DETERMINANTS OF COMMUNITY HEALTH

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DETERMINANTS OF COMMUNITY HEALTH

• POWER SEARCHING
• Fall 2003

?2003, Faculty of Medicine, University of Toronto
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GOAL

• To design search strategies
• that find the best research

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OUTLINE

• Introduction
• MEDLINE
• practice
• PsycINFO
• practice
• Questions and discussion

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STEPS IN A SEARCH

• Choose a database
• Formulate a search question
• Identify primary topics
• Identify searchable terms
• Relate the concepts
• FILTER!

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SELECTED DATABASES

• MEDLINE, 1966-
• CINAHL, 1983-
• PsycINFO, 1967-
• Cochrane Library, 1995-
• EMBASE, 1974-

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STEPS IN A SEARCH

• Choose a database
• Formulate a search question
• Identify primary topics
• Identify searchable terms
• Relate the concepts
• FILTER!

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FORMULATING A SEARCH QUESTION

• ORIGINAL QUESTION
• How can we improve our methadone maintenance
  program?

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FORMULATING A SEARCH QUESTION

• precise, testable
• narrowly focused
• phrase as a question or hypothesis

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FORMULATING A SEARCH QUESTION
P
I
E
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FORMULATING A SEARCH QUESTION
P population or problem
I
E
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I
E
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue
E
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue methadone
E
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue methadone
E effect or evaluation
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue methadone
E effect or evaluation compliance
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FORMULATING A SEARCH QUESTION

• What factors affect compliance in a methadone
  maintenance program for heroin addiction?

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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue methadone
E effect or evaluation
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FORMULATING A SEARCH QUESTION
P population or problem heroin addiction
I intervention or issue methadone
E effect or evaluation effectiveness
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FORMULATING A SEARCH QUESTION

• What factors affect compliance in a methadone
  program for heroin addiction?
• Is methadone an effective intervention for heroin
  addiction?

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STEPS IN A SEARCH

• Choose a database
• Formulate a search question
• Identify primary topics
• Identify searchable terms
• Relate the concepts
• FILTER!

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SEARCH TERMS

• PRIMARY TOPICS
• methadone
• heroin addiction
• effectiveness

• SEARCH TERMS
• vary with each database

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COMBINE
METHADONE
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COMBINE
HEROIN ADDICTION
METHADONE
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COMBINE
AND
HEROIN ADDICTION
METHADONE
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STEPS IN A SEARCH

• Choose a database
• Formulate a search question
• Identify primary topics
• Identify searchable terms
• Relate the concepts
• FILTER!

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FILTER
HEROIN ADDICTION
METHADONE
AND
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FILTER
FILTER
HEROIN ADDICTION
METHADONE
AND
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• Is methadone an effective intervention for heroin
  addiction?

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SAMPLE SEARCH ASSIGNMENT

• 1. IDENTIFICATION
• John Smith, Fitzgerald Academy
  jsmith_at_utoronto.ca
• Telephone [phone]
• Fax [phone]

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• 2. SEARCH QUESTION
• My field placement is with the Metropolitan
  Toronto Detox Centre. We want to improve the
  effectiveness of the methadone maintenance
  program for heroin addiction. Since compliance is
  a major factor affecting the programs success,
  we want to focus specifically on barriers to
  compliance. I therefore selected as my core
  concepts compliance, methadone, and heroin
  addiction. Rephrased as a question, my search
  question becomes What factors affect compliance
  in a methadone program for heroin addiction?

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• 3. SEARCH PLANNING
• DATABASE
• I decided to search in MEDLINE (Ovidweb),
  because it provides good coverage of the
  addictions literature.
• PRIMARY TOPICS
• 1. Methadone
• 2. Heroin addiction
• 3. Compliance

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• 3. SEARCH PLANNING (contd)
• RELATIONSHIP BETWEEN CONCEPTS
• methadone AND heroin addiction AND compliance
• QUALITY FILTER
• If the base set is large enough, I will narrow it
  down just to studies using questionnaires or
  surveys. This will give me a subset that is
  research-based, using the same type of instrument
  we want to use in our own study.

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• 4. DISCUSSION
• When I typed methadone in Medline, it mapped to
  the MeSH heading methadone. I exploded methadone
  to pick up the narrower term, methadyl acetate. I
  then typed my second concept, heroin addiction.
  This mapped to the MeSH heading heroin
  dependence. I clicked on the term to see the
  hierarchy of terms, and decided to move up to the
  broader MeSH, opioid-related disorders. I
  exploded it to include heroin dependence and
  morphine dependence. My third concept,
  compliance, retrieved three terms, one of which
  was patient compliance. The scope note for
  patient compliance cited treatment refusal and
  patient dropouts as related terms.

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• 4. DISCUSSION (contd)
• I therefore created sets for all three terms,
  and combined them with OR, so that any of these
  terms would be picked up in the search. I then
  combined the sets for methadone, opioid-related
  disorders, and the various terms for patient
  compliance using AND. I limited this set to
  English and human to get a base set of 41. For my
  quality filter, I selected the term data
  collection, which can be exploded to include
  questionnaires and surveys I want articles using
  these qualitative research tools. When I ANDed
  data collection with my base set, I retrieved a
  final set of five items. Most of the items in the
  final set appeared to contain useful information
  relating to my question.

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• 5. SEARCH STRATEGY
• Database MEDLINE lt1996 to October Week 4 2003gt
• Search Strategy
• --------------------------------------------------
  ------------------------------
• 1 exp METHADONE/ (834)
• 2 exp Opioid-Related Disorders/ (1533)
• 3 1 and 2 (475)
• 4 limit 3 to (human and english language)
  (409)
• 5 Patient Compliance/ (3902)
• 6 Patient Dropouts/ (565)
• 7 Treatment Refusal/ (1034)
• 8 5 or 6 or 7 (5303)
• 6 4 and 8 (41)
• 7 exp data collection/ (130425)
• 11 6 and 7 (5)

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• 6. RESULTS
• lt1gt
• Authors
• Cushman P Jr.
• Title
• Ten years of methadone maintenance treatment
  some clinical observations.
• Source
• American Journal of Drug Alcohol Abuse.
  4(4)543-53, 2002.
• lt2gt
• Authors
• Morral AR. Belding MA. Iguchi MY.
• Title
• Identifying methadone maintenance clients at risk
  for poor treatment response pretreatment and
  early progress indicators.
• Source
• Drug Alcohol Dependence. 55(1-2)25-33, 2001
  Jun 1.

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• 6. RESULTS (contd)
• lt3gt
• Authors
• Belding MA. McLellan AT. Zanis DA.
  Incmikoski R.
• Title
• Characterizing "nonresponsive" methadone
  patients.
• Source
• Journal of Substance Abuse Treatment.
  15(6)485-92, 1999 Nov-Dec.
• lt4gt
• Authors
• Zanis DA. Woody GE.
• Title
• One-year mortality rates following methadone
  treatment discharge.
• Source
• Drug Alcohol Dependence. 52(3)257-60, 1999
  Nov 1.

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