SYSTEMATIC LITERATURE REVIEW Optimal study designs according to the clinical question:

Types of Study Designs

Tips: Clinical
o Dedicated Laptop/Computer Question
o Good Internet Connection Intervention Systematic reviews of Randomized
o USB Flash Drive Controlled Trials (RCTs)
o Ergonomics Diagnosis Studies comparing the new test
with a reference standard test,
Literature Search Randomized Control Trials.
Prognosis Cohort studies, Case-control
o Systematic search of all types of literature
studies
regarding a specific topic.
Etiology Case-control or Cohort Studies
o Maximizing the time, quality, and scope. Meaning Qualitative Studies
TYPES OF SOURCES Rating System for the Hierarchy of Evidence
PRIMARY SECONDARY TERTIARY Level I SR or Ma of RCTS
Original Study Study of Collated and Level II RCTs
Primary filtered primary
Level III Controlled trials without
- Journals Literature and secondary
randomization
- Theses sources
Level IV Case-control and cohort
- Tabulated - SR
Level V SR of descriptive and qualitative
Health - Meta- - Encyclopedia
studies
Statistics analysis - Fact Books
- Data Level VI Single descriptive or qualitative
studies
compilations
Level VII Opinions and/or reports

Step 1: Define the Problem

Step 2: Choose the appropriate database
Step 3: Formulate the search strategy
Step 4: Perform the search
Step 5: Evaluate the result
Step 1: Define the Problem
o Review questions or search statement
o Specify what you need to search.
Framing the Question
P – patient (and their condition)
I – Intervention (under examination)
C – Comparison (that is most relevant)
O – Outcomes (that matter to the patient)
*What non-pharmacologic interventions are effective in
reducing the blood pressure of adolescents? Be specific.
Narrowing the questions helps.
**Is chocolate effective in reducing the blood pressure of
hypertensive adolescents? Specific?
Is dark chocolate (I) effective in reducing the blood
pressure (O) of hypertensive adolescents (P)?
Step 2: Choose the appropriate database
o Use more than one source
o Selection depends on the areas of interest
1. Google Scholar
2. Cochrane Database of Systematic Reviews
o Contains synthesized evidence (pre-
appraised)
o Full test of regularly updated systematic
reviews
3. EBSCO Host
4. The Joanna Briggs Institute
5. Medline/PubMed Resource Guide
o Citations from 4,600 biomedical journals
in medicine, nursing, pharmacy, dentistry,
and allied health.
o 80% in English, updated weekly
6. Excerpta Medica database (EMBASE)
o Major European biomedical and
pharmaceutical databases, clinical and
experimental human medicine, health
policy and management, public health,
environmental health, psychiatry.
o Databases from more than 5,000 journal
titles from 70 countries.
7. National Guideline Clearinghouse
 o Contains guidelines that are Cocoa Systoli Lowe HIghblood Teen
systematically developed statements c Blood r pressure
about a plan of care for a specific set of Pressur
clinical circumstances involving a e
particular population. Chocolat Diastol Lesse Hypetnesi
8. CINAHL es ic n on Adolesce
o Articles/journals from journals, monogram, bLood ne
Pressur
dissertations
e
o Contains database from more than 3 million
DEVELOP SEARCH STRATEGY
journal articles, accessed through vendors
o Combine the terms (concepts) t maximize the
(EBSCO)
search
o Uses controlled vocabulary
o Example: If there are 4 concepts (A-B-C-D),
9. PsycINFO – A world-class resource for abstracts
possible combinations are:
and citations of behavioral and social science
A-B A-C B-C B-D
research.
A-B-C A-C-D A-D C-D
o Bibliographic databases in behavioral
A-B-C-D B-CD A-B-D
sciences and mental health that indexes
publications.
SET YOUR INCLUSION CRITERIA
o With more than 1 million citations, 11% are
o Population
books, 12% dissertation.
o Intervention
10. Health Research and Development Information
o Comparison
Network (HERDIN) – database is the national
o Outcome
health research repository of the Philippines.
o Research Design
o Location/setting; Language
SUMMARIES OF EVIDENCE-BASED GUIDELINES:
o Time frame (Year)
o Source (Database/s)
• Joanna Briggs Institute o Cases to be excluded
• Scottish Intercollegiate Network Search Number Keywords*refer
• TRIP to your search
• Bandolier table
1 “dark
Grey Literature – Unpublished Evidence chocolate”OR
• Reports “cocoa” OR
• Unpublished drug trials chocolate”
• Unpublished conference proceedings 2 “blood
pressure”OR
• To minimize bias (file drawer problem)
“systolic blood
• Dissertation and Theses Database pressure”OR
“diastolic blood
Step 3: Formulate the search strategy pressure”
o Formulate keywords based on the research 3 Hypertensive
question OR
o Identify similar or alternative words hypertension
o MeSH headings OR “high blood
• Thesaurus for MEDLINE, EMBSE, pressure”
CINAHL, PsycINFO 4 Adolescent* OR
• Dictionary of index terms teen
5 S1 and S2
6 S3 and S5
DEVELOP SEARCH TABLE
7 S4 and S6
Dark Blood Reduc Hypertensi Adolesce
8 S7 and (reduce
Chocolat Pressur e (C) ve (D) nt (E)
OR lower OR
e (A) e (B)
lessen)
 9 S8and (
experimental MANUAL SEARCHING
OR trial OR o Check the reference of articles
RCT OR o Contact authors and/or experts
“randomized
controlled
trial”)
Step 5: Evaluate the result
✓ Read the title and abstracts of searched articles
Step 4: Perform the search
✓ Check the search terms
o Use Boolean Operators
o Work with truncation and wildcards
o Use quotation marks or parenthesis
o Use search filters

