Critical Care Medicine

Identify all the possible synonyms for each aspect of the PICO(T) question

Example: In critically ill patients, how does a preventative dressing compared to repositioning affect pressure injury development?

Synonyms for each PICO(T) component:

P: critical care, ICU, immobile
I: preventative dressing, foam dressing, sacral dressing
C: repositioning, standard of care, skin bundle
O: pressure injury, pressure ulcers, skin injury, deep tissue injury
T: ---

Boolean Operators

Combine search terms effectively using Boolean operators and logic to create a search strategy.

“AND” logic -- Using AND narrows a search by combining terms

• AND IS LESS - narrow search, less results
• PICO(T) components are separated by AND

“OR” logic -- Using OR broadens a search to include results that contain either of the words

• OR IS MORE - broadens search, more results
• Synonyms are grouped together within a parenthesis ( )

(critical care OR ICU) AND (preventative dressing OR foam dressing) AND (pressure injury OR pressure ulcers)

Other Search Strategy Tips

Below are some additional searching tips that can help broaden or narrow the results retrieved. These are more advanced searching techniquies and should be used if your initial search strategies are not identifying what you want or need.

Phrase Searching - May be done with double quotes (“ “)

• “critical care”
• “pressure injury”

Truncation - Add an * to the end of a root word to look for variations of the word

• nurs*  will search for:  nurse, nurses, nursing
• child*  will search for:  child, children, childhood, childs, childrens
• genetic*  will search for:  genetic, genetics, genetically

Subject Headings -  Controlled vocabulary can be used in certain databases

• PubMed: Identify MeSH (Medical Subject Headings) terms via the MeSH Database
• CINAHL: Identify CINAHL Subject Headings via the CINAHL Thesaurus
• Embase: Identify Emtree terms via Emtree Search

Complete Search Strategy

(“Critical Care” OR ICU OR Immobile OR “Critically ill”) AND (“foam dressing” OR “sacral dressing” OR “Wound care”) AND (reposition* OR “skin bundle”) AND (injury OR ulcer* OR “pressure ulcer”)

This search strategy can be copied and pasted directly into the databases you chose to search.

Select Appropriate Databases

Identify three (3) databases that are appropriate for searching on your topic/question. Below are many of the popular databases available through the MSK Library.

Focus & Scope

Know what the database is best for and chose those matched to the topic you are searching.

Popular EBP Databases

Below are some of the most popular MSK databases to use for N-CARE EBP presentations.

PubMed: PubMed comprises more than 29 million citations for biomedical literature from MEDLINE, life science journals, and online books. Links are available from PubMed to full text articles (Fulltext@MSK) provided by the MSK Library.

• PubMed is the go-to database to start your search
• Simply copy/paste your complete search strategy into the search bar on the main page
• Use filters on the left to limit by publication date and language, as well as study type and publication type
• PubMed also includes publication types such as letters, editorials, comments, etc that are not peer-reviewed journal articles

CINAHL (Cumulative Index for Nursing & Allied Health Literature): Covers nursing, biomedicine, alternative/complementary medicine, consumer health, and the allied health fields. It offers access to health care articles, books, nursing dissertations, selected conference proceedings, standards of practice, educational software, and audiovisual materials.

• CINAHL is a nursing/allied health focused database
• It is considerably smaller (fewer results) than PubMed, and has significant overlap with PubMed
• Simply copy/paste your complete search strategy into the search bar
• Be sure to limit to English language and select a publication date range under advanced search
• CINAHL also includes non-peer reviewed material such as trade journals (magazines), dissertations, and conference abstracts -- use the Peer Reviewed box in advanced search to limit to only peer-reviewed journal articles

Embase: A comprehensive international bibliographic resource with millions of records from journals, conferences, and non-English publications in the biomedical and pharmaceutical fields.

• Embase is a massive database that includes all of MEDLINE (PubMed) as well as unique content, including specialized content in pharmaceuticals and medical devices, international onferences, and non-English language
• Use the Quick Search and simply copy/paste your complete search strategy into the bar
• Use the special PICO search and simply plug your terms into each section and select a publication date range
• Be sure to limit to English language and publication date range
• Embase also includes conference abstracts, so be aware not everything has full-text -- you can limit publication types to Articles, in the filters on the left side of the results

Joanna Briggs Institute (JBI): JBI EBP Database allows you to simultaneously search a wide range of summarized and appraised health care evidence across seven publication types including Evidence Based Recommended Practices, Evidence Summaries, Best Practice Information Sheets, Systematic Reviews, Consumer Information Sheets, Systematic Review Protocols, and Technical Reports.

• Use the Basic Search and simply copy/paste your complete search strategy into the bar
• Be sure to limit to English language and select a publication date range

Assess if the search strategy is too narrow or too broad

Considerations:

• Are there too many or too few PICOT elements included in the search strategy?
• Are the keywords specific enough or too broad? Are too many or too few keywords used?
• Are abbreviations used appropriately? Do they capture irrelevant material? Are the full terms also included not just the abbreviations?

Keep track of the search strategy

It should be able to be replicated by someone else.

• What databases were searched?
• How many results (references) were initially found?
• How many references were kept after screening the titles/abstracts?
• How many papers were kept after reading the full text articles?

Keeper Articles

Requirements for keeper articles:

• A minimum of three (3) databases must be searched
• You must have a minimum of five (5) keeper articles in your presentation
• Articles should be within the last 5 years
  • If article is older than that, please specify reason in Current Evidence slide(s)

EBP Presentation

In your presentation you must summarize each keeper article by including the following:

•  Purpose of the study
•  Method use
•  Results
•  Conclusion/Recommendation
•  If article is older than 5 years, please specify reason for keeping article
• Use 1-2 slides for each keeper article summary
• Use APA citation format for your references

Nurse Mentor

When to seek assistance from your nurse mentor/educator:

• Identifying a clinical question
• Phrasing your question in PICO(T) format
• Broadening your PICO(T) question if you are retrieving too few results
• Narrowing your PICO(T) question if you are retrieving too many results

MSK Library

When to see assistance from the library/librarian:

• Not sure what database to use for your topic
• Identifying additional databases to search
• Troubleshooting database searching (e.g. getting error messages, no results, full-text, etc.)
• Identifying synonyms for your terms (may need to use controlled vocabulary/subject headers)
• Combining terms with Boolean operators/logic (AND, OR, NOT)
• Search is still retrieving too few results, even after modification with your mentor
• Search is still retrieving too many results, even after modification with your mentor
• Your mentor has approved escalating to a librarian for assistance