Finding the Best Evidence Using McGoogan Library's EBM Resources
by Cindy Schmidt, MD, MLS, Associate Professor, & Teri Hartman, MLS, Associate Professor
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Instructions
1. Warning: This tutorial will not work correctly in Internet Explorer. Please use Firefox, Google Chrome, or another non-Internet-Explorer browser.
2. Use the Arrow icons below the instruction screen to go forward and backward in the tutorial.
3. If you want to skip between distant parts of the tutorial, you can use the button above the instruction screen to show the tutorial's "Table of Contents" and can click on the needed section of the tutorial.
4. Clicking the Single-page View link (shown in figure above) will produce a printable transcript of the entire tutorial.
If you are taking this tutorial for credit, your class Blackboard site has questions about the tutorial material. You must answer these questions in order to get credit for taking this lesson.
Objectives After completing this guide, you will be able to:
What are the steps involved in the practice of "evidence-based medicine"?1
First, ask focused questions. Starting with a focused question benefits the patient by directing your search to relevant material and benefits you by directing your search to "relevant and precise answers."
Second, find the evidence using the focused clinical question you created.
Third, critically appraise the reliability, importance, and applicability of the evidence you locate.
Fourth, integrate the evidence with your clinical experience and the patient's values in order to make your decisions on patient care.
Determining the quality of the evidence, step 3, can be one of the most difficult aspects of the EBM process. This tutorial will begin by defining the "highest quality evidence." It will then present two clinical situations that would benefit from an evaluation of the relevant evidence, guiding you as you work through steps 1 and 2 of the EBM process for these clinical situations. 1 Centre for Evidence Based Medicine (CEBM). "The steps of practicing EBM" Oxford, UK: University of Oxford. http://www.cebm.net/resources/cebm-presentations/medical-student-resources/. Last updated 2016, Assessed June 13, 2016.
I. What is the highest quality evidence?
A well done, up-to-date, systematic review or meta-analysis is the highest quality evidence.
This pyramid image is also on the McGoogan Library's Evidence Based Medicine guide: http://unmc.libguides.com/ebm
(you will have to scroll down to see the pyramid)
A. Perhaps you're asking, "What's a systematic review?"
Authors of well-done, systematic reviews:
B. McGoogan Library's sources for systematic reviews and/or lists systematic reviews include these 3 resources:
A well-done, up-to-date, "critically-appraised topic" would be the highest quality evidence in this situation.
A. Perhaps you're asking. "what type of article is considered a "critically-appraised topic"?"
Authors of "critically-appraised topics:"
B. The McGoogan Library's sources for "critically-appraised topics":
C. McGoogan Library resources that are sometimes based on critical reviews of the evidence and sometimes based on expert consensus:
This tutorial will give you a chance to use UpToDate.
Why not look at the other resources? First, time is limited. Also, ACP PIER may be a bit too complex for your needs. NICE sometimes includes information that is specific for UK-based healthcare.
III. What if no relevant, up-to-date, filtered, evidence-based sources are available ?
You will then have to search the primary literature.
Not all primary evidence should be given the same weight when you are making clinical decisions: If you haven't already done so, please, right click on this link and select the "new window" option. Scroll down in the new window to see the evidence-based medicine pyramid. Adjust the size of the tutorial window and size of the new window so that you can see the two side by side.
For questions of therapeutic efficacy in a common disease/condition, the highest quality evidence comes from randomized controlled trials (RCT).
For questions about rare adverse events or therapy for rare diseases, RCTs may be impractical. The best possible evidence may come from cohort or case-controlled studies. For some questions, case reports are the only available evidence
After this brief introduction to EBM, it's time to practice the EBM process with two clinical questions.
The first step in practicing evidence-based medicine is asking answerable questions. What questions would you ask in response to these two clinical situations?
Situation 1: A 20 year-old college student comes to you for treatment of attention deficit disorder (ADD). ADD was diagnosed by one of the college counseling center's psychologists. The patient says he had always been easily distracted, but the distractibility only began to cause problems when he moved to college and was no longer supervised by his parents. The counseling center's psychologist told him that Ritalin (methylphenidate) would probably be helpful.
Type a question that could be addressed by a search for high quality evidence
Situation 2: You are on a committee reviewing all hospital discharge records. You are looking for any use of antibiotics not associated with an infection-associated ICD code. You find that a neurologist is prescribing antibiotics to prevent infection in his stroke patients.
