Fig. 13.1
Steps in developing a search strategy for clinical research
Refining your Search Strategy
In the early stages of any research process, the search strategy is an essential aspect to support success. Depending on the number or volume of search results, there are a variety of adjustments that can be made to generate the appropriate results supporting a full exploration of the desired topic. Table 13.1 provides some common adjustment strategies that can be used for any type of search.
Table 13.1
Strategies for adjusting search results
Too many results |
Add in another concept |
Use more limits |
Use subheadings |
Apply Focus to subject heading |
Too few results |
Remove some limits |
Remove Focus on any subject headings |
Use more text words |
Choose all subheadings |
Use broader subject headings |
Use the Related articles feature |
Combining Search Concepts
Another way to refine your search strategy is to combine term. When combining search terms or concepts, you may use the terms AND, OR, and NOT. These are called Boolean operators and are used to indicate the relationship between search terms (Table 13.2).
Table 13.2
Boolean search operators and outcomes
Boolean search operators | |||
|---|---|---|---|
TERM | AND | OR | NOT |
ACTION | Narrows search | Broadens search | Narrows search |
EXAMPLE | Myocardial infarction AND urokinase | Streptokinase OR urokinase | Streptokinase NOT urokinase |
OUTCOME | Retrieves citations containing both terms | Retrieves citations containing one term or the other, or both | Retrieves citations on streptokinase excluding urokinase citations |
Diagrams of Boolean Operators at Work:
The following video tutorials provide additional guidance on the use of Boolean operators:
Western University (2011) Basic Search: Using Boolean operators. Available: http://www.youtube.com/watch?v=1mmdXFOyRDo
Western University (2011) Basic Search: Boolean operators (Advanced). Available: http://www.youtube.com/watch?v=RkCJNdetsmI
Choosing a Database for Your Search
The appearance or interface for each database varies from one to the next. All databases can be searched by using keywords while many also allow searches using subject headings. Learning how to use subject headings can improve the results of your literature search. One of the most commonly used subject heading systems is MeSH, the U.S. National Library of Medicine’s thesaurus used by the MEDLINE/PubMED databases.
MeSH Terms
Skillful use of subject headings can improve the results of a literature search. MeSH (Medical Subject Headings) is one of the most commonly used subject heading systems controlled by the U.S. National Library of Medicine. It is a vocabulary thesaurus used for indexing articles in PubMed [9]. When it comes to inter-disciplinary research, knowing what MeSH terms correspond to terms you would normally search by is important. For instance, ‘human factors’ is not a MeSH term but ‘human engineering’ is.
All databases should provide the user with the ability to search and save or print their search results. Databases usually contain a section entitled Search Help, Help Topics, FAQs (Frequently Asked Questions) or Tutorials to enable the user to learn how to use the database. In addition, many libraries have developed help sheets, online information or YouTube videos on how to search or use specific databases. YouTube video tutorials for using PubMed are linked to the MeSH website (http://www.ncbi.nlm.nih.gov/mesh).
In addition to MEDLINE citations, PubMed also contains in-process citations that provide a record for an article before it is indexed with MeSH and added to MEDLINE as well as citations for books and book chapters available on the NCBI Bookshelf (http://www.ncbi.nlm.nih.gov/books).
Libraries buy access to databases such as MEDLINE and CINAHL and PsycINFO from different vendors such as Ovid and EBSCOhost. Different databases as well as different vendors for database access have different user interfaces and navigation strategies. PubMed now has various sidebar features such as an editable window with the search details so that you can edit the search strategy in the window and re-run the search. PubMed is available not only to scholars but also to the public.
Open Access
Open access journals are gaining popularity with the intent of making journal articles more freely available to readers. Some journals are subsidized and some require payment from the author to publish. Open access journal publishers include PLOS (Public Library of Science) and BMC (BioMed Central).
Open access journals are likely to continue to gain popularity for various reasons: (1) authors are usually in a position to pay the open access fee, (2) students are usually not able to pay for articles, and (3) they sometimes save libraries the cost of a journal subscription. If journal articles are obtained through a university or hospital, whether or not a journal article is an open access article or not, will not be apparent. From outside an academic institution, open access journal articles can be obtained through public access to databases such as PubMed.
