciences Citation Index• Arts & Humanities Citation IndexArts & Humanities Citation Index

Indexes 54 journals in Dentistry, Oral Surgery & MedicineIndexes 54 journals in Dentistry, Oral Surgery & Medicine

Best resource for cited reference searching/citation searchingBest resource for cited reference searching/citation searching

Cover-to-cover indexing of over 8,700 journalsCover-to-cover indexing of over 8,700 journals

Data Type- Abstract-level coverage - Citation Database RecordsData Type- Abstract-level coverage - Citation Database Records

Evidence-Based Practice (EBP) Evidence-Based Practice (EBP) databasesdatabases

The information contained within EBP databases is not merely peer-The information contained within EBP databases is not merely peer-reviewed information, but has also undergone several more levels of reviewed information, but has also undergone several more levels of analysis- it is “critically appraised” or “filtered” information, distinct analysis- it is “critically appraised” or “filtered” information, distinct from the primary literaturefrom the primary literature

Filtered Information types include Systematic Reviews, Critically Filtered Information types include Systematic Reviews, Critically Appraised Topics, Critically Appraised Articles, and Clinical Practice Appraised Topics, Critically Appraised Articles, and Clinical Practice GuidelinesGuidelines

Study Design Types ranked in order of authority-Study Design Types ranked in order of authority- Randomized Controlled Trials, Clinical Trials, Cohort Studies, Case Randomized Controlled Trials, Clinical Trials, Cohort Studies, Case

Series, and individual Case ReportsSeries, and individual Case Reports

Evidence-Based Practice (EBP) Evidence-Based Practice (EBP) databasesdatabases

EBP databases can be queried to answer either complex clinical EBP databases can be queried to answer either complex clinical questions or general care questions, but are usually queried to questions or general care questions, but are usually queried to answer “Foreground Questions”, which are narrowly-focused answer “Foreground Questions”, which are narrowly-focused clinical questions directly relating to the patient.clinical questions directly relating to the patient.

Background Questions are clinical questions that ask for "general Background Questions are clinical questions that ask for "general knowledge" regarding disease management or a disease process knowledge" regarding disease management or a disease process

What constitutes the “Evidence-Based” Literature is a very small What constitutes the “Evidence-Based” Literature is a very small subset of the much broader biomedical literaturesubset of the much broader biomedical literature

Higher levels of evidence may not exist for all clinical questions Higher levels of evidence may not exist for all clinical questions because of the nature of medical problems, as well as research and because of the nature of medical problems, as well as research and ethical considerationsethical considerations

Cochrane Database of Systematic Cochrane Database of Systematic ReviewsReviews

This database contains the full text of systematic reviews prepared by the This database contains the full text of systematic reviews prepared by the Cochrane Collaboration. Cochrane Collaboration.

Systematic reviewsSystematic reviews are generally regarded as the highest level of medical are generally regarded as the highest level of medical research evidence. If you find a systematic review on your therapeutic modality, research evidence. If you find a systematic review on your therapeutic modality, you have likely identified the most authoritative statement of evidence on that you have likely identified the most authoritative statement of evidence on that therapeutic intervention.therapeutic intervention.

Systematic reviews are a summary of the medical literature on a specific clinical Systematic reviews are a summary of the medical literature on a specific clinical question which include a clearly defined question, comprehensive search question which include a clearly defined question, comprehensive search strategy, explicit inclusion criteria, assessment of methodological quality of strategy, explicit inclusion criteria, assessment of methodological quality of included studies, synthesis of the data, summary of results, & recommendations included studies, synthesis of the data, summary of results, & recommendations for practice.for practice.

CDSR contains 146 completed systematic reviews authored by the Cochrane CDSR contains 146 completed systematic reviews authored by the Cochrane Oral Health Group, based @ University of Manchester, UK..Oral Health Group, based @ University of Manchester, UK..

Data Type- Full Text of Systematic ReviewsData Type- Full Text of Systematic Reviews

Cochrane Central Register of Controlled Trials Cochrane Central Register of Controlled Trials (CENTRAL)(CENTRAL)

CENTRAL is a bibliographic database of definitive controlled trials. CENTRAL is a bibliographic database of definitive controlled trials.

