ANM150 wk1 - research 3.pdf

PICO AND SEARCHING FOR EVIDENCE CASE 1 ANM 150 Dr. Monique Aucoin ND MSc WARM UP OBJECTIVES Ask a question using the pico format Identify databases used to search for evidence Create a pubmed search using a combination of terms, MESH, limits Identify sources of pre-synthesized evidence Identify stra...

PICO AND SEARCHING FOR EVIDENCE CASE 1 ANM 150 Dr. Monique Aucoin ND MSc WARM UP OBJECTIVES Ask a question using the pico format Identify databases used to search for evidence Create a pubmed search using a combination of terms, MESH, limits Identify sources of pre-synthesized evidence Identify strategies to find full text articles Practice designing and executing search strategies WHERE DO WE FIND EVIDENCE? ASKING AN ANSWERABLE QUESTION UNANSWERABLE QUESTION: WHAT HELPS WITH INSOMNIA? Needs to be more specific! STRUCTURED, ANSWERABLE QUESTIONS P.I.C.O. P: Populations I: Intervention C: Comparison O: Outcome PICO EXAMPLE Marion is a retired woman who flies frequently to visit her grandchildren in Vancouver. She often gets swollen legs on the flights and is concerned about developing deep vein thrombosis (DVT). After reading about it in the newspaper, she asks you if she should wear elastic stockings when she travels to reduce her risk? P=? I=? C=? O=? Population: Senior women Intervention: compression stockings Comparison: Compared to nothing, no treatment Outcome: Impacting risk of DVT? NOW YOUR TURN! Christine is a 60 year old woman who received treatment for breast cancer 2 years ago and is currently in remission. She is not taking any medication. She heard that soy contains phytoestrogens and is concerned that eating tofu 3 times per week may increase her risk of breast cancer recurrence. P=? I=? C=? O=? Population - senior women who had breast cancer Intervention - consuming soy/phytoestrogens 3x week Comparison - no soy intake Outcome - risk of breast cancer recurrence SEARCHING FOR EVIDENCE YOU CAN’T USE EVIDENCE IF YOU CANT FIND IT! WHERE TO SEARCH FOR SCIENTIFIC EVIDENCE –PRIMARY PubMed Other subscription based: EBSCO, CINAHL, MEDLINE Google Scholar PUBMED SEARCHING Boolean Operators: AND, OR, NOT (capitals important) Cancer and vitamin C Cancer AND vitamin C Combining search terms capitals AND, OR, NOT will look for the exact phrase ie cancer AND vitamin C in that exact order BOOLEAN OPERATORS AND will narrow your search, results need to include both; “cancer AND vitamin C” OR will broaden your search, can have either “cancer OR carcinoma” NOT will narrow your search “cancer AND vitamin C NOT intravenous” PRACTICE USING “AND, OR, NOT” Ex. Interested in hibiscus tea for hypertension (not interested in tincture) Hibiscus tea AND hypertension Ex. Interested in hibiscus tea for hypertension (not interested in tincture) (blood pressure OR hypertension) AND (hibiscus OR Hibiscus sabdariffa) NOT tincture TRUNCATION Truncation * (hyperten* = hypertension, hypertensive) PUB MED Access: pubmed.ncbi.nlm.nih.gov OR access via the CCNM library log in: CCNM.edu > Student login button > Library > Pubmed (under the database section) Type your search terms FIELD DESCRIPTIONS Way to get ore targeted in search Pubmed can search many “fields” or component of an article: incl date, author name, journal, title, page number, abstract, or any field If you don’t specify, it will search all Ex. if you search 2000 (you want a paper published in this year), pubmed might find you articles with this as the page number, or that used 2000mg of vitamin C or where a result was 2000mg/L etc Instead, SPECIFY that you want 2000 to be searched as the year FIELD DESCRIPTIONS Here’s where you can find the codes: https://www.nlm.nih.gov/bsd/mms/medlineelements.html Example: (DP) = date of publication, (TI) = title, (JT) = journal title You hear about a cool paper by the Author J. Brown, written in 2007 → “Brown [AU] AND 2007 [DP]” This avoids papers where