Literature Review
Learning to review articles critically and efficiently is an important skill for a researcher. A good guide to the steps for performing a critical appraisal of the literature is ‘Reading Research, 5th Edition: A User-Friendly Guide for Health Professionals’ by Davies and Logan [10]. The authors of this introductory book take a step-by-step approach to reading research and assessing its quality.
When reviewing literature it is important to (a) have a method of summarizing the information and (b) share the work of reading and summarizing the literature amongst the research group members. Table 13.3 shows an example of a template used by a nursing research team working on a trauma research project. This research team uses Microsoft Word documents to share their review but there are other methods of archiving research summaries and sharing the summaries amongst research team members. By typing in ‘online research collaboration tools’ into Google, you can find a variety of useful sites, including one at the University of Queensland, Australia. Westlake [11] also provides some practical tips for literature synthesis.
Table 13.3
Example of a template used by a nursing research team working on a trauma research project to summarize an article by Duff [15]
Type of research (qual/quan) | Tools used | Sample |
|---|---|---|
Grounded theory research method: constant comparative analysis 16 months for data collection and analysis | 1–3 interviews per patient + 12 h clinical observation | 11 severe TBI Pts and 25 family members, in PCU/MR from 2 acute neuro centers (Canada). Families followed until patient woke up from coma or died. Length of study was from 7 weeks to 1 year, depending on patients’ progress. Ethnic population (TO, the world’s most culturally diverse city) |
Purpose: To discover the most salient concerns of families who had a close relative with a severe TBI, and how they dealt with the experience during the uncertain trajectory of illness that followed coma | ||
Major Findings: Identified the family’s basic social process of “Negotiating Uncertainty”, which consisted of 4 phases: Willing Survival, Attending Snow White, Reconstructing the Person and Making it Better | ||
Uncertainty related to both the trajectory of the illness and the eventual cognitive, physical and behavioral outcomes that result | ||
Other Findings: | ||
Willing Survival: Spiritual beliefs, medical miracles and the TBI individual’s strength; often determined meaning and provided hope. Families reported that doctors were often pessimistic about outcome, contributing to the family’s need to stay close to the patient and be an advocate for care. Virtually all families turned to friends and relatives for support | ||
Snow White: “Waiting for patient to wake up”. Family first to notice very detailed improvements in pt’s behavior. Family involvement in care very important. Family belief that essential person intact, needs only correct stimuli to awaken from coma/post coma unawareness and return to previous life and personality | ||
If TBI prolonged, family expand efforts to understand brain injury, recovery and rehab, became more adept at negotiating | ||
Transfers both within and outside the hospital were breaking points for family: “very, very traumatic – difficult to overcome fear that he is not ready – not going to be looked after” | ||
If unconsciousness prolonged, dampened hopes and belief in potential for positive outcome. Variable family response: some openly express concerns, some hide fears, afraid that acknowledging/voicing them will negatively affect recovery. Protracted and unpredictable course is very distressing for families. If slow recovery, families often feel forgotten, ignored or patronized | ||
Reconstructing the person: Family constantly engages in process of re-evaluation and reconciliation of pre and post person. Growing realization of long term or permanent effects, resulting in a changed person, and relationships/responsibilities of the family. Degree of recognition and acceptance of families vary widely | ||
With ongoing improvement, HC team more supportive and optimistic for recovery and increased their involvement in care. For pts with limited progress, the HC team (except nurses and SW) do not “see a role” for their services unless the person was acutely ill | ||
Making it Better: Gradual acceptance (timing varies significantly) that person will not return to pre-injury abilities, personality and memories. Families remain committed to helping individual achieve highest level of recovery possible. Often, other pent-up life demands begin to take precedence (“important for me to have some kind of normality”) – gradual return to usual routine. Process of making it better facilitated by trusting relationships with HC team and others contributing to well-being of family. Families unable to access acceptable facilities compelled to remain in attendance, change lives or living arrangements (bringing pt home) or suffer guilt | ||
Strengths: Richness of data, clinical relevance, followed patients and family over entire coma period, multicultural population, consistent interviewer, | ||
Weakness: Small sample size, no demographics available, (other than initial coma) and multi-cultural population. Minimal discussion of method of analysis | ||