The register provides bibliographic information (i.e. abstracts rather than The register provides bibliographic information (i.e. abstracts rather than full-text) on over 415,000 reports of trials identified by contributors to the full-text) on over 415,000 reports of trials identified by contributors to the Cochrane Collaboration. Only well-designed trials with sound Cochrane Collaboration. Only well-designed trials with sound methodologies are accepted into the database.methodologies are accepted into the database.

This source attempts to identify and include Clinical Trials from the This source attempts to identify and include Clinical Trials from the international biomedical literature. It includes studies published in international biomedical literature. It includes studies published in MEDLINE, EMBASE and other electronic databases, as well as reports MEDLINE, EMBASE and other electronic databases, as well as reports published in conference proceedings and other sources not currently listed published in conference proceedings and other sources not currently listed in MEDLINE or other bibliographic databases.in MEDLINE or other bibliographic databases.

CENTRAL indexes approximately 25,000 oral and dental medicine related CENTRAL indexes approximately 25,000 oral and dental medicine related clinical trialsclinical trials

Data Type- abstract and bibliographic information of clinical trialsData Type- abstract and bibliographic information of clinical trials

Database of Abstracts of Reviews of Database of Abstracts of Reviews of Effectiveness (DARE)Effectiveness (DARE)

DARE is a Full Text database containing critical assessments of DARE is a Full Text database containing critical assessments of systematic reviews from a variety of medical journals that have been systematic reviews from a variety of medical journals that have been critically appraised by reviewerscritically appraised by reviewers

DARE contains approximately 3000 structured reviews of DARE contains approximately 3000 structured reviews of systematic reviews systematic reviews

About 150 of these structured reviews are on oral/dental medicine About 150 of these structured reviews are on oral/dental medicine topicstopics

Data Type- Structured Abstracts- Critical Assessments of selected Data Type- Structured Abstracts- Critical Assessments of selected Systematic ReviewsSystematic Reviews

Clinical EvidenceClinical Evidence

Clinical Evidence summarizes the current literature on over 200 Clinical Evidence summarizes the current literature on over 200 common medical conditions and provides the best available common medical conditions and provides the best available evidence on prevention and treatment.evidence on prevention and treatment.

There are a number reviews of conditions relating to oral/dental There are a number reviews of conditions relating to oral/dental medicine contained within Clinical Evidence. medicine contained within Clinical Evidence.

Data Type- Full Text Topical ReviewsData Type- Full Text Topical Reviews

UpToDateUpToDate Widely-used Clinical Reference/Electronic Textbook database Widely-used Clinical Reference/Electronic Textbook database

containing regularly updated topic reviews in internal medicine, containing regularly updated topic reviews in internal medicine, family medicine, pediatrics, and other specialtiesfamily medicine, pediatrics, and other specialties

Provides evidence-based answers to commonly asked questions in Provides evidence-based answers to commonly asked questions in clinical practice. clinical practice.

Physicians-authored topic-reviews on thousands of topics, some Physicians-authored topic-reviews on thousands of topics, some containing a level-of-evidence ratingcontaining a level-of-evidence rating

Contains topical Review-length articles on numerous diseases and Contains topical Review-length articles on numerous diseases and conditions within dentistry, oral health & medicineconditions within dentistry, oral health & medicine

Data Type- Topical Review ArticlesData Type- Topical Review Articles

Other Evidence-Based DentistryOther Evidence-Based DentistrySourcesSources

American Dental Association- www.ada.org American Dental Association- www.ada.org

Directory of Systematic Reviews -Directory of Systematic Reviews -

http://www.ada.org/prof/resources/ebd/reviews/index.asphttp://www.ada.org/prof/resources/ebd/reviews/index.asp

Compiled index of published systematic reviews of direct clinical Compiled index of published systematic reviews of direct clinical relevance to dentistry identified in the literature relevance to dentistry identified in the literature

