1. Searching for the evidence
Binyam Tariku
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2. What is evidence?
“ …the best research evidence is usually found in clinically
relevant search that has been conducted using sound
methodology.”

3. Searching for the evidence
• Looking for high-quality article to answer a specific question
• Scooping the literature to see what’s been published
• Conducting in-depth literature review
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Learn and Practice various SEARCH STRATEGIES:
•To find useful information quickly
•To eliminate irrelevant, inappropriate or weak information

4. SEARCH AND RETREIVE THE BEST EVIDENCE
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5. Searching for the evidence
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6. Developing Search Strategy

7. Developing Search Strategy
Techniques and strategies
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8. Databases
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9. Abstracts
• At some point you will find yourself searching the massive
collections of bibliographic records available in online databases.

10. Example: structured ABSTRACT
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a disease state characterised by airflow
limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an
abnormal inflammatory response of the lungs to noxious particles or gases. Classically, it is thought to be a
combination of emphysema and chronic bronchitis, although only one of these may be present in some people
with COPD. The main risk factor for the development and deterioration of COPD is smoking.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following
clinical questions: What are the effects of maintenance drug treatment in stable COPD? What are the effects of
smoking cessation interventions in people with stable COPD? What are the effects of non-drug interventions in
people with stable COPD? We searched: Medline, Embase, The Cochrane Library, and other important
databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for
the most up-to-date version of this review).We included harms alerts from relevant organizations such as the
US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency
(MHRA).
RESULTS: We found 119 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of
the following interventions: alpha1 antitrypsin, antibiotics (prophylactic), anticholinergics (inhaled), beta2
agonists (inhaled), corticosteroids (oral and inhaled), general physical activity enhancement, inspiratory muscle
training, nutritional supplementation, mucolytics, oxygen treatment (long-term domiciliary treatment),
peripheral muscle strength training, psychosocial and pharmacological interventions for smoking cessation,
pulmonary rehabilitation, and theophylline.

11. Example: Unstructured ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a disease state characterised by airflow limitation that is not
fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory
response of the lungs to noxious particles or gases. Classically, it is thought to be a combination of emphysema
and chronic bronchitis, although only one of these may be present in some people with COPD. The main risk
factor for the development and deterioration of COPD is smoking. We conducted a systematic review and
aimed to answer the following clinical questions: What are the effects of maintenance drug treatment in stable
COPD? What are the effects of smoking cessation interventions in people with stable COPD? What are the
effects of non-drug interventions in people with stable COPD? We searched: Medline, Embase, The Cochrane
Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically;
please check our website for the most up-to-date version of this review).We included harms alerts from relevant
organizations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare
products Regulatory Agency (MHRA). We found 119 systematic reviews, RCTs, or observational studies that
met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In
this systematic review, we present information relating to the effectiveness and safety of the following
interventions: alpha1 antitrypsin, antibiotics (prophylactic), anticholinergics (inhaled), beta2 agonists (inhaled),
corticosteroids (oral and inhaled), general physical activity enhancement, inspiratory muscle training,
nutritional supplementation, mucolytics, oxygen treatment (long-term domiciliary treatment), peripheral muscle
strength training, psychosocial and pharmacological interventions for smoking cessation, pulmonary
rehabilitation, and theophylline.

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PubMed
WHAT IS IT?
Searchable database of medical information compiled by National Library of Medicine in US 1966-present
Catalogs articles from approx 4000 world journals (of estimated 12-15k total)
a free search tool to over 19 million citations
SEARCH METHODS
Any word or words (title, abstract, content, author name, institution, etc.)
Medical Subject Heading (MeSH) terms
A restricted thesaurus of medical titles
Articles categorized by most specific possible MeSH heading