BOOLEAN OPERATORS
o AND – chocolate AND hypertension
o OR- chocolate OR cocoa
o NOT- adolescent NOT adult

TRUNCATION
o A shortcut devise
Eg. Finding the beginning of the word with a different
coding on it; often denoted as * or $
✓ Child* would pick up child, children, childhood,
etc.
✓ Ulcer$ would pick up ulcer, ulcers, ulceration, EVALUATION TABLE TEMPLATE
ulcerated, etc. Cit C De Sa Var Meas Dat Fin Ap
✓ Mentor* would pick up mentors, mentorship, ati F sig m iabl urem a din prai
etc. on n ple es ent An gs sal
aly
WILDCARD sis
o Alternate spellings
o Wildcard is inserted in the middle of a word
where an extra letter or alternative letter might be APPRAISAL
placed; often denoted as ? o Strengths and limitation
o Risk or harm
An?emia would pick up anaemia and anemia o Feasibility od use in your practice
H?emoglobin would pick up haemoglbin and o Level of evidence
hemoglobin
CREATE CONTAGIOUS CONTENT!
QUA”TATION MARKS OR PARENTHESIS STEPPS
o For search to capture the exact phrase, enclose in Social Currency: Make people look good.
quotes – “pressure sore” Triggers: Very easy to remember
o Or us Parenthesis – (“pressure sore” OR “bed Emotion: Very easy to remember
sore”) AND obesity Public: Built to show and grow
Practical Value: Keep it relevant.
SEARCH FILTERS Stories: Create a conversation
o Publication date
o Publication type TEAMWORK TOOLS TO ENHANCE PATIENT
o Language SAFETY
o Age Group
o Sex Tool Brief Description
o Animal vs Human studies
SBAR ▪ A standardized technique for ▪ Ensuring that mistakes or
communicating critical oversights are caught quickly
information that requires and easily.
immediate attention and action ▪ “Watching each other’s back”
concerning a patient’s condition. I’M SAFE A check is used during situation
▪ SBAR stands for Situation, checklist monitoring by each team member to
Background, Assessment, and assess his or her own safety status.
Recommendation/Request.
Call-out A tactic used to communicate I’M SAFE stands for:
important or critical information. It ▪ Illness
informs all team members ▪ Medications
simultaneously during emergent ▪ Stress
situations and helps team members ▪ Alcohol and Drugs
anticipate the next steps. ▪ Fatigue
Check-back A strategy of closed-loop ▪ Eating and eliminating
communication to ensure that Two- Empowers all team members to “stop
information conveyed by the sender is challenge the line” if they sense or discover an
understood by the receiver as intended. rule essential safety breach.
Handoff The transfer of information during CUS An assertive statement is used when a
transitions in care across the team member would like to “stop the
continuum. It provides an opportunity line”.
to ask questions, clarify and confirm. ▪ I am Concerned!
▪ I am Uncomfortable!
A specific tool for this is “I PASS THE ▪ This is a Safety Issue!
BATON” which is designed to enhance DESC script An approach for meaning and resolving
information exchange. conflict.
Brief A short session prior to the start of a
procedure or event to share the plan, DESC stands for:
discuss team formation, assign roles ▪ Describe
and responsibilities, establish ▪ Express
expectations and climate, and anticipate ▪ Suggest
outcomes and likely contingencies. ▪ Consequences
Huddle Ad hoc meetings to re-establish
situational awareness, reinforce plans
already in place, and assess the need to
adjust the plan.
Debrief Informal information exchange
sessions are designed to improve team
performance and effectiveness through
lessons learned and reinforcement of
positive behaviors.
STEP A tool for monitoring situations in the
delivery of health care and useful in INFORMATICS LECTURE 1:
situation monitoring of the patient. Applications in EVB Nursing