Topics cover a wide range of topics from amalgam to wisdom teethTopics cover a wide range of topics from amalgam to wisdom teeth ADA strongly encouraging the authorship of systematic reviews ADA strongly encouraging the authorship of systematic reviews

addressing key topics and clinical questionsaddressing key topics and clinical questions Dentists have a need for quality information and synthesized Dentists have a need for quality information and synthesized

evidence, which ultimately saves timeevidence, which ultimately saves time

Overview of Evidence-Based DentistryOverview of Evidence-Based DentistryDefinition of Evidence-Based Dentistry –Definition of Evidence-Based Dentistry – “ “The Integration of Experience & Expertise combined with a criticalThe Integration of Experience & Expertise combined with a criticalanalysis of relevant clinical evidence obtained through systematicanalysis of relevant clinical evidence obtained through systematicresearch, combined with patient’s needs and preferences” (Kao, 2007)research, combined with patient’s needs and preferences” (Kao, 2007)

EBD

Best Research

ClinicalExpertise

PatientValues

Overview of Evidence-Based DentistryOverview of Evidence-Based Dentistry

Dental Practitioners generally support the concept of using evidence-based Dental Practitioners generally support the concept of using evidence-based disease prevention and treatments, but have been slow to incorporate the disease prevention and treatments, but have been slow to incorporate the principle into practice.principle into practice.

Reasons to incorporate EBD into practice-Reasons to incorporate EBD into practice-

-Rapidly expanding knowledge base and literature - 500 dental journals, 2 million -Rapidly expanding knowledge base and literature - 500 dental journals, 2 million new articles published in biomedical journals annually new articles published in biomedical journals annually

-Influx of new Dental Materials and Techniques-Influx of new Dental Materials and Techniques

-Many claims made in commercial information marketed to dental professionals -Many claims made in commercial information marketed to dental professionals are not always evidence-basedare not always evidence-based

-Patients today are better informed consumers & want answers to questions -Patients today are better informed consumers & want answers to questions concerning marketing information directed at them –direct-to-consumer concerning marketing information directed at them –direct-to-consumer advertisingadvertising

Overview of Evidence-Based DentistryOverview of Evidence-Based Dentistry The goal of Evidence-Based Dentistry is to effectively apply the growing The goal of Evidence-Based Dentistry is to effectively apply the growing

body of dental knowledge into effective dental practice to yield better patient body of dental knowledge into effective dental practice to yield better patient outcomesoutcomes

The practice of EBD implies lifelong learning throughout your professional The practice of EBD implies lifelong learning throughout your professional careercareer

Barriers to the implementation of EBD-Barriers to the implementation of EBD-

TimeTime Third-Party payers may deny coverage of newer services or techniquesThird-Party payers may deny coverage of newer services or techniques Clinicians may be unmotivated to change practice – financial concerns for Clinicians may be unmotivated to change practice – financial concerns for

new equipment / technology / facility design / staffingnew equipment / technology / facility design / staffing Many key clinical questions within dentistry remain without definitive Many key clinical questions within dentistry remain without definitive

answers due to lack of published evidenceanswers due to lack of published evidence

The Stages in Evidence-Based PracticeThe Stages in Evidence-Based PracticeIdentify Clinical ProblemIdentify Clinical Problem

Produce a Focused Clinical QuestionProduce a Focused Clinical Question

Search for EvidenceSearch for Evidence

Evaluate the EvidenceEvaluate the Evidence

Incorporate Evidence into PracticeIncorporate Evidence into Practice

Evaluate the Impact on PracticeEvaluate the Impact on Practice

Levels of Evidence in EBDLevels of Evidence in EBD

Different types of evidence have different kinds of authority.Different types of evidence have different kinds of authority.

Level I – Evidence from Systematic Reviews of Randomized Level I – Evidence from Systematic Reviews of Randomized Controlled TrialsControlled Trials

Level II – Evidence from Randomized Controlled TrialsLevel II – Evidence from Randomized Controlled Trials Level III – Evidence from Non-randomized controlled trials OR Level III – Evidence from Non-randomized controlled trials OR

cohort studiescohort studies Level IV – Evidence from Case SeriesLevel IV – Evidence from Case Series

Articles such as single case reports, technical notes, animal studies, Articles such as single case reports, technical notes, animal studies, laboratory studies, non-systematic literature reviews, and expert laboratory studies, non-systematic literature reviews, and expert opinion are all considered lower classes of evidence within EBD.opinion are all considered lower classes of evidence within EBD.