Did you create questions similar to these?
Situation 1: Does the evidence support the use of ritalin/methylphenidate in adults with ADD? How strong is the evidence?
Situation 2: Is prophylactic use of antibiotics justified in stroke patients? How strong is the evidence for or against use of antibiotics?
There are other questions that could be addressed by published evidence, but these are the two questions you'll attempt to answer today.
Creating answerable questions is generally considered easier than searching for high quality evidence to answer the posed questions. This tutorial will guide you, step-by-step, through the searching process outlined below:
A. List the important search concepts
B. Create a search strategy based on these concepts
C. Run the search. The same search strategy will work in all the filtered, EBM resources that you'll use today
A. Start by listing the important search concepts in the two questions.
In case you need a reminder, here are the questions:
Some experts suggest that you outline your question using the PICO anagram.
P- patient characteristics I-intervention C-comparison intervention O-outcome/s of interest
When using PICO, be careful to avoid adding unnecessary terms to your search. If one or more of the letters -- P, I, C, or O -- are not central to your question, don't include term/s for that letter.
If you are still having trouble listing the important concepts, ask yourself what search words you would use if you were using Google to find an answer to each of these questions.
Using a separate document, record your concept list.
A. important search concepts (cont.)
Now that you've thought about the important concepts, please answer the questions below.
Question 1:
Which of the following lists of search words/concepts is best for the question -- "Does the evidence support the use of ritalin/methylphenidate in adults with ADD?"
Question 2:
Which of the following lists of search words/concepts is best for the question -- "Is prophylactic use of antibiotics justified in stroke patients?"
If you chose number 2 as the answer for the second question, please note: Infection is almost always one of the outcomes of interest when antibiotics are mentioned. If we include the infection concept in our search strategy, during the next step of search construction we will have to think of all the terms that indicate a discussion of infection. If we miss one of these terms, we risk missing a relevant article. For instance, if we forget to include meningitis in our infection term list, relevant articles that mention meningitis but fail to use the general term "infection" will not be retrieved.
Take Home Message: Use the minimum number of concepts necessary to define your question.
Repeating the Take Home Message: Use the minimum number of concepts necessary to define your question.
Now it's time to create your search strategy.
1. The first step is listing alternate terms for your concepts.
On a separate document, write down the important alternate terms for your search concepts, then enter them into the box below.
Be sure you include:
-unabbreviated forms of abbreviations -generic names of drugs -British spellings (especially if searching the Cochrane Library) -important synonyms -hyphenated and non-hyphenated versions of frequently hyphenated words
Important alternate terms for Question 1 search concepts
Important alternate terms for Question 2 search concepts
Do your lists of alternate terms include the terms listed below? If not, please add any terms you missed to your term lists.
Question 1: "Does the evidence support the use of ritalin/methylphenidate in adults with ADD?"
ADD, attention deficit disorder, attention-deficit disorder
methylphenidate, Ritalin
adults
Question 2: "Is prophylactic use of antibiotics justified in stroke patients?"
stroke
antibiotics
prophylactic, prophylaxis, prevention, preventing
There are a lot of additional terms that could be included in these alternate terms lists. The brand name -- Ritalin -- is not essential; most medical literature will include the generic name. Otherwise, the terms shown are the minimal term lists for these two questions.
Now that you have lists of alternate terms, you can proceed to the next step.
2. Remove any unnecessary words from multi-word phrases and enclose the remaining multi-word phrases in quotes. Make these changes on your separate document and enter them in the boxes below.
Remove any unnecessary words from multi-word phrases in Question 1 and enclose the remaining multi-word phrases in quotes.
Remove any unnecessary words from multi-word phrases in Question 2 and enclose the remaining multi-word phrases in quotes.
Do your lists of terms now look something like the following?
ADD, "attention deficit" , "attention-deficit"
Did you remove the word "disorder" from your ADD phrases? It's best to remove words like "disorder" and "syndrome" when possible. Words like "condition", "disease", "syndrome", "disorder", etc. are often used interchangeably. If you don't remove the interchangeable word from your phrase, you have to include all the alternate phrases. In other words, by removing "disorder," you reduce your term list for the ADD concept from --
ADD, "attention deficit disorder", "attention-deficit disorder", "attention deficit syndrome", "attention-deficit syndrome"
-- to--
ADD, "attention deficit", "attention-deficit"
In this case, you have even more reason to remove "disorder" as removing the word makes it possible to ignore the many alternate phrases that contain the word hyperactivity.
