Most books on Evidence Based Medicine give little attention to the first two steps of EBM: asking focused answerable questions and searching the evidence. Being able to appraise an article, but not being able to find the best evidence may be challenging and frustrating to the busy clinicians.
“Searching Skills Toolkit: Finding The Evidence” is a pocket-sized book that aims to instruct the clinician how to search for evidence. It is the third toolkit book in the series edited by Heneghan et al. (author of the CEBM-blog Trust the Evidence). The authors Caroline de Brún and Nicola Pearce Smith are experts in searching (librarian and information scientist respectively).
According to the description at Wiley’s, the distinguishing feature of this searching skills book, is its user-friendliness. “The guiding principle is that readers do not want to become librarians, but they are faced with practical difficulties when searching for evidence, such as lack of skills, lack of time and information overload. They need to learn simple search skills, and be directed towards the right resources to find the best evidence to support their decision-making.”
Does this book give guidance that makes searching for evidence easy? Is this book the ‘perfect companion’ to doctors, nurses, allied health professionals, managers, researchers and students, as it promises?
I find it difficult to answer, partly because I’m not a clinician and partly because, being a medical information specialist myself, I would frequently tackle a search otherwise.
The booklet is in pocket-size, easy to take along. The lay-out is clear and pleasant. The approach is original and practical. Despite its small size, the booklet contains a wealth of information. Table one, for instance, gives an overview of truncation symbols, wildcards and Boolean operators for Cochrane, Dialog, EBSCO, OVID, PubMed and Webspirs (see photo). And although this is mouth watering for many medical librarians one wonders whether this detailed information is really useful for the clinician.
Furthermore 34 pages of the 102 (1/3) are devoted on searching these specific health care databases. IMHO of these databases only PubMed and the Cochrane Library are useful to the average clinician. In addition most of the screenshots of the individual databases are too small to read. And due to the PubMed Redesign the PubMed description is no longer up-to-date.
The readers are guided to the chapters on searching by asking themselves beforehand:
- The time available to search: 5 minutes, an hour or time to do a comprehensive search. This is an important first step, which is often not considered by other books and short guides.
Primary sources, secondary sources and ‘other’ sources are given per time available. This is all presented in a table with reference to key chapters and related chapters. These particular chapters enable the reader to perform these short, intermediate or long searches.
- What type of publication he is looking for: a guideline, a systematic review, patient information or an RCT (with tips where to find them).
- Whether the query is about a specific topic, i.e. drug or safety information or health statistics.
All useful information, but I would have discussed topic 3 before covering EBM, because this doesn’t fit into the ‘normal’ EBM search. So for drug information you could directly go to the FDA, WHO or EMEA website. Similarly, if my question was only to find a guideline I would simply search one or more guideline databases.
Furthermore it would be more easy to pile the small, intermediate and long searches upon each other instead of next to each other. The basic principle would be (in my opinion at least) to start with a PICO and to (almost) always search for secondary searches first (fast), search for primary publications (original research) in PubMed if necessary and broaden the search in other databases (broad search) in case of exhaustive searches. This is easy to remember, even without the schemes in the book.
Some minor points. There is an overemphasis on UK-sources. So the first source to find guidelines is the (UK) National Library of Guidelines, where I would put the National Guideline Clearinghouse (or the TRIP-database) first. And why is MedlinePlus not included as a source for patients, whereas NHS-choices is?
There is also an overemphasis on interventions. How PICO’s are constructed for other domains (diagnosis, etiology/harm and prognosis) is barely touched upon. It is much more difficult to make PICOs and search in these domains. More practical examples would also have been helpful.
Overall, I find this book very useful. The authors are clearly experts in searching and they fill a gap in the market: there is no comparable book on “the searching of the evidence”. Therefore, despite some critique and preferences for another approach, I do recommend this book to doctors who want to learn basic searching skills. As a medical information specialist I keep it in my pocket too: just in case…
What I liked about the book:
- Pocket size, easy to take a long.
- Well written
- Clear diagrams
- Broad coverage
- Good description of (many) databases
- Step for step approach
What I liked less about it:
- Screen dumps are often too small to read and thereby not useful
- Emphasis on UK-sources
- Other domains than “therapy” (etiology/harm, prognosis, diagnosis) are almost not touched upon
- Too few clinical examples
- A too strict division in short, intermediate and long searches: these are not intrinsically different
- Where to start? Summary tables and charts.
- Sources of clinical information: an overview.
- Using search engines on the World Wide Web.
- Formulating clinical questions.
- Building a search strategy.
- Free text versus thesaurus.
- Refining search results.
- Searching specific healthcare databases.
- Citation pearl searching.
- Saving/recording citations for future use.
- Critical appraisal.
- Further reading by topic or PubMed ID.
- Glossary of terms.
- Appendix 1: Ten tips for effective searching.
- Appendix 2: Teaching tips
- Searching Skills Toolkit – Finding The Evidence (Paperback – 2009/02/17) by Caroline De Brún and Nicola Pearce-smith; Carl Heneghan et al (Editors). Wiley-Blackell BMJ\ Books
- Kamal R Mahtani Evid Based Med 2009;14:189 doi:10.1136/ebm.14.6.189 (book review by a clinician)
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