Guided Lecture Notes, Chapter 3, Finding Relevant Evidence to Answer Clinical Questions
(Note: Learning Objective 1 is addressed after Learning Objective 5 to follow the chapter and
PowerPoint slide flow.)
Learning Objective 2. Discuss at least one advantage to using pre-appraised evidence.
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Use PowerPoint slide 2 to discuss the advantage of searching first for pre-appraised
evidence on which to base clinical decisions.
Learning Objective 3. Compare and contrast the difference among the three levels of
information resources as described by Haynes (2007).
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Use Figure 3.1 in the textbook and PowerPoint slide 3 to discuss the three levels of
information resources.
Mention that the pyramid shape was used to denote that the broader base (original
research articles) had the most content and the top of the pyramid contained the least
(electronic health records with decision support mechanisms).
Explain that the pyramid’s base contains original research articles and forms the
foundation upon which the rest of the pyramid is built. Mention that searching for this
level of evidence would begin with databases of individual research reports.
Refer students to Table 3.1 in the textbook and PowerPoint slide 4. Use these to
describe some appropriate databases that might be used in looking for individual
research reports.
Discuss the middle of the pyramid, which contains pre-appraised evidence and that
the search for evidence should start at that level. Refer students to Table 3.1 in the
textbook and PowerPoint slide 5. Use these to describe some appropriate databases
that might be used in looking for pre-appraised evidence.
Emphasize that while sources of evidence may be pre-appraised, it is important to
look for the appraisal process used to determine if the information is reliable.
Unfortunately, the appraisal process sometimes is difficult to find.
In discussing the top of the pyramid, point out that there are very few electronic
health record systems that are integrated with current evidence for decision support.
The time and money needed to both develop and constantly update the evidence on
which to base clinical decisions is almost prohibitive.
Learning Objective 4. Discuss the advantages and disadvantages of using a combination of a
licensed database (e.g., PubMed) and a web-based search engine (e.g., Google Scholar) when
searching for external evidence.
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Use PowerPoint slide 8 to define what is meant by a licensed database and a webbased search engine.
Discuss why knowing which journals are included in the database search can be an
advantage to the user.
Discuss the findings of Nourbakhsh and colleagues (2012) which found that a webbased search engine (Google Scholar) tended to find more relevant and high-impact
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journal articles than conducting a search through PubMed®. Emphasize that if both
searches were combined, this would result in finding the most comprehensive
evidence.
Learning Objective 5. Describe the three key questions that should be asked when deciding
which databases should be used to answer a clinical question.
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Use PowerPoint slide 9 to discuss the three key questions that need to be asked when
considering databases for an evidence search.
Discuss that if the database contains evidence that is more than 20 years old, there
needs to be consideration of whether a date limit needs to be included in the search
parameters.
Learning Objective 1. Compare the strengths and weaknesses of three commonly used evidence
search strategies.
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Use PowerPoint slide 10 to discuss the use of keywords as a search strategy. Point out
the major strengths and weaknesses and use an example from the textbook to
illustrate these.
Use PowerPoint slide 11 to discuss the use of subject headings as a search strategy.
Point out the major strengths and weaknesses and use an example from the textbook
to illustrate these.
Use PowerPoint slide 14 to discuss the use of title searches as a search strategy. Point
out the major strengths and weaknesses and use an example from the textbook to
illustrate these.
Use Table 3.3 to compare the strengths and weaknesses of each search strategy with
the others.
Emphasize that the best results will be obtained when the three search strategies are
combined.
Learning Objective 6. Describe the difference between the use of Boolean operators “AND” and
“OR.”
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Use Figure 3.2 (Boolean operator “AND”) and PowerPoint slides 15 and 16 to
discuss the use of Boolean operator “AND.”
Use Figure 3.3 (Boolean operator “OR”) and PowerPoint slides 15 and 17 to discuss
the use of Boolean operator “OR.”
Learning Objective 7. Discuss the advantages and disadvantages of using the “limits” function
when performing an evidence search.
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Use PowerPoint slide 18 to discuss the uses and main disadvantages of the “limits”
function in performing an evidence search.
Emphasize that when defining limits to the search the possibility of excluding
relevant evidence needs to be weighed against the utility of using the limit
parameters.
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Learning Objective 8. Discuss the uses of reference management software (RMS) systems.
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Use PowerPoint slide 19 to discuss the use of RMS systems. Point out the two opensource (free) RMSs highlighted in the Web Alert in the textbook and on the
PowerPoint slide.
If Internet access is available, open one of the RMSs and discuss some of the features
(file-sharing, organization tools, etc.) and how these would assist in managing
evidence found in a search.
Alternately, as an assignment, have students go to one of the open-source RMSs and
describe one of the features and how they would use in in managing search material.
Learning Objective 9. Compare and contrast several databases of external evidence for the type
of documents and related information available and the search strategies that they support.
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Use Table 3.1 in the textbook and PowerPoint slides 20 to 23 to discuss the types of
documents and related information contained and search strategies supported by
seven popular healthcare databases.
Mention that although full-text availability is indicated in several of them, this feature
may only be available through subscription.
If Internet access is available, open two of the databases to demonstrate the difference
between search feature functions.
Point out to students that the website addresses of these databases can be found in the
Web Alerts in Chapter 3 of the textbook.
Learning Objective 10. Describe at least three unique features of the PubMed® database and
related search engine.
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Use PowerPoint slide 26 to discuss several unique features of PubMed®.
Use Figure 3.5 in the textbook and PowerPoint slide 27 to describe the sorting options
available.
Use Box 3.2 in the textbook and PowerPoint slides 28 and 29 to describe the threestep mapping process used by PubMed® for searches.
Use Figure 3.6 in the textbook and PowerPoint slide 30 to discuss the “send to”
options available in PubMed®.
If Internet access is available, open PubMed® and demonstrate some of the above
features.
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