13. PubMed: SEARCH SCENARIO
• Search Scenario-1: Possible risk of mobile phones causing cancer
in children
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14. PubMed: SEARCH SCENARIO
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15. PubMed: Techniques and strategies
 Boolean Operators
 AND
 OR
 NOT
 Technical Recommendation
 Use capital letter for all Booleans
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16. PubMed: Techniques and strategies
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17. PubMed: Techniques and strategies
 Find articles on any of these concepts
 Use OR with synonyms to expand the number of results
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18. PubMed: Techniques and strategies
 Looks for articles about cancer, but removes articles that talk about Leukaemia
 What is the Disadvantage of using NOT?
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19. PubMed: Techniques and strategies
 Removes articles that could be relevant
 Miss articles that address Adults and Children
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20. PubMed: Nesting
 How to use a mix of ANDs and OR's
 By default PubMed read from left to right
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21. PubMed: Nesting
 use parentheses around OR terms
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22. PubMed: Phrase Searching
 PubMed automatically adds AND in between words
 It can cause a problem with phrases
Task 1: Look how PubMed Search for phrases?
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23. PubMed: Phrase Searching
 Use quotation marks around phrases
“Mobile Phones”
 However, We don't need quotes around single word
Smartphones
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24. PubMed: Truncation Symbol
 the PubMed truncation symbol is asterisk (*)
 Truncation used to match various word endings
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25. PubMed: Truncation Symbol
 Cautions of using truncation
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26. Activity: Search strategy
 Develop and export search strategy in PubMed/ Embase
Case study 1
Question :
In patients with prostate cancer, do androgen deprivation therapy reduce the recurrence rate,
compared to no treatment?
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27. Activity: Search strategy
 Develop and export search strategy in PubMed/ Embase
Case study 2
Question:
Does the application of topical anaesthetic applied on the skin reduce pain in new-born infants who
require a procedure that punctures the skin?
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28. Question: In patients who have had a heart
attack, does simvastatin reduce mortality?

30. To increase sensitivity:
1. Expand your search using (broader terms in) the thesaurus.
2. Use a text word search of the database
3. Use truncation and wildcards to catch spelling variants.
4. Use Boolean OR to make sure you have included all
alternatives for the terms you are after (for example
(myocardial AND infarction) OR (heart AND attack)).

31. • To increase specificity:
1. Use a thesaurus to identify more specific headings
2. Use more specific terms in text word search
3. Use Boolean AND to represent other aspects of the question
4. Limit the search by publication type, year of publication, etc.

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• Research4Life is a public-private partnership of the WHO, FAO,
UNEP, Cornell and Yale Universities and the International
Association of Scientific, Technical & Medical Publishers.
• Research4Life is the collective name for three programs –
HINARI, AGORA and OARE.
• It provides developing countries with free or low cost access to
academic and professional peer-reviewed content online.

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http://www.research4life.org

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 Online portal to access information on Agriculture and related sciences
Coordinated by FAO/Cornell University, USA
Free/Low cost to 105 countries
2500 journals / 75 publishers
>1800 registered institutions
Data: 07 2011
http://www.aginternetwork.org/en/
AGORA
(Access to Global Online Research in Agriculture)

37. OARE
(Online Access to Research in the Environment)
Online portal to access environmental information
Coordinated by UNEP/Yale University
Free/Low cost to 105 countries
Over 3900 journals / 75 publishers and scholarly societies
Environment and related sciences
1400 registered institutions
Data: 07 2011
http://www.oaresciences.org/en/

39.  HINARI Access to Research in Health program provides free or very low cost
online access to the major journals in biomedical and related social sciences
to local, not-for-profit institutions in developing countries.
 HINARI was launched in January 2002 for “free access” countries (Band 1).
 In Jan. 2003 it was launched to “low-cost" countries (Band 2).
HINARY Background

40. Eligibility
• Band 1/Group A: Institutions in countries included in the United
Nations Least Developed Country (LDCs) List;
• HDI (human development index) less than 0.63; or GNI (gross national income)
per capita at or below $1600 may be eligible for free access
• Band 2/Group B: Institutions in countries with either
• GNI per capita less than $5000 or
• HDI at or below 0.67 may be eligible to pay a fee of $1000 per year
• Some publishers opt out of this option and do not allow access to their
journals
• For details, see www.who.int/hinari/eligibility/en/

43. http://www.who.int/hinari/

44. Using PubMed through HINARY

45. Task
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