STEP stands for: WHAT ARE THE BENEFITS OF EVIDENCE-BASED

Status of the patient NURSING PRACTICE?
Team members o It helps in providing the highest possible quality
Environment of care in the most cost-efficient manner.
Progress toward goal o The practice also enables nurses to incorporate
Cross- A harm error reduction strategy that clinical expertise and current research into the
monitoring involves: data and turn it into a useful basis in the decision-
▪ Monitoring the actions of other making process.
team members
▪ Providing a safety net within
the team
HOW CAN WE UTILIZE EVIDENCE-BASED
NURSING PRACTICE?
The use of information technology allows more efficient
facilitation in the applications in Evidence-Based Nursing
Practice such as the computerized nursing care plan, use
of clinical pathways, clinical practice guidelines, and e-
journals that provide the latest and up-to-date accessible
literature that can be used as support for new evidence-
based nursing practice projects. This unit will provide you
with an overview of the above-mentioned applications
and its intended purpose.
EVIDENCE BASED MEDICINE
APPLICATIONS IN EVIDENCE-BASED PRACTICE
o Nursing Care Plans (NCP) are essential to
delivering the appropriate care to patients. NCP will
differ in every place you work – they can also be
called Care Tracks or Care Maps. These are used to
outline the patient’s care on daily basis.
o Nursing care plans or NCPs as we use them in our
conversations with our colleagues, have been
introduced to us during our stay in the nursing
school. It has been used extensively inside the
academic institution as an essential teaching tool to
present the value of planning patient care, which
has been also reinforced by the Joint Commission
on Accreditation for Hospitals (JCAH). But in
actual clinical settings, it is difficult to find
completely written nursing care plans. If in any case
that a written care plan is found, they can be
incomplete, outdated, rarely used for determining
care and infrequently relied upon as a means of
communicating problem management from one
shift to another.
o The nurses view the care plan burdensome, as it is
time-consuming paperwork, preparation or revision
of the plan is low in practice settings (Dharmarajan
and Gangadhara, 2013). It is with this practice that
the initiation of a computer-generated nursing care
plan was done.
o The computer-generated nursing care plans
promote the value of planning care but at the same
time address the burden of the ·workload NCPs can
consume from the nurses. It works by providing a
template that nurses can work on and· modify based
on the individual cases of their clients.
o Nursing documentation, which is often identified as
the sixth step in the nursing process, nursing
process is vital in information management.
Therefore, it is necessary for nurses to document
accurately and precisely to determine the desired
outcome. Remember the Rule “Garbage In-
Garbage Out” also applies to nursing
documentation

