Where to search

Where you search is determined by what you are looking for. Thinking about your question and your search strategy before you start will help point you in the right direction. This section will provide a guide to specialised information that is useful in clinical care. Such information is, by necessity, research based.

Gone are the days when the individual person is expected to trawl through mountains of primary research data and somehow make sense of it! In many cases, particularly those relating to common or important problems, the hard work has been done before you. For fast, reliable access to clinically relevant research, the best bet is to access "secondary sources" of information.

The other important issue is knowing that different types of clinical question are answered by different types of study and stored, in some cases, in separate databases.

The essential place to start therefore is by having a basic understanding of research design.

After that, you need to think about levels of evidence. All research is not the same. Some answers are worth more than others!

Bear in mind though, that some questions cannot be answered by quantitative research. Some questions require a qualitative approach. Making decisions about clinical care may require evidence from both types of research.

Typically, health care professionals and consumers want answers to questions about what disease they might have and how certain they are about it, or whether certain therapies will work, or what causes a particular disorder, or what is likely to happen to them in the future with the disease that they have.

The questions most commonly asked are about therapies or other interventions. The highest level of evidence for answers to these questions are systematic reviews.

If a systematic review hasn't been carried out on the question / topic that you are looking for then the next best bet is one of the other secondary sources.There are now a large number of sources of clinically focused, evidence based reviews of subjects, some of which are published as journals, and which focus on providing the best evidence available for a particular scenario. So, what do you do? Trawl through each of the many sources one at a time? Well, you could...

Or else you could use a meta-search engine. A meta-search engine is a search engine that simultaneously searches multiple databases for you.

Only after you've tried and failed to find what you want from secondary sources should you try and find primary data from sources such as Clinical Queries at PubMed.

Medline and other databases will give you the abstract of the article, but not usually the full text. Most journals require subscription - or else access to a medical library that subscribes to these journals. However, there are an increasing number of journals that are available freely in electronic format and the best places to locate these are Highwire and AMEDEO.

The Medical Journal of Australia, the British Medical Journal, and the Journal of the American Medical Association are freely available in electronic format.

You may also find useful information by accessing evidence-based guidelines.

If your question requires information that is related specifically to nursing, allied health, psychology, dentistry or education you may wish to search their specific evidence based sites and databases.

Sources of systematic reviews

The Cochrane Library is the best place to start if you are looking for systematic reviews. Full access to the library is now available free of charge in Australia.

Next, try looking at DARE, the Database of Reviews of Effectiveness at the NHS Centre for Reviews and Disseminations.

ASERNIP-S is the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical and their website provides access to systematic reviews of surgical interventions.

The Joanna Briggs Institute provides systematic reviews of nursing related topics. This site requires a subscription to access its library.

Other secondary sources (*= subscription only site)

• Clinical Evidence* is one of the best and most comprehensive sites.
• ACP Journal Club is published six times a year. The site provides searchable access to back issues.
• Bandolier is a monthly journal offered in an easy to read format. It is quick and easy to search.
• POEMS (patient oriented evidence that matters) is a collection of primary care focused, evidence based articles. The full service is available only on subscription, but the collection of poems is available free of charge.
• ATTRACT is a service to Welsh GPs that provides rapid answers to clinical questions. The colllection of questions and answers are easily searchable by topic.
• BestBETS provides rapid evidence based answers to real life clinical questions in emergency medicine.
• Medscape is a site designed for doctors that provides clinical updates and other resources.
• Medical Matrix* is a subscriber only site that provides peer reviewed updates on clinical topics.
• The Centre for Clinical Effectiveness at Monash University provides reviews of a number of topics.
• Effectiveness Matters has a number of easy to read articles. The collection is currently quite limited but is growing.
• Effective Health Care provides a rigorous approach to clinical topics but currently has a very limited coverage.
• CATbank is a collection of Critically Appraised Topics. A CAT gives a bottom line summary of the evidence for a clinical question. However, the list of CATs on this site is still quite limited.
• ASERNIP-S is the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical and their website provides access to a wide range of information and resources relating to surgical procedures.

 

Meta-search engines

Meta search engines are a very useful place to start indeed. They simultaneously search across a large number of databases for you.

The TRIP database searches across 75 different sites with high quality medical information. It presents results in separate categories that identify how rigorous the evidence base is for the information presented.

SUMSearch also searches multiple sites. It has the helpful feature of providing questions and prompts when you enter your search strategy.

Drs Desk is a site primarily aimed at GPs that searches multiple sites for evidence based solutions and presents them according to the type of publication.

Evidence Based Guidelines

Guidelines have their pros and cons and these are not discussed here! Not all guidelines are evidence based despite their appearance. Below are a few sites that publish good quality guidelines.

• NHMRC is the Australian National Health and Medical Research Council. It publishes a wide range of detailed guidelines. They can be useful, but are not always immediately applicable to the clinical setting.
• Clinicians Health Channel Guidelines & Protocols is another useful site that provides local context.
• New Zealand Guidelines Group publish a large selection of guidelines and related resources, including a section on how to develop and appraise guidelines.
• SIGN is the Scottish Intercollegiate Guidelines Network. It publishes a wide range of guidelines and other resources.
  
  Also worth a look are:
  
• The American Primary Care Clinical Practice Guidelines, and
• The Canadian Medical Association Clinical Practice Guidelines Infobase.

Nursing, Allied Health, Psychology, Dentistry & Education

Many of the sites previously listed have information that is relevant to all areas of health and medical care. However, the more specialised sites listed in the Advanced Guide do have a focus that can make them more appropriate to doctors. This section provides a list of key sites and databases that focus specifically on nursing, allied health, dentistry and education.

* = subscription only

• CINAHL* is the Cumulative Index of Nursing and Allied Health Literature.
• EBN Online* is the Evidence Based Nursing journal published by the BMJ.
• The Centre for Evidence Based Nursing at the University of York.
• The Joanna Briggs Institute at Adelaide University
• Evidence Based Nursing website at the University of Minnesota.
• PEDro is a physiotherapy trials database.
• NMAP is a high quality gateway site for internet resources in nursing, midwifery and allied health provided by the University of Nottingham.
• PsycInfo is the premier database for psychology.
• The Centre for Evidence Based Dentistry is the best place to start for dental information.
• ERIC is the Educational Resources Information Centre and covers the whole area of education including those aspects that overlap with health.