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Sensitivity and specificity of electronic databases: The example of searching for evidence on child protection issues related to pregnant women

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Background. There are increasing demands on health and social care (HSC) professionals to make decisions based on best evidence to inform their practice. To do this, they must be skilled in searching the literature. A robust approach to literature reviewing that results in optimal outcomes is highly desirable in a climate where time and resources are limited. Aim. This paper explores the processes of undertaking a structured literature search and measuring the effectiveness of five commonly used health and social care databases. Method. A review question was posed using the qualitative version of PICO (Population, Interest, Context and Outcome): 'How do HSC professionals (P) make decisions (I) in relation to pregnant women (C) where there is a safeguarding concern (O) regarding an unborn child?' Databases selected for review were: ASSIA, CINAHL Plus, Ovid MEDLINE, PsycINFO and Social Care Online. Searches were undertaken from October 2014 to April 2015. A rapid update was undertaken in March 2016 prior to publication. Papers were screened for their suitability for inclusion using a screening tool developed by the research team. Papers were required to report empirical research; to have been published in peer-reviewed journals, as an indicator of a measure of quality; and to be available in the English language. Full-text papers were chosen if the data were gathered from or about decision-making regarding safeguarding in pregnancy by midwives, nurses, social workers and professional managers. The quality of the chosen databases was determined by sensitivity (capacity to retrieve a satisfactory number of papers), precision (to prevent the retrieval of too many irrelevant papers) and Number Needed to Read (NNR) - number of papers needed to read to find one paper to include. Results. A total of 866 papers were identified, titles and abstracts were reviewed by the researcher and full-text papers were further reviewed by the research team, both using a screening tool. These results were discussed and nine papers were identified for review. Sensitivity was greatest on CINAHL Plus and Ovid MEDLINE. Precision scores were generally low; CINAHL Plus scored the highest at 4%. CINAHL Plus was found to be most effective with an NNR score of 26%, followed by PsycINFO with an NNR score of 36% and Ovid MEDLINE was the lowest precision with an NNR score of 45%. Implications. The challenges of robust searching for literature indicate that if evidence-based practice is to become a reality, regular training for midwives, social workers and other healthcare professionals in database searching is essential.
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© 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34 29
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): 29-34
Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to
pregnant women
Helena Mc Elhinney1 MSc, BSc. Brian Taylor2 Phd, PGCert, PGDip, BSc. Marlene Sinclair3 Phd, RM, RN, RNT. Mary Rose
Holman4 MSc, BA, PGChep.
1. PhD student, Institute of Nursing and Health Research, Maternal Fetal and Infant Research Centre, Ulster University, Belfast BT37 0QB Northern Ireland.
Email: mc_elhinney-h@email.ulster.ac.uk
2. Professor of social work, Institute for Research in Social Sciences, Ulster University, Belfast BT37 0QB Northern Ireland. Email: bj.taylor@ulster.ac.uk
3. Professor of midwifery research, Institute of Nursing and Health Research, Maternal Fetal and Infant Research Centre, Ulster University, Belfast BT37 0QB Northern
Ireland. Email: m.sinclair1@ulster.ac.uk
4. Subject assistant librarian, Life and Health Sciences, Ulster University, Belfast BT37 0QB Northern Ireland. Email: mr.holman@ulster.ac.uk
The authors would like to acknowledge the PhD scholarship received by Helena Mc Elhinney from the Department of Employment and Learning in Northern Ireland.
Abstract
Background. There are increasing demands on health and social care (HSC) professionals to make decisions based on best
evidence to inform their practice. To do this, they must be skilled in searching the literature. A robust approach to literature
reviewing that results in optimal outcomes is highly desirable in a climate where time and resources are limited.
Aim. This paper explores the processes of undertaking a structured literature search and measuring the effectiveness of five
commonly used health and social care databases.
Method. A review question was posed using the qualitative version of PICO (Population, Interest, Context and Outcome): ‘How
do HSC professionals (P) make decisions (I) in relation to pregnant women (C) where there is a safeguarding concern (O) regarding
an unborn child?’ Databases selected for review were: ASSIA, CINAHL Plus, Ovid MEDLINE, PsycINFO and Social Care Online.
