Is this peer reviewed?

The student group who have to justify their choice of database (see separate post "Why use that database?" for discussion of that) also have to choose a peer reviewed paper to appraise.

How do you know?

Here are some ideas.

Cinahl has a limit for "peer reviewed journals".    PubMed does not.    But I think a peer reviewed journal (like the BMJ) might publish pieces that are not peer reviewed (like editorials or letters).

Perhaps you can assume that research, review and systematic review articles in a peer reviewed journal have been peer reviewed.   But I think you would need to check the journal's own policies, on the journal website, to see what process articles go through.

You can certainly assume that a preprint, something from somewhere like medRxiv, has not been peer reviewed.   Preprints like that are appearing now in PubMed, but it is clear when you reach the full text that it has not yet been peer reviewed.

What else can you do?

You could check the database policies - does it only include peer reviewed articles or journals?   It would explain PubMed's lack of "peer reviewed journal" filter, if PubMed only included peer reviewed journals, but but PubMed itself does not say either way and so I would not assume anything.   Also, it does include BMJ editorials and correspondence to journals, so actually we know that not every item in PubMed has been peer reviewed.

I wondered if the list of journals indexed in Medline says if a journal is peer reviewed.   It does not, as far as I can tell.   

Perhaps the article itself will tell you?   If it shows dates when it was accepted, modified, and published, it tells you the article has been through a process, but it does not tell you what the process is.

You can, as alluded to above, check the journal itself.   Can you tell from the journal website (and I would hope you can) if it has a peer review process, and if it does, what it is, and what article types it applies to?    

I hope that helps, at least a bit!

Why use that database?

A module done by some of our students in nursing and midwifery involves an assignment, in which students need to find a peer reviewed paper to critically appraise.

One thing students have to do is choose a peer reviewed paper - see separate post "Is this peer reviewed?" for a discussion of that.

Another thing is to explain and justify their choice of databases.

Is "the librarian told me about it" or "we covered it in a library class" a good enough reason?     In the spirit of evidence based practice, where expert opinion (and I flatter myself) is at the base of the pyramid, I think it is not.

So, how to choose?

First, I think, is the idea that you would use a structured database like Cinahl or Medline, and not something simpler to use like Google Scholar or even Google, or even choosing a paper you saw in the media or social media.   

If you choose a structured database, you can conduct a structured, deliberate, search, having more control over what you are looking for.  You choose the words and phrases you will use, to increase the likelihood of finding papers on the precise subject you are interested in.    And you are using keywords, and not natural language searching, so you know how things are being found.   You know where the search is being done (titles, abstracts, keywords, or places you choose) and you know where the database is looking (a defined set of journals).

Then you choose the database on the basis of the subjects and types of material it covers.    For any topic in their subject (and I did give them this opinion in a class), Cinahl is the place to go, because it indexes a wider range of journals in nursing and allied health than other databases. 

But you could choose a second place, depending on your topic, as there are other databases that concentrate on related subjects. For us these are:

Mental health - APA PsycInfo

Medical practice, microbiology, genetics - PubMed (or Medline)

Childbirth, antenatal care, postnatal care, maternal health - MIDIRS (which we have as Maternity and Infant Care Database)

And if you want to venture outside the health literature, we have Web of Science and Scopus, which I think are useful for social science or education topics (and psychology as well).  Those two will also pick up conference material, and in Scopus' case, books.

All of this carries the warning that if you want literature published in the Global South, then you will need to look outside these "standard" databases into things like SciELO, African Journals Online and Global Index Medicus.  As I have documented elsewhere, the "standard" ones are not so good at indexing journals from the Global South (by which I mean Central and South America, Asia, Africa).

And for our students, there is the possibility of using NHS databases if you particularly wanted British journals about nursing (British Nursing Index) or material about health management (HMIC).  Or, since very recently, Social Policy and Practice for those subjects.

I did have a quick look in the books for arguments about database choice, and Helen Aveyard's Doing a literature review in health and social care (Aveyard, 2014, p.82) does say "for those undertaking a nursing-based literature review, CINAHL would be an appropriate start".  She goes on to list some of the other databases you might consider, and recommends talking to a librarian for advice and also, of course, to see what you have access to.    You, reading this post, may have other databases we do not have, and of course we may have access to things you do not.

Reference

Aveyard, H. (2014) Doing a literature review in health and social care: a practical guide. 3rd edn. Maidenhead, McGraw-Hill Education.

PICSO: Population, Intervention, Control, Setting, Outcome

Things like this NICE manual talk about setting, when formulating a search question, and there is the SPICE scheme, where S is the setting.    But I am not sure I have seen a version of the PICO grid which includes setting.

