Chapter Six

EBM and Information Searching

Geleta N. [BSc, MPH-HI]

Department of Health Informatics
 Outline
 Evidence based medicine(EBM)
HINARI
 Information Retrieval Process PubMed
 Search Strategy PubMed Filter

 Google and Google Scholar PubMed Advanced Search

 Research4Life MeSH (optional)

Introduction
Evidence-based medicine:
 Integration of the best available research evidence with clinical
expertise and patient values.
 Careful, explicit and judicious use of current best evidence in
making decisions about individual patients .
Components of EBP with some elaborations
 Why Evidence-Based
Practice?
 So much information, but too little time

 Need high-quality, filtered information to

make informed decisions.

 Value of scientific knowledge for decision-making

 Decisions should not be based only on perception, opinion

or unreliable information
5
 Evidence-Based medicine

Best Evidence
Expertise,
from Knowledge
Social values,
Politics,
Research
Economics
$
Decisions for Public Health Practice
• Interventions, programs, and policies

6
Rise of Evidence-Based Medicine

 First described in 1992

 A new Approach to teaching medicine

 Considered as a revolution in medical practice

 Factors Driving EBM

 Vast size of the literature

 Inadequacy of textbooks

 Increased number of RCTs

 Available computerized databases

Factors Hindering EBM?

 Steps in EBM

 Convert the need for information into an answerable

question…ASK

 Track down the best evidences…AQUIRE

 Critically appraise that evidence….APPRAISE

 Integrate the appraisal with one’s clinical expertise and the

individual patient…APPLY

 Evaluate….ASSESS
Information Retrieval
Process
Information need Documents

Query formulation Indexing

Query Indexed documents

Matching

Feedback Received documents

Source: (Ruban S. et al, 2014)
 Indexing
Indexing: the process of assigning metadata to documents to facilitate its
retrieval.
1. Manual indexing: Human indexers, usually using a controlled
terminology, assign indexing terms and attributes to documents.
2. Automated indexing: Computers make the indexing assignments,
usually limited to breaking out each word in the document (or part of
the document) as an indexing term
Search Strategy
 Search Strategy
 A search strategy is an organized structure of key terms used to

search a database.
 The search strategy combines the key concepts of your search question in order to

retrieve accurate results.

 Your search strategy will account for all:
• possible search terms
• keywords and phrases
• truncated and wildcard variations of search terms
• subject headings (where applicable)
 Why Search Strategy is Important?

Health care includes the provision of information to consumers or professionals (reliable,

accurate, up-to-date)

Information explosion- billions of documents in the WWW; hard to find the ‘needle in the hay

stack’ and know which source is best for a specific situation;

Evidence-Based Practice - clinicians are not using enough evidence in practice

A systematic search strategy should be adopted when dealing with clinical questions to avoid

‘information malpractice.
Example (Steps 1-4)
1. Ask: What health problems are associated with water pollution?
2. Need: scholarly primary research
3. Main Concepts: health, water, pollution
4. Select terms:
– Broader terms: ‘health’, ‘environmental degradation’, ‘agricultural management’,
– Synonyms:
health, illness, disease, etc.
water, rivers, lakes, sea, domestic water, etc.
pollution, ‘oil spills’, chemical, biological, toxicity, etc
– Alternative spellings: none
– Plurals: river(s), lake(s), disease(s)
– Capitals: e.g. name of a specific lake, disease, region
Boolean (Search) Operators

 Connect terms and locate records containing matching terms

 Inserted in a search box – AND (+), OR (-), NOT

 Must be in UPPERCASE when used
 AND, NOT operators are processed in a left- to right sequence.
These are processed first before the OR operators
 OR operators are also processed from left-to-right
 AND Operator
(to combine two concepts and narrow a search)

the AND operator is used to combine two concepts

e.g. hip AND fracture – in the shaded area;
retrieves items containing all the search terms
 AND Operator
(to combine three concepts)

the AND operator is used to combine three

concepts e.g. hip AND fracture AND elderly –
in the shaded area.
 OR Operator
(info containing one or other term; will broaden a
search)

renal OR kidney – in the shaded area with the

overlap in the middle having both search terms;
retrieves items containing either search term or
both search terms
NOT Operator
(in one term or the other - will narrow a search)

pig NOT guinea – in the shaded area;

eliminates items in 2nd term (guinea) or both
terms
Africa AND (malaria OR tuberculosis)

malaria tuberculosis

africa

Africa AND (malaria or tuberculosis) – in the shaded area

The (OR) operator retains items in each term and the AND
operator is used to combine two concepts
 Other search engine functions
• Phrase or proximity searching: “…” or (…)
– allows you to search for an exact phrase
– E.g. “information literacy”
– E.g. prevention and (malaria parasite)

• Truncation/wildcards: *
– allow you to search alternative spellings
– E.g. child* for child OR childs OR children
– E.g. parasite* for parasite OR parasites

• Alternate spellings: ?
– can be used to substitute for characters anywhere in a word
– E.g. wom?n would search for “woman” and “women”
 More Search Techniques
• Field Specific Searching
– author, title, journal, date, url, etc.