the word brown or the number 2007 are included in the title or abstract ADVANCED SEARCH BUILDER Helps you to be more specific in your search Especially helpful when looking for a particular article MESH TERMS Clear labels that can apply to publications - can search for publications that have the specific labels attached to it MeSH Terms: Medical Subject Headings specify EXACTLY what you’re looking for Controlled vocabulary Ex. Search for the term Depression → respiratory depression, cytokine depression VS Depression the psychiatric condition MESH TERMS MESH TERMS You can pick how more broad or narrow you want your search term to be Once you have decided which term to use, “add it to the search builder” (and then add more terms) or “search pubmed” to search for it alone HEDGES AKA FILTERS Combinations of terms or standardized search strategies that can be easily used CLINICAL QUERIES: PUBMED.NCBI.NLM.NIH.GOV/CLINICAL/ SUBSETS Dietary Supplement Subset: dietsuppl [sb] CAM: cam [sb] No longer being updated but can still access and use the combination of search terms Dietsuppl: https://www.nlm.nih.gov/bsd/pubmed_subsets/diet_strategy.html CAM: https://www.nlm.nih.gov/bsd/pubmed_subsets/comp_med_strategy.html Search example: dietsuppl [sb] AND osteoarthritis Looks for the term “dietary supplements” as a MeSH heading, a key word, etc & lists a whole bunch of them Can copy and paste this into pubmed Ie arthritis AND Paste CREATE YOUR OWN SAVED SEARCH USING THIS STRING OF TERMS SAVED SEARCH BOTANICAL MEDICINE No subset for botanical/herbal medicine Consider saving the following terms: "Plants, Medicinal"[Mesh] OR "Ethnopharmacology" [Mesh] OR "Phytotherapy"[Mesh] OR "Ethnobotany"[Mesh] OR "Plant Preparations"[Mesh] DIET Diet [Mesh] – included Mediterranean, DASH, keto, veg etc Can also look at: Food [Mesh] PUBMED SEARCHING Limits: Study type Subjects (human/animal) Age of publication Age of subjects, gender Free full text Useful! Some risk of missing results but helpful if doing a quick search Use caution when searching for naturopathic topics Limits/ Filters GOOGLE SCHOLAR Sourcing full text articles More abstract concepts, qualitative research Pro: can be more user friendly Con: less stringent requirements vs pubmed, less control over search strategy Links to full text article PRE-SYNTHESIZED EVIDENCE Systematic reviews & meta-analysis Cochrane Library –HIGHLY rigorous SRs and MAs Natural Medicines –access through CCNM library and CAND member website Trip Database – free and upgraded version Others, subscription: UpToDate, Examine.com TRIP DATABASE TRIP DATABASE PRE-SYNTHESIZED EVIDENCE Advantages? Ease, speed, efficiency Disadvantages, Risks? Bias SOURCING THE FULL TEXT ARTICLE Google Scholar Research Gate Email the study author -corresponding author -“pre-publication copy” LET’S PRACTICE! Does the DASH Diet improve blood pressure in adults? If so, by how much? LET’S PRACTICE Can eating blueberries protect against the development of Alzheimer’s Disease? MORE PRACTICE Does eating 2 eggs for breakfast every day increase cardiovascular risk in a diabetic patient, compared with a high carbohydrate breakfast? Do phytoestrogens increase the risk of breast cancer in healthy premenopausal women? How do acupuncture and medication compare in their ability to treat chronic migraines? Does exposure to phthalates increase the risk of breast cancer in women? QUESTIONS? PART 2: SEARCHING FOR EVIDENCE RELATED TO THIS WEEK’S CASE REFLECTIONS? ANY NEW THOUGHTS OR PERSPECTIVES? QUESTIONS? Navigating "lack of evidence" Strep A pharyngitis in a 14 year old What did you discover in your searching? If the evidence appears to be low, why not just use the intervention that has more evidence? (whether it is "naturopathic" or not … what does that even mean?) Epistemic bias? Cost Patient preference Benefit n=1 (Collective?) clinical experience Evidence (Epistemic bias) Therapeutic order