Searches were undertaken from October 2014 to April 2015. A rapid update was undertaken in March 2016 prior to publication.
Papers were screened for their suitability for inclusion using a screening tool developed by the research team. Papers were required
to report empirical research; to have been published in peer-reviewed journals, as an indicator of a measure of quality; and to be
available in the English language. Full-text papers were chosen if the data were gathered from or about decision-making regarding
safeguarding in pregnancy by midwives, nurses, social workers and professional managers. The quality of the chosen databases
was determined by sensitivity (capacity to retrieve a satisfactory number of papers), precision (to prevent the retrieval of too many
irrelevant papers) and Numbers Needed to Read (NNR) – number of papers needed to read to find one paper to include.
Results. A total of 866 papers were identified, titles and abstracts were reviewed by the researcher and full-text papers were
further reviewed by the research team, both using a screening tool. These results were discussed and nine papers were identified
for review. Sensitivity was greatest on CINAHL Plus and Ovid MEDLINE. Precision scores were generally low; CINAHL Plus
scored the highest at 4%. CINAHL Plus was found to be most effective with an NNR score of 26%, followed by PsycINFO with
an NNR score of 36% and Ovid MEDLINE was the lowest precision with an NNR score of 45%.
Implications. The challenges of robust searching for literature indicate that if evidence-based practice is to become a reality,
regular training for midwives, social workers and other healthcare professionals in database searching is essential
Key words: Search methodology, systematic literature searching, sensitivity and precision, decision-making, child safeguarding,
pregnancy, evidence-based midwifery
Introduction
This paper discusses the methodology for searching the
literature to retrieve papers using an example of professional
decision-making around child safeguarding in pregnancy.
It specifically focuses on sensitivity and precision measures
of database quality, appropriateness and effectiveness of
the search strategy and its ability to be replicated by future
researchers in this area of study (Taylor et al, 2007). With the
increasing demand on midwives and social workers to make
decisions based more explicitly on best evidence, effective and
efficient strategies need to be available to facilitate access to
online resources for research (Beall, 2007).
Background
Service provision is grounded in a solid foundation of
evidence-based practice. The term ‘evidence-based practice’
indicates the quality, robustness or validity of evidence
and is applied to current issues within the health service
(Hoagwood et al, 2001). The importance of combining
clinical and research knowledge is imperative in professional
decision-making in order to deliver effective services or
indeed improve current service provision (McCullough et
al, 2014) as many research questions emerge from clinical
practice issues (Polit and Tatano Beck, 2014).
There is growing demand on those in the health and social
care professions to further develop their skills in collating,
synthesising and critiquing information for the advancement
of their profession and for use within clinical practice (Rees,
2011). There is increasing pressure from government,
taxpayers and managers of health and social care services for
evidence of money well spent and efficient delivery of services
(Taylor and Campbell, 2011). Both the code (NMC, 2015)
30 © 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): 29-34
for midwives and nurses and the code of ethics for social
work (BASW, 2012) for social workers make it clear that
professionals are responsible for maintaining and improving
their knowledge, skills and practice and must act with the
best evidence possible at that time. Therefore, there is an
assumption that all professionals should learn core skills,
such as literature searching of databases, and regularly
update their knowledge in this area.
In the process of undertaking scientifically robust research,
careful consideration must be given to analysing the evidence
that exists within the literature. A systematic approach to
literature searching has the potential to provide robust data
and this evidence will subsequently inform clinical practice
(Taylor et al, 2007). This approach must be undertaken
in an unambiguous, transparent and replicable manner,
beginning with a comprehensive literature search strategy
(Arthur et al, 2012). Careful scrutiny of the literature will
aid in the identification of the body of knowledge that
currently exists on a topic and also highlight the gaps where
further investigation is needed (Ford and Pearce, 2010).