Different Types of ResearchDifferent Types of Research Practical Searching vs. Systematic SearchingPractical Searching vs. Systematic Searching

What types of research projects, questions, or other factors necessitate one or What types of research projects, questions, or other factors necessitate one or the other?the other?

Practical SearchingPractical Searching

Rapid scan of the current literature to find quick answers to specific clinical Rapid scan of the current literature to find quick answers to specific clinical questions or references on specific topicsquestions or references on specific topics

Time ConstraintsTime Constraints Short Essay/Communication/PaperShort Essay/Communication/Paper Need 5 most recent references/Literature from last X yearsNeed 5 most recent references/Literature from last X years Need to answer to clinical question in 15 minutes or lessNeed to answer to clinical question in 15 minutes or less Not an exhaustive searchNot an exhaustive search Clinicians querying literature more often within their own practicesClinicians querying literature more often within their own practices

Different Types of ResearchDifferent Types of ResearchSystematic SearchingSystematic Searching

Exhaustive search of the literature in an attempt to identify every relevant Exhaustive search of the literature in an attempt to identify every relevant reference relating to a topic or questionreference relating to a topic or question

Literature ReviewLiterature Review Thesis/DissertationThesis/Dissertation Research Project –Capstone ProjectResearch Project –Capstone Project Critically Appraised Topics (CATs)Critically Appraised Topics (CATs) Writing for Publication- Research or Review Article Writing for Publication- Research or Review Article Cochrane- Systematic Review/Meta-Analysis – exhaustive search required Cochrane- Systematic Review/Meta-Analysis – exhaustive search required Component of Evidence Based PracticeComponent of Evidence Based Practice Requires full documentation of all search terms AND sources searched to Requires full documentation of all search terms AND sources searched to

allow for replication and to avoid duplicationallow for replication and to avoid duplication

The Search ProcessThe Search ProcessSteps in the process of conducting a systematic search of the literature Steps in the process of conducting a systematic search of the literature

include: include:

Formulating your focused clinical questionFormulating your focused clinical question – P-I-C-O Strategy – P-I-C-O Strategy Problem/Patient – Intervention – Comparison – OutcomeProblem/Patient – Intervention – Comparison – Outcome

Dissecting a question into its component parts or conceptsDissecting a question into its component parts or concepts to facilitate to facilitate finding the best evidence – a fundamental skill of evidence-based finding the best evidence – a fundamental skill of evidence-based practitionerspractitioners

Literature searches most likely to be successful if they’re based on clinically Literature searches most likely to be successful if they’re based on clinically relevant, well-formulated questionsrelevant, well-formulated questions – Etiology, Diagnosis, Therapy, Harm, – Etiology, Diagnosis, Therapy, Harm, Prognosis categories of clinical questions Prognosis categories of clinical questions

Example- What is a myocardial infarction and how would a history of infarction Example- What is a myocardial infarction and how would a history of infarction affect the delivery and timing of dental care? affect the delivery and timing of dental care?

The Search ProcessThe Search Process Consider all of the variant terminology that can be used to express your Consider all of the variant terminology that can be used to express your

concepts- synonyms, acronymsconcepts- synonyms, acronyms

Example – Primary Teeth = Deciduous TeethExample – Primary Teeth = Deciduous Teeth

Limiting your retrieval Limiting your retrieval to appropriate references or citations (i.e., English to appropriate references or citations (i.e., English language, human, age groups, years of publication, publication types, etc.) – e.g. language, human, age groups, years of publication, publication types, etc.) – e.g. - PubMed Clinical Queries Filter- PubMed Clinical Queries Filter

Document each of your searches to avoid immediate duplication and enable Document each of your searches to avoid immediate duplication and enable future replicationfuture replication

Hand-searching of journals not indexed by databases and grey literature may be Hand-searching of journals not indexed by databases and grey literature may be necessary to complete your due diligencenecessary to complete your due diligence

Repeat this process until “point of diminishing returns” is reachedRepeat this process until “point of diminishing returns” is reached