Locating Evidence
A sample database search for the clinical question:
Does handwashing among healthcare workers
reduce hospital acquired infection?
Susan Kaplan Jacobs/Health Sciences Librarian
Bobst Library 5th Floor, #512
email:
[email protected] phone: 212-998-2432
STEP 1: Write out your clinical question:
Does handwashing among healthcare workers reduce hospital
acquired infection?
For questions of therapy/intervention, use the PICO (T) formula to
identify the following elements in your question:
• Patient (or Problem or Population):
• Intervention:
• Comparison:
• Outcome:
• (Time factor/Type of study) (optional)
Does handwashing among healthcare workers reduce hospital
acquired infection?
• Patient ( or Problem or Population):
– Hospital acquired infection
• Intervention:
– Handwashing
• Comparison:
– Standard hand washing; other solution; no hand washing
• Outcome:
– Reduced infection rate
• (T) (not relevant for this question) 3
Does hand washing among healthcare workers reduce hospital
acquired infection?
TIP: Consider Patient/Problem and
• Patient ( or Problem or Population): Intervention first when planning
– Hospital acquired infection your search strategy and selecting
database search terms.
• Intervention: [look for the Comparison and
– handwashing Outcome when you browse
abstracts and review full text of
articles]
• Comparison:
– Standard handwashing; other solution; no handwashing
• Outcome:
– Reduced infection rate 4
STEP 2: Select a specialized database
From the libraries home page, http://library.nyu.edu/
select Articles via Databases, then choose a database from
the A to Z list
• Medline/PubMed: the premier biomedical database; 1950 to present with
some older refs; more than 20 million records
• Web of Science (Social Science Citation Index, Science Citation Index, Arts
and Humanities Citation Index)
• CINAHLPlus (Cumulative Index to Nursing and Allied Health Literature);
indexes nursing and allied health literature for more than 3200 journals back
to 1937.
• PsycINFO: International coverage of the professional and academic
literature in psychology, medicine, psychiatry, nursing, sociology, education,
pharmacology, physiology, linguistics, and other areas.
• Proquest multidisciplinary resource for research on contemporary topics or
for the beginning stages of a research project. Includes Joanna Briggs
evidence summaries.
• COCHRANE Database of Systematic Reviews: Provides access to the
Cochrane Collaboration’s systematic reviews in addition to other sources of
reliable information, from other systematic review abstracts, technology
assessments, economic evaluations and individual clinical trials. Includes
Cochrane Database of Systematic Reviews(CDSR), Database of Abstracts
of Reviews of Effects (DARE), Cochrane Central Register of Controlled
Trials (CENTRAL), Cochrane Methodology Register (CMR), NHS Economic
Evaluation Database (NHSEED), and Health Technology Assessment
Database (HTA) 6
From the A-Z list, select: PubMed
Widely recognized as the premier source for bibliographic and abstract
coverage of biomedical literature. Encompasses information from Index
Medicus, Index to Dental Literature, and International Nursing Index, as
well as other sources in the areas of allied health, physical therapy,
health education, biological and physical sciences, humanities and
information science as they relate to medicine and health care,
communication disorders, population biology, and reproductive biology.
More than 16 million records from more than 5200 journals are indexed.
A simple search on one term: handwashing
Notice the Search details box in the
lower right corner, the Search
details translate to the MeSH term:
hand disinfection
MeSH (Medical Subject Headings) is
NLM's controlled vocabulary thesaurus
used for indexing MEDLINE articles.
Or use the MeSH browser to locate terms and scope notes:
A search on “hospital acquired infection” in the MeSH browser
directs us to the term: Cross Infection
Search steps
schematically…
Hospital acquired handwashing
infection
AND
Handwashing MeSH term: hand disinfection
AND
Hospital-acquired infection MeSH term: cross infection
12
Search steps
schematically…
Cross infection Hand
disinfection
AND
13
Search steps
schematically…
cross infection Hand
disinfection
AND
The AND connector narrows a search.
14
BOTH search terms must be in the retrieved records.