Now that you've removed unnecessary words, proceed to step 3.
3. In your separate document and in the boxes below, truncate the terms with multiple useful endings using *
Remember to truncate when you need to retrieve singulars and plurals, multiple verb forms, verb forms of nouns, noun forms of verbs, adjective forms of nouns, etc.
For Question 1, truncate the terms with multiple useful endings using *
For Question 2, truncate the terms with multiple useful endings using *
Did you truncate adult*, stroke*, antibiotic*, prophyla*, and prevent*? If not, correct the list of terms in your separate document.
adult*
stroke*
antibiotic*
prophyla*, prevent*
You've truncated terms with multiple useful endings. You can now proceed to step 4.
4. In your separate document and in the boxes below, remove any other intervening punctuation or conjunctions and join the alternate terms for a single concept with OR. (The OR's must be in all caps.) The OR's tell PubMed that you don't care which of the adjacent terms is present -- either one OR the other is fine.
For Question 1, remove any other intervening punctuation or conjections and join the alternate terms for a single concept with OR.
For Question 2, remove any other intervening punctuation or conjections and join the alternate terms for a single concept with OR.
Do your OR'd together lists of alternate terms look something like the following? If not, make any needed corrections on your separate document.
ADD OR "attention deficit" OR "attention-deficit"
methylphenidate OR Ritalin
prophyla* OR prevent*
You've joined alternate terms for a concept with OR and can proceed to step 5.
5. To make PubMed retrieve sets of articles retrieved by OR'd terms before performing other operations, surround the OR'd terms with parentheses. In your separate document and in the boxes below, enclose the alternate terms for a single concept in parentheses ()
For Question 1, enclose the alternate terms for a single concept in parentheses ().
For Question 2, enclose the alternate terms for a single concept in parentheses ().
Are your parentheses positioned as shown below? Make any needed corrections on your separate document.
(ADD OR "attention deficit" OR "attention-deficit")
(methylphenidate OR Ritalin)
(adult*)
(stroke*)
(antibiotic*)
(prophyla* OR prevent*)
Note for those who want to achieve advanced searching skills: Parentheses may even be nested -- Parentheses in PubMed work in the same way parentheses work in algebra. The operations inside the inner-most set of parentheses are done first.
Once you've enclosed your alternate terms for a single concept with (), you can join the terms for the disparate concepts. In your separate document and in the boxes below, join the disparate concepts using AND. The AND's must be in all caps.
For Question 1, join the disparate concepts using AND.
For Question 2, join the disparate concepts using AND.
Do your search strategies look like the search strategies shown below? If not, make any needed corrections on your separate document.
(ADD OR "attention deficit" OR "attention-deficit") AND (methylphenidate OR Ritalin) AND (adult*)
(stroke*) AND (antibiotic*) AND (prophyla* OR prevent*)
Now it's time to use the search strategies you've created in McGoogans' filtered, evidence-based resources, beginning with the Cochrane Library.
The Cochrane Library includes the Cochrane Database of Systematic Reviews, a source of high quality, systematic reviews that are carefully monitored for quality and thoroughness.
The Cochrane Library also provides access to DARE (Database of Abstracts of Reviews of Effectiveness). This database contains critiques of systematic reviews and can lead you to the critiqued reviews.
To access the Cochrane Library, click on the "Literature Databases" link on the Library homepage window on the right side of this tutorial.
Then click on Cochrane Library.
In case you need a reminder, your "adult ADD" search statement should look something like the following:
The number of results for each database in The Cochrane Library is shown to the left of the "results" frame.
For the ADD question, there are 5 results in the "Cochrane Reviews" database (aka The Cochrane Database of Systematic Reviews) and 8 results in the "Other Reviews" database (aka Database of Abstracts of Review of Effectiveness or DARE).
The radio button in front of "Cochrane Reviews" is selected, indicating that the four results in the Cochrane Reviews database are being displayed.
Only one of the listed results is highly relevant - "Methylphenidate for attention-deficit /hyperactivity disorder in adults " . Note that this relevant result is a "Protocol" rather than a "Review." A protocol is the outline for a planned review. To see the protocol, RIGHT CLICK on the title and select the "NEW WINDOW" option. This will open a new browser window. (Be sure to keep this tutorial window open as well.)
