Indah P. Kiay Demak Medical Education Unit

Faculty of Medicine & Public Health Tadulako University

� 1.  Know  the  current  medical  science  and  

technology  of  diseases  

2.  Understand  how  to  search  the  best  evidence  

LEARNING  OBJECTIVE  

� � Each  group  has  its  own  disease  topic  (e.q.  tuberculosis,  malaria,  thypoid  fever,  dengue  fever,  etc)  based  on  clinical  problem  

� Formulate  PICO,  search  literature,  appraise  the  arOcle,  answer  the  clinical  quesOon.  

Assignment  

� 1. Question and PICO (Population/problem, Intervention,

Comparator/Control, Outcome)

2. How to get the answer (searching) keyword and searching flow

3. Critical appraisal (see the form report) 4. Answer 5. References

Report  form  

� Disease Topic: Colorectal Cancer (screening) Scenario: A 50 yr old man, his father died at age 60 of colorectal cancer. He wonders if he should be screened for colorectal cancer. Faecal Occult Blood-testing is available in your setting for screening colorectal cancer. The patient ask you as his family physician if the screening could prevent him from early death due to colorectal cancer.

EXAMPLE  

� Possible  quesOon:    

“  In  adults  screened  with  faecal  occult  blood-­‐tesOng,  compared  to  no  screening,  is  there  a  

reducOon  in  mortality  from  colorectal  cancer  ?  “  

QUESTION  

� � POPULATION/PATIENT Colorectal cancer

� INTREVENTION Screening

� COMPARISON No screening

� OUTCOME Mortality

PICO  

�  Defining  the  topic:    �  What  are  the  key  words?  �  Are  there  other  words  which  could  be  used,  

such  as  synonyms,  variaOons  in  spelling?  

HOW  TO  GET  THE  ANSWER  

Boolean

A ‘AND’ B A ‘OR’ B A ‘NOT’

B

A   B   A   B  A   B  

� – the ‘*’ acts as a wildcard indicating any further letters,

¨ Keywords such as – Child OR Childs OR Children OR childhood child* – Diabetics OR diabetes diabet* – Obese OR Obesity obes* – Diagnose OR Diagnosed OR Diagnosis OR diagnostic Diagnos*

TRUNCATION  (*)  

� ¨ Use PICO to direct your search. – It is also worth looking for synonyms for each component ¨ General structure of question – (Population OR synonym1 OR synonym2…) AND – (Intervention OR synonym1 OR synonym2…) AND – (Comparator OR synonym1 OR synonym2…) AND – (Outcome OR synonym1 OR synonym2…)

PICO  to  searching  

� Question Part Question Term Synonyms

POPULATION/PATIENT Colorectal cancer Bowel cancer

INTERVENTION Screening Screen, Early detection

COMPARISON No screening -

OUTCOME Mortality Death, Survival

Synonims  for  keywords  

�  a  search  string  might  be:    

(Colorectal  cancer  OR  bowel  cancer)  AND  

(Screen*  OR  early  detecOon)  AND  

(Mortality  OR  death  OR  survival)  

Examples  

� Examples  

Mortality  

Colorectal  cancer  

Screen  

Mortality  AND  screen  represents  the  overlap  between  these  two  terms  —retrieves  only  ar:cles  that  use  both  terms  

Colorectal  cancer  AND  screen  AND  mortality  represents  the  small  area  where  all  three  circles  overlap  —retrieves  only  ar:cles  with  all  three  terms  

� ¨Which  databases  did  you  search?  Tips  please  use  following  database  for  searching  the  arOcles  –  hap://www.ncbi.nlm.nih.gov/pubmed  –  hap://highwire.stanford.edu/    hap.search.proquest.com  Username:  T84P3A92L6  Psword:  pqtadulako  

4.  How  to  get  the  answer  

� ¨  Each  group  has  two  arOcles    ¨  IdenOfy  use  the  worksheet  to  appraise  criOcally  the  arOcle    ¨  Diagnosis,  therapy,  prognosis  and  harm  

CRITICAL  APPRAISAL  

� Answer : Specify the answer for the clinical question based on your finding on the articles. Student will present the answer in their group (in power point slides) with supervision from their instructor.

Assignment