DETERMINANTS OF

COMMUNITY HEALTH

POWER SEARCHING

Fall 2003
2003, Faculty of Medicine, University of Toronto
 GOAL

To design search strategies

that find the best research
 OUTLINE
Introduction
MEDLINE
practice
PsycINFO
practice
Questions and discussion
 STEPS IN A SEARCH

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

MEDLINE, 1966-
CINAHL, 1983-
PsycINFO, 1967-
Cochrane Library, 1995-
EMBASE, 1974-
 STEPS IN A SEARCH

Choose a database
Formulate a search question
Identify primary topics
Identify searchable terms
Relate the concepts
FILTER!
 FORMULATING A SEARCH
QUESTION

ORIGINAL QUESTION:

How can we improve our methadone

maintenance program?
 FORMULATING A SEARCH
QUESTION

precise, testable
narrowly focused
phrase as a question or hypothesis
FORMULATING A SEARCH
QUESTION
P

E
FORMULATING A SEARCH
QUESTION
P population or
problem

E
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

E
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or
issue

E
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or methadone
issue

E
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or methadone
issue

E effect or
evaluation
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or methadone
issue

E effect or compliance
evaluation
FORMULATING A SEARCH
QUESTION

What factors affect compliance in a

methadone maintenance program for
heroin addiction?
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or methadone
issue

E effect or
evaluation
FORMULATING A SEARCH
QUESTION
P population or heroin addiction
problem

I intervention or methadone
issue

E effect or effectiveness
evaluation
 FORMULATING A SEARCH
QUESTION

What factors affect compliance in a

methadone program for heroin
addiction?
Is methadone an effective
intervention for heroin addiction?
 STEPS IN A SEARCH

Choose a database
Formulate a search question
Identify primary topics
Identify searchable terms
Relate the concepts
FILTER!
 SEARCH TERMS
PRIMARY TOPICS SEARCH TERMS

methadone vary with each

heroin addiction database
effectiveness
 COMBINE

METHADONE
 COMBINE

METHADONE HEROIN
ADDICTION
 COMBINE

METHADONE AND HEROIN

ADDICTION
 STEPS IN A SEARCH

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

METHADONE HEROIN
AND ADDICTION
 FILTER

METHADONE HEROIN
AND ADDICTION
Is methadone an effective intervention
for heroin addiction?
 SAMPLE SEARCH ASSIGNMENT

1. IDENTIFICATION

John Smith, Fitzgerald Academy

jsmith@utoronto.ca
Telephone 416-777-7777
Fax 416-778-5666
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?
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
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.
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.
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.
5. SEARCH STRATEGY

Database: MEDLINE <1996 to October Week 4 2003>

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)
6. RESULTS
<1>
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.

<2>
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.
6. RESULTS (contd)

<3>
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.

<4>
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.