If there is one, it would be good to know about it and you can tell me in the comments.&nbsp But if not, I may have just invented it.   But I can't claim the credit.   My eye was caught by a Guardian article today about whether face masks work to prevent the spread of COVID-19, and my eye was particularly caught because the author is Professor Trisha Greenhalgh of Oxford University, author of How to read a paper,  a staple of any reading list about critical appraisal.

Greenhalgh discusses how you would design a randomised trial to examine whether wearing a face mask prevents COVID-19 infection in others.   Read the article, it is very well worth reading, an exploration of trial design, philosophy of science, and what evidence is possible.

Greenhalgh writes:

"Let's therefore test, in all members of the general public (population), the impact of cloth face coverings (intervention) compared to no coverings (control) in public places (setting) for preventing infection in other members of the public (outcome)."

So I had the thought  - that is a scheme to use to plan a literature search, and to formulate an answerable question:

Population
Intervention
Control
Setting
Outcome

= PICSO

I then had the thought - isn't this PICOS?   But in PICOS, the S is Study design. 

So, PICSO is not the same as PICOS.    A PubMed search for PICSO finds a few things about "pressure-controlled intermittent coronary sinus occlusion", and one possibly two about "physiological contributions in spontaneous oscillations", and one where it might actually be PIC50, but nothing about literature searching or evidence based practice.  Indeed, PubMed asks "Did you mean picos?".   There are far more about picos, using PICOS with S as Study Design (and some about the Picos de Europa in Northern Spain).

C could be "comparison".

I've used this search example (admittedly not a very answerable question) with nursing and midwifery students:

Compression stockings to prevent deep vein thrombosis in middle aged hospital inpatients>

In the session, P = middle aged hospital inpatients, I = compression stockings, C = implicitly, no stockings; O = DVT

With PICSO:

P - middle aged people
I - compression stockings
C - no stockings
S - hospital
O - DVT

I think there is scope for PICSO as a search planning tool and as an alternative to PICO as a tool to help devise answerable questions.

Maggots and wound debridement

I think I am enjoying CBBC's Operation Ouch rather more than my lad, who is within the target age group of CBBC!  This is a series about the body, medicine and health, and the presenters are doctors.

Today's edition included a journey with paramedics, a six year old visiting A and E having fallen on gravel, and bacteria being grown after people have kissed a Petri dish.

And sterile fly larvae being bred and used to treat wounds, with a warning before the footage was shown of a foot wound being debrided.  I remembered that this was a search topic we used to use in classes as an example to work on, as there are things to decide about search terminology (maggots, larvae?   wounds, debridement?).

I have an iPad to use in my clinical librarian post, with several apps to use on the ward.  What do they find? 

UpToDate: searching for maggots (I typed as much as "magg" and "maggots" appeared as the list of results) finds "Basic principles of wound management".  The literature review is current as of November 2015 (although there is a peer review process), and the last update to the topic was in May 2015.  The Find facility takes you to the section "Biologic", under "Wound debridement", which outlines uses of maggots.  RCTs have not found consistent reductions in the time to wound healing, although maggots compare well in terms of cost to hydrogel.  Maggots may reduce the duration of antibiotics in some patients, although there are negative perceptions associated with the use of maggots and pain may limit its use.

The NICE app: nothing found for "maggots" or "larval".   As you type a search term, results are shown, so there is nothing for "maggot" or "larvae" either.  Searching for debridement finds items (I got as far as "debrid") including "Wound care - debriding agents", from 2001.  Following this takes you to NICE Guideline CG74, "Surgical site infections: prevention and treatment", from 2008, which replaced it.  This seems more specific, and although I can't find a way to search the full text, there is no obvious sign of larvae.

PubMed for Handhelds: a quick use of the PICO search for P = wounds and I = maggots (or larvae or debridement) finds some useful looking results, although a change of search terms seems to make a lot of difference, and using "maggots or larvae" as the I finds a Cochrane review that I can't spot in searches for a single term.  I am not sure without checking what order results are shown in.  The Cochrane review turns up in a search of a final resource:

NICE Evidence Search: maggots, and filtering to systematic reviews, finds that Cochrane review (Debridement for venous leg ulcers, September 2015), as does a search for debridement.  It is also worth noting that NICE Evidence Search finds information in the BNF and about how to get hold of and dispose of maggots, which are available on the NHS.  That Cochrane review seems not be be referenced in UpToDate, but it was published very close to the last literature review, and the UTD peer review process may still be looking at it.   Having said that, it is not obvious from the abstract (viewed in PubMed itself) what the review has to say about maggots.  They are certainly investigated in some of the RCTs in the review, but in the abstract they are not clearly distinguished from other methods of debridement.