Nursing Clinical Practice (Point-of-Care Systems and

Clinical Information Systems)

A. Computer-Generated Nursing Care Plans

B. Critical Pathways o WHAT IS GIGO?
C. Clinical Guidelines o The quality of information coming out cannot
D. E-Journals be better than the quality of information that
went in.
A. Computer-Generated NCP
▪ Demonstrates commitment to continuity of care.
 ▪ Guides safe and effective nursing action.
▪ Legal record of the care provided.
▪ Improves policy and procedure compliance.
▪ Reduces risk by early identification and tracking of
problems or needs.
B. Critical Pathways
o Clinical pathways (CP) are made to follow
certain policies and procedures and there is
generally one for a certain area, illness, and
procedure.
o Care pathways are one of the best tools hospitals
can use to manage the quality of healthcare
concerning the standardization of care processes
since they promote organized and efficient patient
care based on evidence. It has been proven that
their implementation reduces the variability in
clinical practice and improves outcomes.
o Care pathways are also known as Clinical or
Critical pathways. A care pathway is a
multidisciplinary healthcare management tool
based on healthcare plans for a specific group of
patients with a predictable clinical course, in
which the different tasks or interventions by the
professionals involved in the patient care
(physicians, nurses, pharmacists, physical
therapists, social workers etc.) are defined,
optimized and sequenced either by hour (ED) or
day (acute care). Outcomes are tied to specific
interventions.
NCP AND CRITICAL PATHWAYS
Are not generally patient-specific but changes or
additions can be made depending on the patient’s plan of
care.
E.g. Patient is having daily dressing, can write the type of
dressing used.
All care plans must have a patient label, have a
commencement date and time and should be signed on a
per shift basis.
Clinical Risk Assessment Tools should be filled out on
admission so that clinical pathways and NCP can meet the
needs of the patient.
HOW TO DOCUMENT VARIANCES
o SCOPE OF CLINICAL PATHWAYS
o Medical Protocols
o Standardized Care Maps
o Nursing Protocols Clinical Practice
Guidelines
o Care pathways are a powerful tool for care
process management, since they permit to check
the compliance of all the interventions included
in the healthcare plan, fix care standards and -
traduce clinical audits as a part of the process.
Likewise, pathways are very useful to identify
improvement areas in these standardized care
processes, under the umbrella of the culture of
Continuous Quality Improvement (CQI).
B.2 CONTINUOUS QUALITY IMPROVEMENT
- The development and implementation of a care
pathway involves change in the organizational culture
at any setting. This process may involve overcoming
of some hurdles in its way of implementation.
o Following are some of the activities to be done
to develop and implement a care pathway:
o Preparing multidisciplinary
documents
o Reviewing the process by all the
concerned staff
o Holding care pathway meetings to
facilitate the exchange of opinions about
patient care by different professionals.
o Conducting periodic reviews to monitor
some defined indicators.
o Analyzing variances or deviations
o Preparing common record documents for
all the staff
1. Similar to DAR (Data, Action, and Response)
format, we utilize VAO (Variance, Action, and
Outcome) io document variance.
 2. Variance – includes all subjective and objective o Research should be conducted on how to
data observed by the nurse to be outside of the effectively implement clinical practice
pathway management of the patient’s case. guidelines, and the impact of their use as quality
3. Action – include all interventions used to address measures.
the variance. o Algorithm for the management-oriented risk
4. Outcome – includes all patient care outcomes stratification of CAP among immunocompetent
after the interventions were performed to address adults:
the variance.