Key Points: negotiating uncertainty underlying process, four stages as identified above. Many relevant recommendations for implications for practice and research | ||
Comparisons: need for hope (Bond, Johnson), need for involvement with care (Serio, etc.), increased stress with transition (Grossman) | ||
Commentary: | ||
The richness of the data collected, the examples of statements of family members and the relevance of the clinical observation make this research an excellent example of qualitative research. Unfortunately, the study is limited by the fact that there is no demographic information on the patients and families, and limited definitions of family and the severity of injury | ||
One of the strengths of Duff’s article is the variety of recommendations that she identifies, both in the clinical and research context. Some of the activities she recommends include the involvement of advanced practice nurses in the delivery of information on an early and frequent basis, the development of protocols for experiences the patient undergoes (ie agitation, tracheostomy weaning), which will decrease uncertainty for families and the presence and involvement of families in the patient’s care, beginning in the critical phase. Duff emphasizes that although “there are many areas of uncertainty, such as eventual outcomes, that cannot be determined; there are many other causes of uncertainty that can be addressed” | ||
Excellent article – very clinically relevant | ||
Reference Management Software
The great advantage of using reference management software such as Reference Manager, RefWorks, EndNote, EndNoteWeb, Zotero, Mendeley, and recently Papers 2, is that it provides not only bibliographic storage for citations but it also automatically changes the style of the references depending on what style you need your references to be in for publication or for other types of papers. Choosing the right reference management software for you can be simple if your university, hospital or other organization has a license for reference management software or you have colleagues that already use a particular one. If you are starting from scratch, you can find various comparisons of these programs. For instance, from the John Hopkin’s University library, or by typing ‘online research collaboration tools’ into a search engine such as Google.
This Reference Manager demo will give you an idea of why reference management software is popular with researchers.
Qualitative Research, Quantitative Research and Mixed Methods Research
The broad choice of research designs can be classified as quantitative, qualitative or mixed methods. Qualitative research investigates a phenomenon in a variety of ways in order to develop a deep understanding or narrative of a phenomenon. The narrative is generated through a variety of research strategies such as ethnography, grounded theory, and other approaches [2, 12]. Quantitative research is often associated with randomized control trials where there are defined independent variables and defined dependent variables. However, there are other types of quantitative designs, often referred to as ‘quasi-experimental designs’ where it is not possible to randomize [13]. Mixed methods research uses a mixture of quantitative and qualitative methods [14, 16].
Qualitative Research
Qualitative research defined by Polit and Beck [2] is “The investigation of phenomena, typically in an in-depth and holistic fashion, through the collection of rich narrative materials using a flexible research design” (p. 739).
Data Collection
There are many methods of gathering data for qualitative research including interviews and focus groups. Data collection can be done by hand, by computer, or by audiotaping and later transcribing the data into text. MacLean et al. [17] discuss how to improve the accuracy of transcripts. Areas discussed include the following issues:
Use of voice recognition systems
Notation choices
Processing and active listening versus touch typing
Transcriptionist effect
Emotionally loaded audiotaped material
Class and/or cultural differences among interviewee, interviewer, and transcriptionist
Errors that arise when working in a second language
It is worth noting that voice recognition systems, although used in interactive voice response systems and medical dictation (e.g. Dragon), are more problematic for research use. The challenge for using such technology for interviews is the necessity of voice-training the system. Focus groups pose additional challenges for this type of technology because of the many different speakers. As an alternative method of data collection, Scott et al. [18] discuss the use of court reporters to improve the accuracy of focus group data.
Data Analysis
Thematic analysis of qualitative data can be done without qualitative analysis software if the data set is small. However, for large data sets, a software package that performs thematic analysis is recommended. Qualitative analysis software can select and code data based on the researchers’ choice of words and phrases, group the codes, and produce graphical relationships based on the findings. However, the software does not determine the theme, define the codes or interpret the data. The software is a tool to help organize data but is no substitute for keen observation, careful data collection, and analytic interpretation on the part of the researcher.
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