Note: If you don't right click, the protocol will probably open in a new tab and you will have to keep clicking back and forth between the tutorial tab and the protocol tab.
Notice the online publication date for this protocol. It's taking the authors of this review a long time to produce the completed review.
Click on the "Article" tab to see the full contents of the protocol.
Click on the "Jump to" drop-down menu to see a list of the types of information included in the protocol.
Are any concluding recommendations offered in this protocol?
You need to return to the search results, which should still be on the right side of this tutorial window.
Look at the left-hand navigation column of the Cochrane page. Click on the "Other Reviews" radio button to go to the DARE database results. DARE contains critiques of systematic reviews. It can help you find systematic reviews and can help you decide whether the systematic review itself has been carried out correctly.
When you reach the DARE results, you may wish to sort by "Date".
Several of the results in "Other Reviews"/DARE are relevant. For the purposes of this tutorial, you will only look at the highly relevant 2011 article. RIGHT CLICK on the title of this 2011 result and select the "NEW WINDOW" option. This will open a new browser window. (Be sure to keep this tutorial window open as well.)
You should now be looking at the record produced by the Centre for Reviews and Dissemination for DARE. In this case, the record is "provisional." The Centre for Reviews and Dissemination has determined that the article meets criteria for inclusion in DARE but has not yet produced its critique.
The reviewed article's citation information is shown after the "Original article" heading. You will need to use the Library's "Online Journal Finder" to gain access to the full-text of the cited article.
To get back to the Library's homepage click on this link. RIGHT-CLICK on the "Online Journals/EBooks" link located on the top of the Library homepage and select the "NEW WINDOW" option. This will open a new browser window. (Be sure to keep this tutorial window open as well.)
Click on the eJournals only tab. Enter the journal's name - in this case, "CNS Drugs", and hit the "Search" button.
Look at the dates of the electronically available issues. Is the date of the issue you need included? Once you know the issue you need is available, click on the link to the full-text source (orange arrow). Depending on the full-text source, you may have to click the needed year, then issue, etc. (as for this journal - 2011; volume 25, issue 2, pages 157-159) or look for a browse/past issues/archives feature, or use a search feature to search for the article title of interest.
When you find an entry for the article, look for a link or button for the .pdf version.
Question: Based on the information in the conclusion of the 2011 article, would you recommend that the college student take methylphenidate?
You may well be unsure of your conclusions. You will consult other sources of filtered evidence-based information before reaching a firm decision
Click (left-click) on this link to return to the Cochrane "Search" page and run the second search: "antibiotics in stroke". In case you need a reminder, the "antibiotics in stroke" search should look something like:
For the "antibiotics in stroke" question, there are four results in the Cochrane Reviews database.
The first Cochrane Review listed in the "Relevance" ranked list is really relevant (see red arrow)! It was published in January 2012 and is a full "Review."
RIGHT-CLICK on the review's title and select the "NEW WINDOW" option. (Be sure to keep this tutorial window open as well.)
Compare the publication date to the date when the article was last assessed as up-to-date. Often, you will find a significant difference between these dates.
Do you remember how to get to the contents of the full article (hint:you did this to see the full contents of the "adult ADD" protocol)?
Click on the "Article" tab now. When you are using this resource in the future, you may choose to click on one of the .pdf icons. However, unless you need to save a copy of a Cochrane Review, you will probably find the html version with it's "Jump to" menu easier to use than the pdf version.
Use the "Jump to" menu to go to the "Authors' Conclusions" section.
Do the authors support use of prophylactic antibiotics in stroke patients?
Why do you think the Cochrane authors are hesitating to recommend the use of prophylactic antibiotics in stroke patients even after confirming that prophylactic antibiotic use produces a statistically significant drop in the infection rate? Base your answer on your own medical knowledge.
Did you say that the decrease in number of infections may be counterbalanced by morbidity and mortality related to the use of antibiotics -- adverse drug effects, allergic reactions, antibiotic-resistant infections (in the experimental subjects and other hospital patients), etc.? If so, you're right.
If the evidence from the Cochrane Review was important to a real-life decision, what should you find out about the studies reviewed by the Cochrane Review's authors?
For the sake of the tutorial, let's say that you have reviewed the individual studies that had been reviewed by the Cochrane authors, you have determined that the studied populations and their care is similar to your hospital's stroke population and it's standard of stroke care.
You now have an answer to the "prophylactic antibiotics in stroke" question that is based on information from a recently published Cochrane Review. This is about as good as it gets in the practice of evidence-based medicine.