So, there is evidence there worth exploring.   You might need to use more than one source and which tool you use might determine what you find first, and what search terms you use may do the same. You will need some idea of what forms of evidence are viewed as the strongest, and will need to read the items you find in detail. 

Critically appraised topics

Via social media I find out about this paper from the British Journal of Dermatology (you will need a subscription to see the full paper).  It is a critically appraised topic about the use of diphenylcyclopropenone to treat alopecia areata, and involves a literature search carried out by Jacqueline Limpens, a medical librarian at the Academic Medical Center in Amsterdam, which is how I found out about it.

What is a "critically appraised topic"?  

Also known as a "CAT", a critically appraised topic is "is a short summary of the best available evidence, created to answer a specific clinical question", quoting from the University of Groningen listed below.  

Here are some resources about what a CAT is and how to carry one out:

BestBETs - Best Evidence Topics are a modification of the CAT.

CATMaker, software for creating CATs, from the Centre for Evidence Based Medicine, Oxford. 

CATWalk: a guide to critically appraised topics (University of Alberta)


LibGuide from the University of Groningen (in English)

Occupational therapy critically appraised topic
 
Physiopedia: Critically Appraised Topics

University of Texas Health Science Center - what is a CAT?

And here are some articles with links to PubMed:

How to perform a critically appraised topic: part 1, ask, search, and apply.

Kelly AM, Cronin P.

AJR Am J Roentgenol. 2011 Nov;197(5):1039-47.
PMID: 22021494

How to perform a critically appraised topic: part 2, appraise, evaluate, generate, and recommend.

Kelly AM, Cronin P.

AJR Am J Roentgenol. 2011 Nov;197(5):1048-55.
PMID: 22021495

How to write a critically appraised topic (CAT).

Sadigh G, Parker R, Kelly AM, Cronin P.

Acad Radiol. 2012 Jul;19(7):872-88.

There is also this:

Sauve S, Lee HN, Meade MD, et al. The critically appraised topic: a practical approach to learning critical appraisal. Ann Roy Soc Phys Surg Can 1995; 28:396–398

 

(One of the et al. is David Sackett, and I wonder if this is the original description of the idea).

Playing doctors and nurses. And medical librarians

This is a toy figure belonging to my younger son.  Working on a large model boat, he managed to fall off, and needed treatment.  

He had hurt an arm.  We know about slings - about a year ago I had one.  So my son made a sling (more like a splint, I think) out of something he had to hand (sorry), to immobilise the arm.  Then we needed to know if there were any other injuries, so we conducted an X ray (with a torch).  You can begin to see the things we talk about at home - never have a medical librarian for a parent, is possibly the lesson.

Anyway, we discovered he had a head injury.  We know about those too - about a year ago I had one of those too.  So, we kept him under observation and asked him questions from time to time about if he knew where he was, and so on.  

And we found that he had broken ribs.  What to do with broken ribs?   We did not know.  I had not had any of those.  So, we looked it up.  I managed to persuade him in a previous episode of this game (which involved dinosaurs, which is another story) that medical librarians could look things up if doctors and nurses did not know what to do.   Or, they could show the doctor or nurse how to look things up.

So, I looked it up in a first aid book.  A bit there, but nothing about how to treat them.  I tried the impressive St John's Ambulance app, with similar results.   So, off to the computer, to NICE Evidence Search.  I tried rib fractures first, thinking that more medical language might be appropriate.  Among the results, some things about whether CPR causes rib fractures, but nothing immediately that answered the question of what we could do for this poor man.  So I tried broken ribs, and the first result was from Patient (as Patient.co.uk, a favourite with our medical students, is now called), and the second from NHS Choices.   Having looked at those, we decided that we did not need to bind the ribs up, in fact we should not do so, and that painkillers, rest, ice packs and sleeping standing up were what was required.  We also had information about when he should go to A and E.

There we are.  Imaginative play, but it reminded me of one of the purposes of medical and health librarianship.  You may know what to do, because you are a doctor or nurse, or you have done it before (assuming you did the right thing then, of course), but if you do not, you have to look it up, and that is where librarians come in.

Evidence based practice for seven year olds

Or, "to rinse or not to rinse".  

