In individuals with psychotic disorders (including schizophrenia) who require long term antipsychotic treatment, are anticholinergic medications more effective in preventing or reducing extrapyramidal side-effects and/or improving treatment adherence than placebo/treatment as usual?
In children and adolescents with anxiety disorders, what is the effectiveness and safety, considering system issues in low- and middle-income countries, of using pharmacological interventions in non-specialist settings?
Is removing means for self-harm better than no intervention for persons with thoughts or plans of self-harm in the last month or acts of self-harm in the last year?
Is hospitalization better than no hospitalization for persons with self-harm?
In individuals with a first psychotic episode with full remission, how long should antipsychotic drug treatment be continued after remission in order to allow for the best outcomes?
What are the effective maternal mental health interventions to prevent developmental problems in early infancy?
For people with dementia, which cognitive/psychosocial interventions (such as cognitive stimulation, cognitive rehabilitation, reality orientation, reminiscence therapy) when compared to placebo/comparator produce benefits/harm in the specified outcomes?
In people with depressive symptoms (in absence of depressive episode/disorder) - who are in distress or have some degree of impaired functioning - is a problem-solving approach better (more effective in symptom reduction) than treatment as usual?
In individuals with psychotic disorders (including schizophrenia), is the use of two or more antipsychotic medications concurrently more effective and safer than the use of one antipsychotic only?
In individuals with psychotic disorders (including schizophrenia) and bipolar disorders are psychoeducation, family interventions and cognitive-behavioural therapy feasible and effective?
Background
In children and adolescents with anxiety disorders, what is the effectiveness and safety, considering system issues in low- and middle-income countries, of using pharmacological interventions in non-specialist settings?
Converting an information need into a clinical question
Is your question a background question or a foreground question?
Background questions such as broad information on a disorder or a treatment are best answered in textbooks and in online clinical tools such as UpToDate.
Foreground questions are very specific such as the adverse effects of a particular drug, or the comparable effectiveness of different treatments. A foreground question requires a search for evidence in a citation database. Formulating a precise and answerable clinical question is critical for translating the question into searchable concepts.
PICO is a mnemonic framework for the four elements of a clinical foreground question. The patient or population, the intervention or treatment we are considering, the comparison of one intervention to another - if this is applicable - and the outcome we are interested in. PICO is just one tool that is particularly suitable for looking at interventions.
Once a well-structured question is formulated, you will be in a better position to effectively search the literature.
The PICO elements only inform the search - not all the elements of the PICO are used in the search. While it's important to consider the outcome in developing an answerable clinical question, we want to undertake a discovery process and so the Outcome element is not used in the search strategy.
Activity:
Read through the module: Introduction to systematic searching and complete the tasks.
Levels of evidence (sometimes called hierarchy of evidence) are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. These decisions gives the "grade (or strength) of recommendation."
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Level of evidence (LOE) |
Description |
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Level I |
Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results. |
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Level II |
Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT). |
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Level III |
Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental). |
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Level IV |
Evidence from well-designed case-control or cohort studies. |
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Level V |
Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis). |
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Level VI |
Evidence from a single descriptive or qualitative study. |
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Level VII |
Evidence from the opinion of authorities and/or reports of expert committees. |
This level of effectiveness rating scheme is based on the following: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. (p. 7). St. Louis, MO: Mosby Elsevier.
PubMed Clinical Queries
The PubMed Clinical Queries search is designed to filter one search by three clinical research areas: Clinical Study Categories, Systematic Reviews, and Medical Genetics.
Clinical Study Categories
Therapy: Retrieves clinical studies that discuss the treatment of disease. This is the search default.
Diagnosis: Retrieves clinical studies addressing disease diagnosis.
Etiology: Retrieves clinical studies addressing causation/harm in disease and diagnostics.
Prognosis: Retrieves clinical studies addressing disease prognosis.
Clinical Prediction Guides: Retrieves clinical studies which discuss methods for predicting the likelihood of disease presence or absence.
Systematic Reviews
Your search terms combined with citations that have been indexed as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, or guidelines.
Medical Genetics
Your search terms are filtered by medical genetics topics.
This tutorial is from the Yale Library https://library.medicine.yale.edu/tutorials/subjects/systematic-searches
Have a look at this guide and timeline for the systematic review process, and how librarians can assist at different stages.