• Language Restrictions, Humans or Animals, Gender and other limits

• Relevancy Ranking
– a grading that gives extra weight to a document when the search terms
appear in the headline or are capitalized
– every found document is calculated as 100% multiply by the angle formed
by weights vector for request and weights vector for document found
Google and Google
Scholar
We have displayed the Advanced
Search option of Google. Note the
various options for refining a search
including Reading level, Results per
page, Language and File Type.
Google Scholar provides a simple way to broadly
search for scholarly literature. You can search across
many disciplines and sources: peer-reviewed papers,
theses, books, abstracts and articles, from academic
publishers, professional societies, preprint repositories,
universities and other scholarly organizations.
We have displayed the Advanced
Scholar Search option of Google
Scholar. Note the various options for
refining a search and also that you can
change the number of results per page.
 Research4Life
 Research4Life is designed to enhance the scholarship, teaching, research and
policy-making of the many thousands of students, faculty, scientists, and
medical specialists, focusing on health, agriculture, environment and other life,
physical and social sciences in the developing world, through free or low-cost
access to academic and professional peer-reviewed content online.

 Research4Life is the collective name for five programs – HINARI, AGORA

OARE, ARDI, GOALI.

 It provides developing countries with free or low cost access to academic and
professional peer-reviewed content online.
 HINARY
• Online portal to access information on health and related social
sciences
• Coordinated by WHO and Yale University
• Offering up to 13,500 journals / 60,000 books / 110 other
information resources / 150 publishers' content included [June
2018]
• www.who.int/hinari
Click on the Hinari logo to open the program.
All the programs your institution is registered for are listed. Login to
any of the other programs by returning to this page (use the R4L
Portal – Applications tab at the top of the web browser). To open
another program, click on the specific logo. Your Hinari username
and password will grant access to the other programs (and ditto for
your institution’s AGORA, ARDI GOALI or OARE logins).
PubMed
Once logged in to the HINARI Content
page, access PubMed by clicking on
Databases for discovery list.