C. Clinical Guidelines (CPGs)

o Old Definition: “Systematically developed
statements to assist practitioner and patient
decisions about appropriate health care for
specific clinical circumstances.” (IOM, 1990)
o Increasing international interest in the
development and implementation of CPGs.
o Clinical practice guidelines are statements that
include recommendations intended t optimize
patient care. They are informed by a systematic
review of evidence, and an assessment of the
benefits and harms of alternative care options.
CPG’s should follow a sound, transparent
methodology to translate best evidence into
clinical practice for improved patient outcomes.
Additionally, evidence-based CPG’s are a key
aspect of patient-centered care.
o Clinical practice guidelines should be feasible,
measurable, and achievable.
o Clinical performance measures may be
developed from clinical practice guidelines and
used in quality improvement initiatives. When
these performance measure are incorporated into
public reporting, accountability, or pay for
performance programs, the strength of evidence
and magnitude of benefit should be sufficient to
justify the burden of implementation.
o Clinical practice guiIn the clinical setting,
implementation of clinical practice guidelines
should be prioritized to those that have the
strongest supporting evidence, and the most
impact on patient population morbidity and
mortality.

D. E-Journals
1. You can search the contents pages and/or the
full text of journals to find articles on a
certain subject.
2. You can read journal articles on your desktop;
you don't have to be in the library.
3. You can e-mail articles to yourself or
download them for printing.
4. The article that you want to read will always
be available, even when the library is closed.
5. Hypertext links allow you to move to
different sections within individual journals
or articles and can link you to related
resources on the Internet.
6. Journals can include more images and audio-
visual material.
7. Journals can be interactive - you can e-mail
the author or editor with your comments.
o E-journals or electronic journals are scholarly
publications in digital form, which are accessible
on the web. In the Philippines, we have the
Philippine E-journals (ejournals.ph)
o Where you can find an online bibliographic
database & repository of academic journals in
different.
o Disciplines from various resources; These are
often used as acceptable review of related
literature.
o For research projects and evidence-based nursing
practice.
LESSON 2 PART 1: NURSING INFORMATION
SYSTEM (Relevance of Informatics System to
Communications in Nursing)
o In health care setting, patient safety is of utmost
priority of the health care team. To reach this
goal, it is imperative to practice EFFECTIVE
COMMUNICATION.
o These communication techniques can be found
on team STEPPS by the Agency for Healthcare
Research Quality (AHRQ). According to
AHRQ (2013), individuals can learn four/five
primary trainable teamwork skills. These are:
o Team Structure (addition) –
Identification of the components of a
multi-team system that must work
together effectively to ensure patient.
o Communication – Structured process by
which information is clearly and
accurately exchanged among team
members.
o Leadership – Ability to maximize the
activities of team members by ensuring
that team actions are understood, changes
in information are shared, and team
members have the necessary resources.
o Situation Monitoring – Process of
actively scanning and assessing
situational elements to gain information
or understanding, or to maintain
awareness to support team functioning.
o Mutual Support – Ability to anticipate
and support team members’ needs
through accurate knowledge about their
responsibilities and workload.
o If a team has tool and strategies, it can leverage
to build a fundamental level of competency in
each of those skills, research has shown that the
team can enhance three types of teamwork
outcomes:
o Performance
▪ Adaptability
▪ Accuracy
▪ Productivity
▪ Efficiency
▪ Safety
o Knowledge
▪ Shared Mental Model
o Attitudes
▪ Mutual Trust
▪ Team Orientation
WHAT IS A SHARED MENTAL MODEL IN
HEALTHCARE?
Shared mental models are the overlap of individuals’ set
of knowledge and/or assumptions that act as the basis for
understanding and decision making between individuals.
Within healthcare, shared mental models facilitate
effective teamwork and are theorized to influence clinical
decision making and performance.
Essential Communication Techniques Under
TeamSTEPPS according to AHRQ (2013)
SBAR – a technique for communicating critical
information that requires immediate attention and action
concerning a patients’ condition. Situation, Background,
Assessment, and Recommendations/Request.

