Tripping for Evidence - Part 2

(Please go HERE for Part 1)

Nowadays everybody is using PubMed.

Not a bad choice but not necessarily the place where you would want to start. PubMed is the search engine for Medline, an indexed bibliographic database curated by the U.S. National Library of Medicine. Which means that the amount of evidence is, at the same time, impressive and overwhelming. You need to know how to find what you are looking for when faced with such an enormous amount of data.

So, given the choice, why not making it easier on yourself? How about getting some help, ie, letting someone else do some of the tedious work of filtering and grading the evidence before you try your hand at it.

Suppose that you just saw a patient with a diagnosis of schizophrenia, suffering of chronic auditory hallucinations on his current regimen of ziprasidone (Geodon) and divalproex (Depakote). You have tried all the others second generation antipsychotics and a few of the first generation - they were either only partially effective or poorly tolerated. The patient tells you he's heard of asenapine (Saphris), a new drug that has been recently approved for the treatment of schizophrenia. He asks if you would consider switching him to this new drug.

You've read the news about asenapine but didn't get a change to review the litterature. You tell him you will look it up and then discuss the options.

Before searching Medline, which you know will bring uo quite a few articles, you decide to call in your helpers. Their names are Trip Database and SUMSearch.

What do you find?

Your SumSearch, well, search for the simple "asenapine and schizophrenia" search term returns 31 hits under the "Original Studies" tab, 2 hits under the "Systematic Studies" tab, and 0 hits under the "Guidelines" tab (search conducted on Tuesday, 12 March 2012 05:55:34 at SUMSearch). A similar TripDatabase search returns 20 hits, classified according to the level of evidence.

Compare that with the 60 hits returned by the same strategy on PubMed.

This is actually one of the instances where less is more.

When time is of essence (think busy outpatient clinic or evidence-based answers needed pronto for the inpatient rounds) what defines a good search is not sensitivity but specificity. Less hits that are highly informative are preferred to more comprehensive but less specific coverage.

Ergo: let's take a TRIP and SUM the search.

© Copyright Adrian Preda, M.D.