Recognizing that clinicians have time constraints and yet want to provide the best possible care to their patients, an evidence-based approach offers a convenient method of finding current research to support clinical decisions, answer patient questions, and explore alternative treatments, procedures, or materials. It also requires understanding new concepts and developing new skills. The EBDM process provides a strategy for improving the efficiency of integrating new evidence into patient care. By integrating good science with clinical judgment and patient preferences, clinicians maximize the potential for successful patient care outcomes.
Traditionally, the first step in the EBDM approach required writing a PICO question where the specific problem (P), intervention (I), comparison (C), and outcome (O) were identified. This was necessary to narrow the focus and establish key terms for conducting an effective search.
Fortunately, there is a shortcut to accessing relevant evidence through the PubMed “Clinical Queries” feature. It uses evidenced-based filters to quickly and effectively access relevant articles using structured algorithms that streamline the process of searching the literature. For example, using the “Find Systematic Reviews” specialized Clinical Query, an individual with limited computer-searching skills can find relevant evidence by typing in a main topic or specific interest, such as fluoride varnish, and automatically be given citations of relevant systematic reviews to answer the question.
However, it may be necessary to use PubMed directly when citations are not retrieved using Clinical Queries, or for comprehensive searches involving multiple variables and for those conducting individual research studies or systematic reviews. In these cases, there are several online resources that provide instruction in how to do so, including the PubMed tutorial.
CDHM Library Workshop Presentations by Janet Rothney, University of Manitoba Dental Librarian
PICO Search Sites
There are many guides to the PICO research method on the Internet, such as the University of Washington’s Health Links “Construct Well-Built Clinical Questions using PICO” article, and the University of Toronto’s “Formulating Answerable Questions” guide.
Some search engines, such as the Evidence-Based Dentistry Search Engine, provide PICO search terms right in their search function.
Another resource is University of Southern California’s Evidence Based Decision Making clinical/patient circumstances.
Creating and Using Key Words
Once you have a topic that is adequately focused and narrowed, it is helpful to create a list of key words to facilitate searching for resources. It will also help keep track of searches you’ve done by ensuring that the same keywords are used in all the databases you’ve searched (i.e., internet search engines, journals, library catalogues, etc.). It is also a good idea to think about possible synonyms and alternative phrases for the key words in order to do a more comprehensive search.
Using the Correct Operators
Boolean operators can add even more specificity to a search. By placing one of the Boolean operators between terms you can include and exclude terms, find cases where terms occur close together, and account for synonyms for words in a phrase. Here are some basic Boolean operators
The operator AND indicates that the keywords must be found together.
The operator OR indicates that either, or both, of the keywords must be found.
The operator NOT allows you to exclude certain words in the search.
To access a guide to properly using operators, see Boolean Logic (AND, OR, NOT, NEAR). The tables address the use of special operators, including Boolean logic, to focus keyword searches. http://www.slu.edu/colleges/AS/ENG/cai/research/page8.html
CDHA Cochrane Corner
Cochrane Collaboration uses systematic reviews of randomized controlled trials in oral health.
ADA Center for Evidenced- Based Dentistry
This website provides systematically assessed evidence as tools and resources to support your clinical decisions.
The following articles are a good place to start:
Translating evidence-based decision making into practice: appraising and applying the evidence. Available from PubMed.