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1. Level 5 Semester 9 Module EBM934 Faculty of Medicine Medical Education- Damietta University

2. How to search for relevant scientific papers (stepwise manner ) Prepared by : Dr Marina H any Medical education demonstrator Faculty of medicine ,Damietta university [email protected]

3. Share with us?? Where do you usually search for papers ??

4. ILOS : by the end of this session the students will be able to 1)Explain literature searching 2) classify medical literature 3) Mention steps of finding relevant scientific paper 4 ) ask the proper research question using PICO 5) use keywords,synonyms,MeSH 6 ) compare different databases & choose the appropriate one for you 7) develop a research strategy 8) use different filter & evaluate results

5. What i s literature searching??? refers to the systematic process of identifying, locating, and reviewing of the existing published materials relevant to the particular research topic or question. The scientists conduct literature searches to gain knowledge and help make accurate and relevant research conclusion . Literature search is an integral component of the scientific investigation process and it is usually called evidence-based research practice that is applied to produce the best available proof.

6. Other purposes to conduct literature search include: Identify the existing knowledge . Formulate research questions and objectives . Build a theoretical framework Identify appropriate methodologies and methods . Support arguments and evidence. Avoid bias and ensure rigor.

7. Literature review: reviewing the studies which have been identified ( narrative review) Systematic review: Systematically searching the literature to identify all relevant published and unpublished data in order to appraise their quality and summarise the overall findings. Meta-analysis study Combining the results of similar subsides into one study to obtain one final result summarizing all the included studies.

8. TYPES OF MEDICAL LITERATURE These classifications are based on the originality of the material and the proximity of the source or origin . Primary literature Secondry literature Tertiary literature

9. Research problem is typically a topic of interest and of some familiarity to the researcher. It needs to be channelised by focussing on information yet to be explored. Once we have narrowed down the problem, seeking and analysing existing literature may further straighten out the research approach . A research hypothesis is a carefully created testimony of how you expect the research to proceed. It is one of the most important tools which aids to answer the research question The literature search can be exhaustive and time-consuming, but there are some simple steps which can help you plan and manage the process. The most important are formulating the research questions and planning your search.

10. Stepwise approach to search for relevant scientific paper

11. Step 1 Ask the right question : If you are not aware of where you want to go …YOU WILL NEVER REACH THERE The same way ,A badly formulated clinical question will not yield the information you need.

12. Step 1 Ask the right question : The FIRST step The HARDEST step The MOST IMPORTANT step ! → You should form a search question before you begin. → Decide the topic of your search You should start by deciding the topic of your search. This means identifying the broad topic, refining it to establish which particular aspect of the topic interests you, and reframing that topic as a question.

13. Characteristics of Good Question When practicing EBM, a good clinical question must: Be specific (identify the problem, clarify the clinical issue). Be answerable (through the literature ). Contain multiple aspects ( patient,options , comparisons, outcomes… etc .).

14. Two types of questions: ⦿ Background questions: Ask about general knowledge about a condition or issue. ⦿ Foreground clinical questions: Ask about specific knowledge to inform clinical decision or action. Have 4 components (PICO): o P = Patient and/or problem o I = Intervention o C = Comparison o O = Outcome

15. The 4 Scopes of PICO Questions Therapy/Treatment Question: In patients with migraine headaches without auras, is Depakote more effective than Inderal for prophylaxis of headaches? Diagnosis Question: In geriatric patients with suspected carotid stenosis, is duplex ultrasound as good as magnetic resonance angiography in detecting significant carotid stenosis ? Harm/Etiology Question : For pregnant women, does the consumption of large amounts of coffee (compared to no coffee drinking ) increase the rate of spontaneous abortion? Prognosis Question: In diabetic patients with foot ulcers, is the diagnosis of osteomyelitis with MRI as predictive of healing as an audible pulse on Doppler examination?

16. Example: Case 1 A patient who is found to be HCV RNA positive . His liver biopsy reveals periportal inflammation , some piecemeal necrosis and early fibrosis. He wants to know whether a combination therapy of interferon with ribavirin really offer much more chance of viral clearance than interferon alone.

17. The clinical question: In a patient who is HCV RNA positive , does treatment with interferon + ribavirin , compared to interferon alone offer a significant chance of viral clearance ?

18. Step 2 : identify keywords & synonyms We need to make sure we cover all possible ways the concept could appear in the literature, so we don’t miss important papers . 1. Extract Core Concepts Look at your PICO question,Pull out the main ideas (Patient, Intervention, Comparison, Outcome ). •Example : pneumonia, co- amoxiclav , azithromycin, treatment failure . in adults with community-acquired pneumonia, is co- amoxiclav compared with azithromycin more effective in reducing treatment failure?

19. 2. Brainstorm Synonyms, Abbreviations, Variations Authors may use different words for the same idea . •To find alternative keywords or phrases for your concepts try the following: Use a thesaurus to identify synonyms. https ://www.thesaurus.com/ Search for your concepts on a search engine like Google Scholar, scanning the results for alternative words and phrases . Example: Pneumonia → “lung infection”, CAP Co- amoxiclav → “amoxicillin- clavulanate ”, Augmentin Azithromycin → “macrolide” Include US/UK spellings: “behavior” vs “ behaviour ”. Include abbreviations: “MI” for “Myocardial Infarction ”.