Towards the end of last term, it was health week at my younger son's school.  Parents were invited in to take part in a lesson about oral health, with the teacher and pupils talking about different types of teeth and doing some tasks.  One was to use dental disclosing tablets to show how clean your teeth really were.  Sadly I could not stay for this bit, but I did watch the video about cleaning your teeth.  This included the advice not to rinse your mouth after you had brushed.  I had never thought of this, but the idea was not to wash the toothpaste away, leaving the flouride to remain working.

And then some weeks later, Dr Ranj on the very good Get Well Soon (CBeebies) had a programme about teeth, in which he was observed by my son rinsing.

So, who was right?  

I asked my lad about this.  Who was right?   Dr Ranj, he thought, was a grown up and a lot of grown ups did not know not to rinse.  His teacher had said she did not know, and so of course had I.  So, I asked, how did he know not to rinse?   The video had said so, he said.  How did he know the video was right, I asked.  Because the person in the video was a woman, he said.  

I am not sure which of Isaacs' Alternatives to evidence based medicine this is, although it occurs to me that since my lad is actually called Isaac, this may well be Isaac's Alternative!   Anyway, is there another explanation?   What is the evidence? 

NICE have a guideline on oral health, and there are recommendations relating to action that schools can take.    But nothing about rinsing (that I can see).

A search of NICE Evidence Search led me to a record in Central, about toothbrushing education, but not quite on the right topic.  It did however tell me there was a MeSH term Toothbrushing/, so I tried that in PubMed combined with the word rinsing.  This was on the right lines, and some of the related citations were useful looking.  One of those was indexed also with the MeSH term Water/Administration and Dosage (some of the other references were about mouthwash, not water).  Trying the two MeSH terms together finds five items, some rather old.  In this one, some children rinsed with water and some did not, and there was little difference in flouride retention (the abstract does mention that previous studies did indicate that there was).   This one compared rinsing methods (one involved mouthwash, and two water), but with a smaller number of people, and found there was a difference.

Then, I tried a search of PubMed using toothbrushing (water OR rins*), filtered to systematic reviews, and found this (which actually appears to be a report of a consensus meeting, thus being an example of the problem of using a preset limit!).  An examination of the full text is needed to see what the recommendations are.  The abstract suggests that studies come to various results and that the evidence is of varying quality, although international guidelines, interestingly, come to the same conclusion (the abstract does not say what this is).   The full text seems to be freely available, and says "The consistent message emerging from the guidelines in Table 2 is to spit and avoid excessive rinsing with water" (in the section headed "Clinical guidelines"), based on four referenced clinical studies, although it does say that the evidence levels and the methods used to grade the evidence vary.

Searching PROSPERO

Prospero is an international database of systematic reviews.  Reviewers can register review protocols in it, and link to publications once they appear.   Prospero is hosted by the Centre for Reviews and Dissemination at the University of York.  There is information about registration and the data that is required here.

Searching Prospero before you start a review could stop you duplicating work that is already in progress.  

As part of an enquiry at work, I was searching Prospero for reviews to include in a review of reviews (an "umbrella review").   Searching Prospero would locate reviews in progress, and would identify published reviews (alongside those identified using Medline and other databases). 

I have not found any search help specific to Prospero.  I am fairly sure the search help at http://www.crd.york.ac.uk/crdweb/GuideToSearching.asp applies to the other CRD databases.  

The References and Resources section contains a lot of useful information, including reviews of progress, and there are some interesting articles about Prospero under "Registering a systematic review", but the main emphasis of all the material seems to be about registration, not searching.  So, I thought it might be useful to "publish" my notes about searching Prospero.

Complex search strategies are difficult.  You can't see a search history, and so can only submit one query at a time.  If you use one search box, you can't use Boolean operators, although you can use * to truncate.  You can't enter phrases in inverted commas, but I wonder if phrase searching is the default.  Using more than one search box does give you a way to search using Boolean in one field (change the drop down box at the top) or across fields, but you have to have just AND or OR.  

You can't export results, only view them, so reviewing results for items to include in your research would need to be done on screen, and I am not sure how you would then put those items into reference management software for retention.

The Participants/Population field records details about the group(s) being studied in the review.  My enquiry involved finding material relating to older people.  Searching for aged did not work, as this found phrases like "patients aged 10 or above".  Older worked better, although that still found phrases like "30 years and older".  Elderly and geriatric worked as well.  There is no standardisation in this field, and no equivalent of Medline's age limits.

You can display all published records, and doing so shows that at the moment there are 5739 records, so the dataset is a lot smaller than something like Medline, and this combined with the fact that searching Prospero would be to augment more systematic searches done elsewhere, means that broader searches are still practical.