However, before making any final, real-world decisions based on the information from the Cochrane Review, you would need to search PubMed to see if any relevant, systematic reviews or any relevant, high quality trials had been published since the Cochrane Review was last assessed as up-to-date.
If, in the future, you wish to do a quick search for randomized controlled trials, you can do so quickly by adding --
random*
-- to the end of your search strategy, as in--
(stroke*) AND (antibiotic*) AND (prophyla* OR prevent*) AND random*
-- copying your search strategy, pasting it into the PubMed search, box and hitting the "Search" button.
It's often possible find relevant, recently published systematic reviews in PubMed that haven't yet been added to the Cochrane "Other Reviews" (DARE) database.
Searching PubMed for Systematic Reviews
PubMed includes records for systematic reviews published either in journals or in the Cochrane Database of Systematic Reviews. An increasing number of book chapters and online, evidence-based reports (including some systematic reviews) are also represented by PubMed records.
To access PubMed:
Paste your "ritalin in adult ADD" search strategy into the PubMed search box. In case you need a reminder, this search strategy should look something like --
(ADD OR "attention deficit" OR "attention-deficit") AND (ritalin OR methylphenidate) AND (adult*)
Hit the "Search" button.
When the results appear, click the "Customize" link on the left hand side of the page under the "Article Types" heading.
A list of "Article Types" will appear. Check the box in front of "Systematic Reviews" and click the "Show" button.
When the "Systematic Reviews" link appears in the "Article Types" list, click on it.
After you click the "Systematic Reviews" link, the page will refresh and the limited result set will appear.
A few words about the "systematic review" filter/limit:
The "systematic review" filter consists of OR'd together words, phrases, and indexing terms that limit your search to systematic reviews, meta-analyses, practice guidelines, consensus reports, etc. You will not see the terms for the added concept in the search box but a note indicating the filter has been added will appear above the search results and the filter will be checked. PubMed will continue to apply the "systematic reviews" filter to your searches until you uncheck or clear the "systematic review" filter.
A word about indexed vs. unindexed records:
Unindexed citations show on the Abstract View as either "in process" or "as supplied by publisher". Citations that have already been indexed show as Indexed for MEDLINE.
The "systematic review" filter, the "language" filters, and the "publication date" filters do not depend on indexing terms. You can use these filters without removing unindexed records from your result list.
Most of the popular filters -- e.g. humans/animals filters, sex, age -- depend on information added by indexers and will eliminate unindexed records. Avoid all these filters if you want to retrieve unindexed records ("in process" or "as supplied by publisher").
Why you should worry about unindexed records? The great majority of the records in PubMed are indexed. However, some very important records are unindexed. Many recently published articles aren't completely indexed yet. The book chapters and online reports will probably never be indexed. If you want to see the most recently published information, you must avoid the filters that exclude unindexed records.
You should also avoid using the "full text available" filter on the left-hand side of the page. It has nothing to do with availability through our Library. Instead, use the filters on the right-hand side of the page to limit to articles that are either "Free Full Text"-from the publisher or, Review, or Systematic rev. + Meta-analyses + guidelines, which are in the McGoogan Library holdings.
Scroll down to the "Long-term efficacy and safety of treatment with stimulants and atomoxetine in adult ADHD: a review of controlled and naturalistic studies" record. This record is #21 as this tutorial is being written (June 2015).
RIGHT CLICK on the "GetIt!@UNMC" button under the abstract and select the "New Window" option. If you left-click you will have to click back and forth between the tutorial tab and the new tab produced by the "GetIT!@UNMC" button.
If "Article" links are present under the "Content is available via the following links" heading, you can reach full-text through a UNMC subscription. Once you know that the needed issue is available, click on one of the full-text links. Find the link to the .pdf version and open it.
Question:
Does the evidence support the efficacy of immediate release methylphenidate vs. placebo in adults?
Does the evidence indicate that long term use is effective?
Did you indicate that methylphenidate is more effective than placebo and that longterm use is effective?
If so you are correct.
Now we are going to review the PubMed search results again.
Most PubMed records have publisher buttons and "GetIt!@UNMC" buttons. When looking at the PubMed buttons, keep your eyes open for the words "Open access" OR "Free". Try these buttons first. If the free or "open access" button doesn't provide access to free full-text, go back to the PubMed record and give the "GetIt!@UNMC" button a try.