20. 3. Use Truncation & Wildcards Truncation (*) = captures different word endings.(useful for finding singular and plural forms of words ) therap * → therapy, therapies, therapist. Wildcard (?) = captures spelling variations.( useful for finding British and American spellings) behavio?r → behavior OR behaviour . •There are sometimes different symbols to find a variable single character. For example, in the Medline database, “ wom#n ” will find woman and also women.

21. MeSH = Medical Subject Headings • https://www.nlm.nih.gov/mesh/meshhome.html •It is the National Library of Medicine's controlled hierarchical vocabulary that is used for indexing articles in PubMed, with more specific terms organised underneath more general terms. It is indexed Keywords specific for PubMed articles

22. MeSH = Medical Subject Headings https://pubmed.ncbi.nlm.nih.gov/

23. ex:Physical therapy for rehabilitation after total hip arthroplasty 753

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25. Step 3 : choose database There is a wide variety of search platforms and databases available for public access. Depending on the publisher, some literature pieces are open-access, so you can view and download the original articles without a subscription,With others you will only be able to view the abstracts or portions thereof, and you must pay a subscription or library fee for access to the full text. Example of search platforms and databases Cochrane Library -Google Scholar –MEDLINE -Ovid EmCare -PubMed ScienceDirect -Scopus – Web of Science

26. Database Coverage Strenghts Limitations Best use

27. Step 4 :Develop a search strategy ( boolen ) Each database works differently so you need to adapt your search strategy for each database. You may wish to develop a number of separate search strategies if your research covers several different areas. •You can use the following techniques which are used to find scientific papers. •Choosing search terms (discussed before) •Searching with keywords (discussed before) •Searching for exact phrases •Using Limiters/Filters(discussed later) •Using truncated and wildcard searches (discussed before) •Using Boolean logic

28. Searching for exact phrases Use quotation marks (") to bind terms as phrases (words to appear next to each other in a exact phrase) Example : “self-esteem”. Phrase searching decreases the number of results you get and makes your results more relevant. Most databases allow you to search for phrases, but check the database guide if you are unsure .

29. Using Boolean logic Boolean logic defines logical relationships between terms in a search Boolean operators (AND, OR and NOT) allow you to try different combinations of search terms or subject headings. Databases often show Boolean operators as buttons or drop-down menus that you can click to combine your search terms or results. •The main Boolean operators are: OR – AND - NOT 1.AND •Narrows the search → retrieves results containing all the specified terms . Ex, diabetes AND hypertension → Finds articles that discuss both diabetes and hypertension.

30. 2.OR •Broadens the search → retrieves results containing any of the specified terms (useful for synonyms ). Ex,adolescent OR teenager OR youth Finds articles mentioning any of these words. 3.NOT •Excludes specific terms → useful to filter out irrelevant results Ex,cancer NOT lung Finds articles about cancer, but excludes those about lung cancer So, Boolean operators are essential in research searching because they help make your results more specific, comprehensive, and relevant.

31. AND → only the overlap of both terms. OR → either term or both. NOT → only Term A without any overlap with Term B.

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33. Step 5 : run search & apply filters : Searches can often produce large numbers of results (papers). This may be an appropriate number for a systematic review, where you need to ensure your search is very comprehensive. However , if your search retrieves several irrelevant results, techniques can be used make your search more effective Different types of filters ( example on pubmed ) Article type: clinical trial or randomized controlled trial or systematic review Publication date :last 5 to 10years Species :human Language : english Full text - limit results to full text only Material or resource type - journal article, book, video, etc Journal type - limit results scholarly, peer-reviewed, etc.

34. Step 6 :Screen , Evaluate Results & critical appraise : 1. Screening Results “ Once you run your search, you’ll probably get hundreds or even thousands of results. We need a systematic way to screen them so we don’t waste time.” Title & Abstract screening : Read quickly → Does it match your PICO question? Inclusion / Exclusion criteria Example: Include : RCTs, humans, last 5 years. Exclude : case reports, animal studies, non-English.

35. 2. Evaluate Results “Not every paper that looks relevant is high-quality evidence. We need to evaluate critically before we accept it.” Check source → Is it a peer-reviewed journal? Study design → RCT > cohort > case-control > case report (Hierarchy of evidence ). Sample size → Was it big enough to give reliable results? Bias → Any conflict of interest, funding issues ?

36. 3. Critical Appraisal “Critical appraisal means judging the reliability, validity, and applicability of a study .” Key tools: CASP checklists (Critical Appraisal Skills Programme ) – free, simple https://casp-uk.net/casp-tools-checklists/

37. Step 7 : Save, Export, Manage References Save copies of the useful records you find and where possible save a copy of your search strategy. This will ensure that you don’t have to repeat work Always save or print the useful article records you find. Most databases give you a few options, such as: save – usually as a text file or an RIS file,print,email , direct export to reference software such as EndNote. Getting full text Generally you will not be able to download the full text of the documents directly from the database. In many databases you will have to follow the "full text" links. If the Library has a subscription, you will be able to download the article.

38. Questions:

39. references C. Heneghan , P. Glasziou . Evidence-based Medicine. Chapter 33. In: John Dent, Ronald Harden (Eds.). A Practical Guide for Medical Teachers. Churchill Livingstone Elsevier. 4th edition, 2013 Paul Glasziou , Chris Del Mar and Janet Salisbury. Evidence-based Medicine Workbook: Finding and applying the best research evidence to improve patient care. BMJ Publishing Group. 1st edition, 2003 https:// grunigen.lib.uci.edu/sites/all/docs/gml/ebm-guidebook.pdf