However, the enormity of this task should not be
underestimated. The advancement of technology has seen a
move away from the use of traditional print journals towards
journals based on electronic bibliographic databases that are
accessible online (Best et al, 2014). Ironically, accessibility of
journals may be improved through their availability online
but the process of identifying and wading through material
can be time consuming, and a daunting task (Rowley and
Johnson, 2013). This requires a skilled researcher, librarian
or search coordinator with a carefully designed search
strategy and the ability to identify the relevant papers from
those that are irrelevant (Creaser et al, 2006).
Method
Data sources
In consultation with a subject librarian at the university,
five electronic databases (ASSIA, CINAHL Plus, Ovid
MEDLINE, PsycINFO and Social Care Online) were
accessed for the purpose of this study. All databases
provide abstracts of journal papers to professions including
midwifery/nursing and social work, academia and managers
and were deemed appropriate for use with this study
topic. CINAHL Plus, Ovid MEDLINE and PsycINFO use
individualised controlled vocabulary thesaurus for indexing
papers. CINAHL Plus (subject headings which are adapted
from Medical Subject Headings (MeSH), Ovid MEDLINE
(MeSH) and PsycINFO (American Psychological Association
(APA) thesaurus of Psychological Index Terms).
ASSIA and Social Care Online use phrase searching and
are aimed at those in social science. Nevertheless, using a
wide variety of databases ensures a comprehensive search
across both professions (Finfgeld-Connett and Johnson,
2013). To compete with health and social care (HSC)
professionals’ time demands, it is crucial that a search
undertaken in these databases produces relevant papers in
a replicable approach. Good sensitivity (retrieving a high
number of relevant papers from a database) and good
precision (low number of irrelevant papers retrieved) scores
depend upon the researcher’s ability to design an effective
search strategy, the effectiveness of the indexing against
the thesaurus, the number of journals abstracted and how
well the database supports the searchers in their searching
(Taylor et al, 2007). High sensitivity and precision scores are
indicative of an effective search strategy which emphasises
the importance of securing this from the outset (Lee et
al, 2012).
The majority of journal papers, PhD theses and research
reports rest on a foundation of a solid review undertaken
of previous literature to ascertain gaps in knowledge that
also informs evidence-based practice within the HSC
setting (Taylor et al, 2007). The Cochrane and Campbell
Collaboration reviews focus on questions of effectiveness
and mainly on research designs that are experimental in
nature. However, different types of research questions,
similar to this study on decision-making, require different
study designs. The methodology and systems for identifying
studies, appraising quality and synthesis are not as well
developed as they are for questions of effectiveness. This
paper hopes to complement existing knowledge by adding
an additional layer of scrutiny to the process, which includes
sensitivity and precision measurements of databases.
Search question
Prior to choosing appropriate databases, it is important to
have a clear review question using the PICO framework.
This framework is used to structure clinical questions
for systematic review and to increase the likelihood of
retrieving papers which are relevant to the question (Schardt
et al, 2007). There are two versions of PICO, depending
upon whether the search is for qualitative or quantitative
reviews. Searching for quantitative studies uses the Patient,
Intervention, Comparison and Outcome (PICO) version.
However, the qualitative version, Population, Interest,
Context and Outcome (PICO) was used to frame the search
question for this paper (Lewensen and Truglio-Londrigan,
2015). Consequently, the question was framed as ‘How
do HSC professionals (P) make decisions (I) in relation to
pregnant women (C) where there is a safeguarding concern
(O) regarding an unborn child?’
Inclusion criteria for search
This paper focuses on the rigour of the searching process
but does not include the synthesis of literature to create a
systematic narrative review on the search question posed.
Predetermined criteria were established for the purpose of
this. Papers retrieved from this search were screened for their
suitability for inclusion using a screening tool developed by
the research team. Papers were required to report empirical
research; to have been published in peer-reviewed journals as
an indicator of a measure of quality (Best et al, 2014); and
to be available in the English language. Full-text papers were
chosen if the data were gathered from or about decision-
making regarding safeguarding in pregnancy by midwives,
nurses, social workers and professional managers. Papers
focusing on the risk factors identified by professionals’ child
safeguarding in pregnancy were excluded. In addition, papers
© 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34 31
that focused on assessment tools used in practice to assess the
risk of harm to an unborn child were also excluded.
