Finding the literature 2

1 Goals of lecture

• Able to search for narrative reviews
• Able to search for clinical trials and systematic reviews
• Be able to use tags and boolean operators (AND, OR)

2 Questions

• Did anyone search?
• Search the literature is a skill that takes practice.
• You can't learn how to search the literature in a textbook.
• All of these things are suggestions and you can break these rules and search anyway you want.

3 Outline

• Find a review
• Skim review to get background information and words for PICO search
• Create synonyms for PICO.
  • Combine synonyms with OR and surround with parentheses
  • For example, (bipolar OR "manic depressive")
• You can find an outcome measure in the review or use my table
• Combine the PICO search terms and search for clinical trial by filtering by trial.
• For example, (bipolar OR "manic depressive") risperidone "young mania rating scale"

4 Finding a review

1. Google scholar and search "lithium review"
2. Also find reviews with pubmed looking at high impact journals (JAMA, Lancet, NEJM, biological psychiatry, molecular psychiatry)and searching for recent reviews.
3. UpToDate

5 Narrative vs systematic review

• Narrative review is an expert review with broad information on the topic such as prevalence, diagnosis, treatment options, pathophysiology, epidemiology, natural history of the disease, and risk factors.
• A systematic review is similar to a study with papers or trials as the participants.

6 Reasons to find a narrative review

• Get a basic understanding of the topic
• To use their bibliography to find articles
• To determine which words are used in the literature so you can search for them
• Look for population terms, interventions, and outcome measures that are used to help with searches.

7 Using pubmed to find a review

8 Search through big journals for big topics

• Search journals using the advanced search

8.1 Search through specific journals

• For big topics like bipolar disorder/alcohol use disorder, you can look for reviews in NEJM, Lancet, JAMA.
• Combine the journals with an 'OR'

8.2 Search through specific journals

8.3 A faster way

• You can also just copy this text into the search to search for the journal.
• I am using pubmed tags to search.
• ("The New England Journal of Medicine"[Journal] OR Lancet[Journal] OR JAMA[Journal])
• For a narrative review you can also use the title tag [title]
• And to filter by review you can use the filter tag with review[filter]
• My favorite tags are here.

9 Let's do an example

• Try to find a narrative review on
  • bipolar disorder

10 Advanced search way

• Demonstration

11 Find bipolar disorder review

• "bipolar disorder"[title] ("The New England Journal of Medicine"[Journal] OR Lancet[Journal] OR JAMA[Journal]) review[filter]
• If you copy this search you can just change bipolar disorder to whatever diagnosis you want to search for and find the review
• "obsessive compulsive"[title] ("The New England Journal of Medicine"[Journal] OR Lancet[Journal] OR JAMA[Journal]) review[filter]
• https://www-nejm-org.foyer.swmed.edu/doi/pdf/10.1056/NEJMra1906193

12 Skim article

• Look for words that could be used in a PICO search
• P - population
• I - intervention
• C - comparator/control (optional)
• O - outcome (scales)

13 Let's review PICO type search

14 PICO Search basics

• So each of the categories for PICO can be combined with OR's
• For the P or population terms, you come up with multiple synonyms and combine them with an OR.
• So if you are search for the evidence for lithium in mania

15 Bipolar mania

• The population we are looking for is bipolar disorder patients that are manic.
• So words used to describe the patients could be "bipolar," "mania," or "manic"
• We may want to limit this to inpatient's or outpatients, but we can do a search first.
• If there are too many articles, we can then limit.

16 ICO terms

• I or intervention is lithium
• C or comparator I usually leave blank. If there are many articles you can make the search more specific.
• O or outcome is Young Mania Rating Scale or YMRS. We can look at this table.

17 Outcome table

• https://inptpsych.com/doku.php?id=ebm:toc

18 Outcome table

• https://inptpsych.com/doku.php?id=ebm:toc

19 Putting it together

• Our search would be
• P = bipolar OR mania OR manic
• I = quetiapine
• C = leave blank
• O = "young mania rating scale"
• Surround each of the OR statements with parentheses.
• (bipolar OR mania OR manic) quetiapine "young mania rating scale"

20 Here is the search

• Let's filter by clinical trial OR systematic review

21 Skimming article we find these two trials

• Looking through the article you find a great table that compares the different medications and their indications for bipolar disorder
• You also see this article cited that may be interesting
• Network meta-analyses have suggest-

ed some differences in efficacy — specifically, risperidone was more effective than aripiprazole and more effective than valproate in some analyses.42,43 The safety profiles of the various antimanic treatments and their acceptability to patients vary (Table 2).42,43

22 Looking at bibliography

• Perhaps it would be better to try to find these reviews without the trouble of looking at a review
• However clinically everyone uses the term mood stabilizer and does not use the term antimanic agent. This may have made finding this article a challenge.
• Yildiz A, Nikodem M, Vieta E, Correll

CU, Baldessarini RJ. A network meta- analysis on comparative efficacy and all- cause discontinuation of antimanic treat- ments in acute bipolar mania. Psychol Med 2015;45:299-317.

1. Cipriani A, Barbui C, Salanti G, et al.

Comparative efficacy and acceptability of antimanic drugs in acute mania: a multi- ple-treatments meta-analysis. Lancet 2011; 378:1306-15.

23 You can attempt to find a more recent meta-analysis now

• (bipolar OR manic OR mania) (antimanic OR "mood stabilizer") efficacy

24 Breakout groups

• Each group can find a narrative review on one of the following topics. Skim article and do a PICO search.
• Goal is to find an article you'd be interested in reading / skimming.
• borderline personality disorder
• schizophrenia
• alcohol use disorder
• suicide
• depression