LESSON 2 PART 2:

CALL-OUT - Strategy used to communicate important

or critical information)
o Informs all team members simultaneously during
emergent situations.
o Helps team members anticipate next steps.
o Important to direct responsibility to a specific
individual responsible for carrying out the task.

CHECK-BACK – using closed-loop communication to

ensure that information coveyed by the sender is
understood by the receiver intended. The steps include the
following:
o The sender initiates the message.
o Receiver accepts the message and provides
feedback.
o Sender double-checks to ensure that the message
was received.

HANDOFF – The transfer of information (along with

authority and responsibility.) during transitions in care
across the continuum. It includes an opportunity to ask
questions, clarify, and confirm. Examples of transitions
in care include shift changes; transfer of responsibility
between and among nursing assistants, nurses, nurse
practitioners, physician assistants, and physicians; and
patient transfers. It is a strategy to enhance information
exchange during transitions in care.
 MIDTERM LAB 1 cont.. of EBP
SYSTEMATIC LITERATURE REVIEW
SITUATIONER
Health care providers are faced with an array of
important clinical decisions
EXAMPLES:
Sacred Cow: Hydrogen peroxide is an effective
antibacterial cleaning agent when applied to
wounds. Bubbling of hydrogen peroxide means
bacteria are present (haka-haka or sabi-sabi lang)
Evidence Eagle: Concentrated hydrogen peroxide
is caustic and exposure may result in local tissue
damage, and can hinder neodermal development,
which is necessary for wound healing, The bubbling
occurs when hydrogen peroxide is exposed to air,
not bacteria (makakatotohan or fact na mayroong
evidence)
Sacred Cow: Instilling 5 to 10 ml of normal saline
before endotracheal suctioning improves
oxygenation and removal of secretions by thinning
them and stimulating coughing to move secretions
out of the lungs.
Evidence Eagle: Oxygen saturation is significantly
lower with instillation of saline than with no instillation
of saline. When saline was used, returns to baseline
oxygenation levels did not occur until 3 to 5 minutes
after finishing the suctioning procedure.
Sacred Cow: Neonates and infants should be
placed in the prone position during sleep periods to
prevent aspiration.
Evidence Eagle: Sleeping in the prone position
among blankets and pillows has been discovered to
be a primary cause of sudden infant death syndrome
through suffocation. Neonates and infants should be
placed on their backs with minimal contact with
pillows, stuffed animals, or blankets. Warm
sleepwear is sufficient to prevent hypothermia.
Sacred Cow: There are more incidents of bleeding,
psychiatric illness, and trauma during the full moon
Evidence Eagle: While the day of the week
influences emergency department admission
volumes, the phases of the moon have no
relationship with the rate of any clinical conditions or
traumatic events.
❖ Minimal resarch findings into patient care
decisions (Melnyk et., al, 2000)
❖ 1/3 of the time, health care providers are not
following established EBP protocols (Cretin et
al., 2001)
❖ About 30% to 40% of patients do not receive
care consistent with the current scientific
evidence (Rassen et al., 2008)
❖ Use of research is poor (Jolley, 2002)
❖ It often takes as long as 17 years to translate
research findings into practice (Balas & Boren,
2000)
❖ Third party payers will provide reimbursement
only for health care practices whose
effectivesness is supported by scientific
evidence (Melynk, 1999)
What drives Evidence-based Nursing?
Benefits
❖ 28% better outcomes (Heater et al., 1988)
❖ Higher levels of satisfaction (Dawes, 1996)
❖ Outstanding care to patients and saving
healthcare costs (Titler et al., 2002)
❖ Reduced turnover rate
Roots of EBP
❖ Archie Cochrane, a British epidemiologist,
criticized the medical profession for not critically
examining evidence (Cochrane, 1971)
❖ Individuals should only pay for health care based
on scientific evidence
❖ Rigorous, systematic reviews of research from a
variety of disciplines be conducted to inform and
policy making
❖ Cochrane Center developed a collaboration.
Evidence-based practice
 The use of the best scientific evidence integrated
with clinical experience and incorporating patient
 values and preferences, in the practice of
professional patient care (Houser & Oman,
 2011).
 Ingersoll (2000) defines EBP as “the
conscientious, explicit, and judicious use of
theory-derived, research-based information in
making decisions about care delivery to
individuals or groups of patients and in
consideration of individual needs and
preference.” (p.152)
 An ongoing process by which evidence, nursing
theory and the practitioners’ clinical expertise are
critically evaluated and considered, in conjuction
with patient involvement, to provide delivery of
optimum nursing care for the individual (Scott &
McSherry, 2008)