Note: The PubMed training modules

use screen captures from a computer.
Open PubMed which is
at the top of the
Browse databases list.
The Search box on PubMed is active with access
to 28 million citations. Place your search
statement in the box.
In this example, enter a search for malaria
infections AND africa into the Search or query box.
To execute the query, click on the Search button.
Results of the search are displayed in the main body of the
page in Summary Format and Sort by Most Recent options.
This is the default setting when you complete a search.
Note that the search displays 20 per page citation.
Note the two additional filters for Free Full Text and HINARI
articles. These have been created for the HINARI/PubMed
searches.
Of the 6630 articles, 2163 are available via the HINARI filter
and 3337 with Free full text filter (there are some overlaps).
Note the useful options in the right column of
the PubMed search results:
Results by year graph
PMC Images listing
Find Related Data
See next slide for Find Related Data and
Search details box.
Note the additional hypertext link for
Free Article and Free PMC Article. By
clicking on this link, you will be re-
directed to the Abstract display and be
able to access the full text.
Also note the bolded terms of the search
– malaria, infections and Africa.
Click on the Free Article or Free Full Text
Article hyperlinks, you are re-directed to
the Abstract Format.
Click on the Full text links to the
publisher’s website and the full text article.
Check the Abstract Format
bullet from the drop down
menu. We have retained the
Sort by Most Recent option.
Note the Abstract Format with the Sort by
Most Recent options are displayed in the
Display Settings line above the abstract.
Per the Free Full Text and HINARI Filters,
using these options is up to your preference.
PubMed Filters
From the initial (HINARI) PubMed page, we
will run the HIV and pregnancy search
and then apply various Filters.
After completion of a search, the default Filters are
displayed in a left-column frame. We will apply different
Filters to the results of the HIV and pregnancy search - a
total of 17258 citations
Note: Filters can be added before the search is begun. Also
search terms can be defined by Boolean Operators (and, or
not) or proximity searching: “…” or (…)
Initially we will apply the Publication dates filter. We have
clicked on the 5 years option. This limits the search results
to 3932. Note the check mark next to Publication Dates
section. Also note clear icon. There is a Clear all option at
the bottom of the page. If you do not clear your options,
they will be applied to future searches.
By using a 2017 01 01 Custom Date Range
filter, there are 384 citations for HIV AND
pregnancy search. Below the results, there is
the Filters activated line that includes the Clear
all option.
The specific Filters Activated is noted with a
check mark. We will click on the Clear option to
remove this . You also can click on the specific
filter.
Click on the Show additional filters link and
now will check the Languages box and
click on Show.
Advanced
Search
To use Advanced Search Builder option,
access to Advanced from the initial
PubMed page or the Search Results
page.
In the Advanced Search Builder, open the All Fields
drop down menu. You can add terms in all or specific
fields using the AND, OR, NOT Boolean operators.
Add the Text Words tuberculosis and drug resistance
to the Builder search boxes. Use the AND Boolean
operator. When entered, these search terms are
displayed in the box above the Builder.
Note that you can display or hide the Index list. We have
displayed the initial list of index terms for tuberculosis.
You can enter any of these terms into the search box.
Enter tuberculosis in the 1st Search Builder box and drug
resistance in the second box.
Click on All Fields in a
Builder box. In the drop
down menu, scroll down and
open the Mesh Terms option.
In the MeSH Terms option in the
Builder drop down menu, insert the
term developing countries into the
search box. Run the Search.
The results of the tuberculosis AND drug resistance AND
developing countries search are 173 citations. To return to
Advanced Search, click on the hypertext link below the
PubMed Search box.
Note, in the Filter your results list, that there are 42 Free Full
Text and 84 HINARI citations.
Now displayed is the Advanced Search Builder
page. Note that the Search History has been
activated and lists the recently completed search as
#1. You can return to the Summary display of the
search results by clicking on the Items Found #.
The All Fields drop down menu has
numerous useful filters. In the search
builder, use the Text/abstract and
MeSH Terms options. Run the Search.
On the Advanced Search Builder page,
note the Search History #2. With these
filters, the search results have decreased
from 173 to 81. Click on the 81 to display
the search results.
Medical Subject Headings (MeSH)
 Medical Subject Headings (MeSH)
 It is a controlled vocabulary produced by the National Library of Medicine
 Used for indexing.
 Cataloguing.
 Searching for biomedical and health-related information and documents.
 Searching with mesh-controlled vocabulary gives you more precise search
results.
To access the MeSH Database from the PubMed
homepage, click on the link from the right column
of the PubMed home page. A second way to
access MeSH is to open the Databases drop
down menu and then to click on MeSH.
MeSH (Medical Subject Headings) is the
controlled vocabulary for indexing articles in
Medline – National Institute of Health’s
bibliographic database of life sciences and
biomedical information.
MeSH Terms are assigned as Keywords to
each record that is “Indexed for MEDLINE”. In
MeSH,l complete search for the term malaria.
From these results, note
that the MeSH has listed
9 terms for Malaria.
To complete a PubMed search with the
Malaria MeSH term, click on Add to
search builder and then click on
Search PubMed.
Note how “Malaria[Mesh]” is displayed
in the PubMed search builder box.
Completed is a search for the
Dengue MeSH term. There
are 19 MeSH terms
containing the term Dengue.
Click on the box for this
(broadest) term.
Now search for the MeSH term Dengue with
the subheadings of epidemiology,
parasitology and transmission. Check the
boxes for these terms and click on Add to
Search Builder and Search PubMed. Note
the search terms in the PubMed search
builder box.
In PubMed, the search has
resulted in 3566 citations.
From the PubMed search screen,
displayed is the Advanced Search
option and highlighted the History
section. Note the Dengue searches
that have been completed.
Complete a MeSH search for the
geographic location Asia. After
entering the term in the search box,
open the Asia, Southeastern term.
Completed is the PubMed
search for Asia, Southeastern
[Mesh] that has 64877 citations
with 12933 Free Full Text and
18482 HINARI articles.
Open the PubMed Advanced Search option to view the
History section. By clicking on ADD for History Searches
#15 and #7, the two searches have been added to the
Search Builder. This combines the MeSH terms Asia,
Southeastern AND Dengue. Click on Search.
The results of the Asia, Southeastern [Mesh]
AND Dengue[Mesh]… search is 712 articles
and also demonstrates one of PubMed’s
Advanced Search options.