Reflection – Research Project

Prior to residency, I had the opportunity to get involved with research through directed studies project and work. It was definitely a very different, but great experience to work on and help lead a research project from beginning to end. Mark was a fantastic project investigator, guiding me through this process yet also providing me with the independence to make this project my own. Additionally, for me, the project was helping to answer a very meaningful clinical question. I am sure that in my practice, I will frequently encounter questions that could be answered with a DUE study, and am glad that my experiences will help me conduct clinical research to answer future questions of my own! 🙂

Some things that I have learned from working on this project are:

  1. Have a clear idea of my clinical question and objectives – and when deciding on what data I should be collecting, consider how I will also be (1) using (e.g. stats, descriptive analysis?), (2) interpreting and (3) presenting the data to answer my clinical question and meet my objectives.
  2. It wasn’t until mid way through my data collection that I started putting dates to all my data collection sheet…Initially, I had saved all my changes on one file…but as I made changes to my data sheet and my analysis, it was challenging to keep track of my progress and figure out where I had left off. Despite having multiple versions of my data collection in the end, it was much easier, at least for me, to refer back and understand my data when writing my manuscript.
  3. When presenting my research, figure out the main points I want my audience to take away and ensure that the data I present helps highlight these points. Also consider what data would be the most meaningful and interesting to pharmacists currently in practice.
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EBM Day #2: Library Research

Library Session:

Despite all the library sessions we had throughout undergraduate, I still find myself struggling with navigating all the available resources when doing a literature search. After this session, I feel more comfortable with finding what resources would be most appropriate for the clinical question given. As I am not tech-savvy at all, I will aim to become familiar with one database for my primary literature searches (e.g. MedLine).

Systematic approach:

  • Obtain demographics of requestor
  • Obtain background information for the situation
  • Determine and categorize the ultimate question
  • Develop strategy, conduct search
  • Critically evaluate information
  • Formulate and provide response
  • Follow-up, document.

Some pearls and guidelines to searching:

  • Start general and then go more specific
    (e.g. tertiary → primary)
  • Purpose of MeSH terms:  ↑ specificity and relevancy of results
  • In order to find hallmark trial (e.g. finding all the analysis of it but can’t find original trial), sorting by date can help
  • Guidelines for Systematic Reviews:
    http://guides.library.ubc.ca/SystematicReviews
  • What characterizes a good drug information response:
    timely, current, accurate, complete, concise, well-referenced, clear, logical, unbiased, etc. “Tell me what you are going to say…Tell me what you said”
  • Tips for writing response:
    Keep it simple, use sub-headings, chronological, strength of evidence, compare/contrast, use tables to succinctly present data, don’t feel you need to include everything you want (e.g. exclude weaker evidence if stronger evidence exists = i.e. be selective)
  • Tips for verbal communication:
    check if requestor has time, dialogue, tailor level of information to requestor, etc.

General:

Specific:

  • Databases available: Medline, PubMed, Embase
    • Medline and Embase are available on Ovid (as Ovid needs to sign for the articles, it is slower than Pubmed) → PubMed is the fastest to update
    • For Medline:
      • Look at scope note (i under scope) and tree (by clicking the subject heading)
      • “Map term to subject headings”: Looks for search word as the key words (very literal)
        • By unclicking it, it will search “mp”: checking search word in multiple places (e.g. abstract, etc)
      • Explode: compile all the narrower headings into the search (depends on how the articles are organized)
        • e.g. useful for antidepressive agents → explode and search for all the names “under” antidepressive agents
      • Focus: finds MeSH term/sub-headings and tries to focus on articles where it is the main thing (i.e. what they think the article is actually about)
      • Able to explode and focus in the same search
      • Able to choose “Limits”
      • Can export up to 2000 at a time to RefWorks
      • Better than PubMed for finding good MeSH terms (PubMed is very literal — e.g. just putting an “s” at the end produces different results)
    • For Embase:
      • Good for Pharmacy Trade Magazines
      • 60% overlap with Medline
        • Available function to exclude Medline journals (exclusion not good for systematic reviews)
      • In Ovid, can change database from Medline to Embase
      • Medline and Embase can export citations
        • Export as RIS (recognized by Mendeley, etc)
      • As with Medline, check the tree (looks different – e.g. narrower words = what it will “explode” into)
      • Zotero and Mendeley don’t always import correctly form Embase
      • Updated weekly
    • For PubMed:
      • Automatically tries to match your search terms with MeSH terms
        • Able to see the MeSH terms in search details box
        • Change dropdown menu in the search bar from PubMed to MeSH to explore what MeSH terms, sub-headings are available
      • Automatically explodes
      • Medline from PubMed and Medline from Ovid = takes same time to get updated articles (updated daily)
    • Tutorials for Ovid: http://guides.library.ubc.ca/Ovid
  • Other Database:
    • CINAHL: http://resources.library.ubc.ca/92/
      • can be useful for qualitative studies
      • Embase and CINAHL has conference notes
    • Web of Science: more multi-disciplinary database (e.g. also has humanities, social science studies, good for doing systematic reviews; can also see who has cited the article since it was published)
    • GoogleScholar: lacking in advanced search terms
  • Citation management: Mendeley, Citeworks
    • merges results from different search databases

Other Resources:

  • Medicines Complete:
    • AHFS Drug Information (Monthly updates)
    • Martindale (Quarterly updates)
    • Stockley’s Drug Interactions (Quarterly updates)
  • Natural Medicines (updated daily)
  • Minor Side Effect of Drugs (print) — from head to toe
    • Available at DPIC or Woodward
  • British Columbia – guidelines from MOH and BCMA
    (can download all or access via compute or mobile device)
    http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines

    • May not be the most up to date, but can see what family physicians/GPs are referring to as standard of care
  • CPG Infobase: Clinical Practice Guidelines Database:
  • National Guidelines Clearing House
    • www.guideline.gov
    • US based but includes international clinical pharmacy guidelines, provides summary and links to full guideline, search by keyword, many filters in advanced search, FDA warnings mentioned, may be useful when local or national guidelines are not available
    • Good advanced search
  • NICE Guidance (National Institute for Health and Clinical Excellance) – from UK
  • TRIP Database (Turning Evidence into Practice):
    • https://www.tripdatabase.com/
    • Clinical search engine to find high-quality research evidence to support practice
    • Meta database – combs through all guidelines
    • Guidelines from around the world
    • PICO search
    • Also yields systematic reviews, evidence-based synopses and primary literature, blogs and eBooks
  • In order to find a book on a topic, can use UBC summons and limit to e-books and books under content type, and limit library location (e.g. to online)
  • Document delivery: click on title of book –> online catalogue –> blue box (order document delivery) –> can deliver to VGH library (e.g. from Okanagan or Woodward, etc)
  • Point of Care Tools: BMJ Best Practice, Dynamed, UptoDate
    • BMJ Best Practice: http://resources.library.ubc.ca/page.php?id=2279
      • over 1000 articles
      • incorporates BMJ’s clinical evidence reviews, guidelines and expert opinion
      • articles are signed and dated
      • easy to read; useful step by step treatment algorithms
      • App available
      • Drug info from martindale
    • Dynamed: considered to be one of the most current databases (can be difficult to read)
  • Evaluation of a Self-Paced Learning Module in Drug Literature Evaluation
    (available in Print)