Search steps
schematically…
hand hand hand
handwashing
disinfection hygiene scrubbing
OR OR OR
Use the OR connector to link synonyms…expand a search,
(OR retrieves MORE…)
15
Search steps
schematically…
(hand disinfection
OR
hand hygiene
cross infection OR
hand scrubbing
OR
handwashing)
AND
You may wish to expand a search, using synonyms…
16
Search steps
schematically…
(hand disinfection
(hospital acquired
OR
infection hand hygiene
OR OR
cross infection hand scrubbing
OR OR
nosocomial infection) handwashing)
AND
You may wish to expand one or both search sets using
synonyms…
17
Click for
full text
options
A sample citation meets the
search criteria:
Hand disinfection
AND
Cross infection are MeSH
terms
Does handwashing among healthcare workers reduce
hospital acquired infections?
In all databases, look for the categorical Limits feature:
• for Age groups, e.g., aged, child, young adult (rather than keywords
such as “pediatric” or “elderly”)
• for Article type: http://nyu.libguides.com/filtering
In the PubMed example let’s limit to Article type: “randomized
controlled trial” to retrieve a higher level of evidence.
In this PubMed
example a search on:
handwashing
AND
cross infection
retrieves 1694 results.
Use left
menu to
filter by
Article type:
For example:
using the filter
for Article type:
“randomized
controlled trial”
reduces search
results and
retrieves a higher
level of evidence.
Search steps Publication
schematically… type:
randomized
controlled trial
(hospital (hand disinfection
acquired infection OR
OR hand hygiene
cross OR
infection hand scrubbing
OR OR
nosocomial handwashing)
infection)
AND
22
A sample citation meets the
search criteria:
Hand disinfection
AND
cross infection
are MeSH terms
AND
Randomized controlled trial
is the publication type
Click on the NYU icon
for full text options
24
Options may link to
article full text
or…
25
If an article is not
available full text
or hard copy in the libraries’
Bobcat catalog,
click to order via Interlibrary Loan.
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Summary…
1. FRAME QUESTION, including the Problem (or Patient or Population) AND
Intervention
2. FINDING: Select a SOURCE, database (CINAHLPlus, PubMed/MEDLINE…)
3. SEARCH: Translate the terms of the question to the controlled vocabulary of the
database, when possible; use keyword searching when necessary.
Use AND to combine terms and narrow a search:
cross infection AND hand disinfection
Use OR to expand a search using synonyms
(hand disinfection OR handwashing OR hand hygiene)
(cross infection OR nosocomial infection* OR hospital acquired infection)
Apply Limits for publication type, year, age groups, For example:
Limit to age group “Aged, 65 and over”
Limit to publication years 2005-2013
Limit to publication type “randomized controlled trial”
4. ASSESSMENT: critical appraisal, applicability, actionability, repeat from 1 if needed
27
• Medline/PubMed: the premier biomedical database; 1950 to present with
some older refs; more than 20 million records
• Web of Science (Social Science Citation Index, Science Citation Index, Arts
and Humanities Citation Index)
• CINAHL (Cumulative Index to Nursing and Allied Health Literature); indexes
nursing and allied health literature for more than 3200 journals back to 1937.
• PsycINFO: International coverage of the professional and academic
literature in psychology, medicine, psychiatry, nursing, sociology, education,
pharmacology, physiology, linguistics, and other areas.
• Proquest multidisciplinary resource for research on contemporary topics or
for the beginning stages of a research project. Includes Joanna Briggs
evidence summaries.
• COCHRANE Database of Systematic Reviews: Provides access to the
Cochrane Collaboration’s systematic reviews in addition to other sources of
reliable information, from other systematic review abstracts, technology
assessments, economic evaluations and individual clinical trials. Includes
Cochrane Database of Systematic Reviews(CDSR), Database of Abstracts
of Reviews of Effects (DARE), Cochrane Central Register of Controlled
Trials (CENTRAL), Cochrane Methodology Register (CMR), NHS Economic
Evaluation Database (NHSEED), and Health Technology Assessment
Database (HTA)
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Evidence is hierarchical.
Explore the resources linked
at:
nyu.libguides.com/pyramid