You can request (no charge) a scanned copy of an article located at McGoogan Library that is not available online, as well as request electronic copies of articles not located at McGoogan Library. The "McGoogan Docs" link in the window produced by the "GetIt@UNMC" button will start the process.
Sign up at this link if you haven't registered your McGoogan Docs account yet.
You've found a recently published systematic review that answers your question. If you were making a real-world decision, it would be a good idea to search PubMed for any randomized controlled trials that were published after the review was published electronically in August 2012.
Here are the steps involved in doing a quick search for RCTs.
1. Clear the "Systematic reviews" limit
2. Place your cursor in the search box and hit the "End" key on your keyboard or scroll to the end of the box. Add a space and enter the phrase--
AND random*
-- to the end of your search statement and hit the "Search" button.
3. On the left side of the PubMed screen under Publication Dates, click on Custom Range. Enter 2012, 08, 01, in order to view citations published since the August 2012 review.
4. Use the "Display settings" drop-down menu above the result list to sort the results by "Publication Date."
At the time of this tutorial's last update (June 201), there were 60 records retrieved by this search for articles published initially (electronically or in print) after August 2012. If you were actually treating this patient, it would be best to quickly review the findings of any RCTs included among these articles and then more thoroughly review any studies disagreeing with conclusions of the systematic review.
You may still find a quick search of our "critically-appraised topic" resources useful in dealing with your ADD patient. A single article in one of the "critically-appraised topic" resources will usually cover all of the most important clinical questions for a particular disease. While you review these resources, ask yourself the following questions:
Do the resources confirm your decision about giving methylphenidate to your patient? Do the resources bring up other things you should consider as you treat your patient?
Some UpToDate articles, but not all, include a critical appraisal of the evidence. UpToDate's publishers have claimed that all are based on the best available evidence.
Click here to reach the Library's homepage. Then, click on the "Clinical Resources" link on the right side of the page.
Then click on the UpToDate link.
--into the UpToDate search box and hit the "Search" button.
A list of relevant UpToDate articles will appear.
Place your cursor over the "Pharmacotherapy for adult attention deficit hyperactivity disorder" link. The sections of the article will appear on the right. Click on "Methylphenidate".
Does the article tell you anything about the strength of the evidence that either supports or discourages methylphenidate use in adults?
Some clinical practice guidelines provide critical appraisals of the available evidence. Some are based on expert consensus (which we all hope has some relation to the available evidence).
There are several ways to search for clinical practice guidelines. One is to use the National Guideline Clearinghouse. Click here to open the resource in the right hand window.
We've found that guideline searches may be more productive when the fewest possible concepts are included. In this case, omit the drug concept. This will leave you with the following search statement:
(ADD OR "attention deficit" OR "attention-deficit" ) AND (adult*)
Paste this search strategy into the National Guideline Clearinghouse search box, and hit the "Go" button.
When the search results appear, click the first guideline: Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults.
Scroll down or search the page using CTRL-F and locate the "Treatment of Adults with ADHD" subsection.
Question: Does this somewhat dated guideline recommend the use of methylphenidate in adults?
Question:Does the guideline provide any critique of the relevant studies?
Congratulations!
You have nearly completed the tutorial.
You have now:
A detailed look at how one critiques the evidence (step 3 of EBM) and then weighs the evidence, patient preference, local resources and physician experience (step 4 of EBM) is beyond the scope of this tutorial. Instruction in really thorough searching is also beyond the scope of the tutorial. Please remember that librarians are members of your interprofessional team and can assist you by searching the literature. We're also on your side and happy to help you perform your own searches. Above all, librarians are here to assist you with information-related needs.
McGoogan's Literature Search Service:
The McGoogan Library offers a free literature search service. Search results should arrive in your email within one weekday (excluding holidays).
There are several methods for requesting a search:
1. You can use the online forms available through the "Search request" of "AskUs" buttons on the Library's homepage.
2. You can contact reference librarians using AskUs Chat box on the library's homepage.
3. You can simply e-mail (askus@unmc.edu), phone (402-559-6221), or text (402-370-5016) the reference desk.
When you request a search, please mention the purpose of your search as well as the topic of interest. Do you need a few, recent articles for a 2-page paper or are you trying to make sure you have a thorough search and have found all the evidence? If you're writing a systematic review, it's especially important that you mention this fact -- systematic review searches take much longer to return than one weekday.
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