Panning for Applied Clinical Research Gold

Article excerpt

Health care literature, though better organized than other knowledge areas, is still cumbersome enough to make effective searching difficult and large retrievals commonplace. Subject searching (for drugs and diseases) is useful for searching an entire database, but a different approach is needed to limit retrieval to articles that health professionals should use for patient care.

Many different groups, such as basic scientists, clinical researchers, health practitioners, eductors, and administrators, produce publications. Their written work ranges from idea papers, which include editorials and case reports, to wet laboratory and animal experimental studies, to small early studies with humans.

Another important category is the reports in the applied clinical literature about the large, carefully controlled trials done in hospitals and institutions with human participants. These trials are the studies that health care professionals should rely on to keep up-to-date and solve patient care problems. These trials have actual evidence that the changes in health care under investigation are proven advances. The applied clinical trials answer the following questions:

1. What caused the disease or disorder? (etiology)

2. How can I decide what the disease or disorders is? (diagnosis)

3. What happens to people with the disease over time? (prognosis/natural history)

4. How can I treat (or prevent) the disease/disorder? (therapy)

Only a fraction of the millions of citations in MEDLINE, CINAHL, EMBASE, and other related databases actually are of reports of applied clinical trials that address the four questions above. Most citations are reports of preparatory work completed before the applied clinical trials can be done. Applied clincal studies are unique in the manner in which they are produced (their study methods).

Authors refer, in their titles and abstracts, to the methods used in the research, and database indexes index these methodologies as keywords describing the articles. Searchers can use the methods textwords and subject headings to only retrieve papers that have sound research methods and can, therefore, be used directly in patient care. We will describe the study methodologies used in each category, list appropriate index and textwords (Table 1), and given search examples of how to use methodology terms for search filtering.

                                  Table 1
                  Search Terms for Clinical Trials Research

                MeSH                                 CINAHL

Searching Terms For Comparative And Clinical Studies
comparative study                 comparatives studies
clinical trial (pt)                clinical trials
Searching Terms For Therapy
double-blind method               duble blind studies
random allocation                 random sampling
randomized controlled trial (pt)   randomized trials
multicenter study (pt)              placebos
placebos
Textwords
random:
double blind
mask:
placebo
Searching Terms For Diagnosis
sensitivity a#d specificity        sensitivity (research)
  predictive value of tests        specificity (research)
  ROC curve                        predictive validity
false positive reactions           flase negative reactions
false negative reactions           false positive reactions
Textwords
sensitivity specificity
false reaction:
predictive value:
ROC
Searching Terms For Etiology/Causation
case-control studies               retrospective studies
retrospective studies              case studies
cohort studies                     case control studied
longitudinal studies               cohort studies
prospective studies                longitudinal studies
follow-up studies                  prospective studies
cross-sectional studies            causal attributes
odds ratio                         odds ratio
risk                               risk factors
causality                          random sampling
risk factors
randomized controlled trial (pt)
Textwords
cohort
case control
risk and (revelant or factor:)
etiol: or aetiol:
causation
Searching Terms For Prognosis/Natural History
cohort studies                     cohort studies
longitudinal studies               longitudinal studies
follow-up studies                  prospective studies
prospective studies                retrospective studies
morbidity                          morbidity
mortality                          mortality
incidnece
prevalence
Textwords
prognos:
natural history
inception cohort
clinical course
Searching Terms For Meta-Analysis
meta-analysis                      meta analysis
Textwords
metaanalysis
meta analysis
meta-analysis
overview

Report of applied clinical research have these two common features:

1. …