ASK
The importance of asking good questions
Framing the Question

• P atient (and their condition) / P – population

STEPS OF EVIDENCE-BASED PRACTICE
1. Ask the clinical question
2. Collect the most relevant and best evidence
3. Critically appraise the evidence (scientific
merit, clinical relevance)
4. Integrate all evidence with clinical expertise,
patient preferences and values in making a
practice decision or change (implementation
potential)
5. Evaluate the practice decision or change
for nursing education
• I ntervention (under examination)
• C omparison (that is most relevant)
• O utcomes (that matter to the patient)
EXAMPLES:
In acute care hospitals, how does having a rapid
response team compared with not having a
response team affect the number of cardiac arrests?
P – acute care hospitals
I – rapid response team
C – no rapid response team
O – number of cardiac arrests
ALIGN 2. Assess validity of the study
3. Assess usefulness of results
Research design, bias, and levels of evidence
Take Note!
 Most research is not fit for immediate
application

Only about 5.4% of the approximately 50,000

articles published in 120 journals reached the
required methodological standard (Cullum,
Cilishka, Haynes, & Marks, 2008)

APPLY

• Making better decisions

Optimal study designs according to clinical • Integrate evidence with clinical expertise and
questions patient’s preferences
Type of Study Designs ACT
clinical
question • Disseminate the information
Intervention Systematic reviews of RCTs • Share the findings
(Randomized Controlled Trials)
Diagnosis Studies comparing the new test
with a reference standard test,
Randomized control trials
Prognosis Control studies, Case-control
studies
Etiology Case-control or Cohort studies BOOLEAN OPERATORS
Meaning Qualititative studies
AND

• chocolate AND hypertension

ACQUIRE
OR

• chocolate OR cocoa
NOT

• adolescent NOT adult

TRUNCATION
A shortcut devise
e.g finding the beginning of the word with a different
coding on it; often denoted as * or $

✓ Child* would pick up child, children,

APPRAISE
• Understanding the evidence/statistics
• Closeness to truth (validity)
• Clinical usefulness
1. Match study design to clinical question
childhood, etc.
✓ Ulcer* would pick up ulcer, ulcers,
ulceration, ulcerated, etc
✓ Mentor* would pick up mentors,
mentoring, mentorship
 WILDCARD
Alternative spellings
Wildcard is inserted in the middle of a word where
an extra letter or alternative letter might be placed;
often denoted as ?

An?emia would pick up anaemia and anemia

H?emoglobin would pick up haemoglobin and
hemoglobin

QUOTATION MARKS OR PARENTHESIS

For search to capture the exact phrase, enclose in
quotes

“ pressure sore ”
Or use parentheses

( “ pressure sore” OR “bed sore” )

AND obesity

SEARCH FILTERS
• Publication date
• Publication type
• Language
• Age group
• Sex
• Animal vs Human studies

MANUAL SEARCHING
• Check the references of articles
• Contact authors and/or experts

EVALUATE THE RESULT

 Read the title and abstracts of searched
articles
 Check the search terms