Selection of databases
In the process of systematically identifying and retrieving
literature, it is recommended that more than one database
should be used to ensure a comprehensive and rigorous
search process (Whiting et al, 2008). Five academic and
professional databases were chosen in consultation with
an experienced subject librarian for use within this review.
Applied Social Sciences and Abstracts (ASSIA), Cumulative
Index of Nursing and Allied Health Literature (CINAHL)
Plus, Ovid MEDLINE, PsycINFO and Social Care Online.
These databases were selected based on their availability at
the university and their suitability to capture the relevant
subject fields as indexing of papers varies between databases.
Papers retrieved from CINAHL Plus, PsycINFO and Ovid
MEDLINE are indexed using either Medical Subject Headings
(MeSH), an adaptation of MEDLINE (MeSH) or APA
Thesaurus of Psychological Index Terms. However, searches
within ASSIA and Social Care Online, which do not have an
indexing system, relied heavily upon retrieving papers through
the use of relevant phrase searching. All these databases are
large interdisciplinary international databases, available in
both the UK and the US. CINAHL Plus, Ovid MEDLINE and
PsycINFO include papers from the professions of psychology,
nursing and medicine and ASSIA and Social Care Online
(provided by the Social Care Institute for Excellence) include
papers from social care and social work. A piloting exercise
to test and refine the search formula was undertaken which
revealed sufficient numbers of papers were available.
Search formulae and filters
The use of Boolean operators within the search forms
relationships between concepts or words for the purpose of
establishing search parameters (Best et al, 2014). The most
frequently used Boolean operators are AND (used between
terms to capture papers containing both terms), OR (used
to retrieve papers using either term) and NOT (to narrow
or refine a search) (Houser, 2012). The search formula used
for CINAHL Plus, Ovid MEDLINE and PsycINFO is shown
in Figure 1. The use of truncation facilitated the retrieval
of papers using singular and plural words with different
endings (Reznowski, 2011).
For the purpose of this review, truncation was used on
several terms including midwi* which returned words such
as midwives, midwife and midwifery. Proximity operators,
which vary through the databases but are generally
represented using N for Near or adjn for adjacent were
used to search for terms within a specific number of words
from each other, for example, significant N1 harm and was
used in CINAHL Plus, Ovid MEDLINE and PsycINFO to
retrieve a paper which contains the term ‘significant’ within
one word of ‘harm’ (Dresch et al, 2015).
The search formula was adapted for use on the databases,
but notably on ASSIA and Social Care Online as searches
were undertaken using phrase searching such as ‘child
protection’ OR ‘child abuse’ OR ‘child neglect’ OR ‘child
welfare AND nurs* OR midwi*’ OR ‘health visitor*’ OR
‘social work*’ AND pregnan* OR perinat* OR matern*
OR fetus OR foetus OR ‘unborn child*’ AND measure*
OR assess* OR decision* OR decide OR judgment* OR
criter* OR regist* OR diagnos* OR threshold OR ‘harm
reduction’ OR ‘significant harm’ OR prevent. Search filters
were applied to narrow the number of papers retrieved to
include those papers available in the English language only
and exclude books to narrow the search strategy (Schneider
et al, 2013).
Sensitivity and precision
Determining the quality of a database can be measured by
its capacity to retrieve a satisfactory number of published
papers available on the study topic (McFadden et al, 2012).
The capacity of the database to do this is generally measured
in terms of sensitivity. Sensitivity is calculated by identifying
the number of relevant papers retrieved by a database,
which is then divided by the total number of relevant papers
identified by all searches (Watson and Richardson, 1999).
However, adding more terms to a particular search makes
it more sensitive, resulting in the retrieval of papers that
are less relevant to the study question (Taylor et al, 2007).
Consequently, a second measure of quality is necessary to
prevent retrieving too many irrelevant papers, as this would
involve a lengthy task of elimination.
Therefore, a calculation of precision was undertaken to
determine the number of relevant articles identified by a
search (Taylor et al, 2007) using the formulae of relevant
number of database hits divided by the total number of
database hits (Taylor et al, 2003). Number Needed to Read
(NNR) is a further measurement of precision of databases
(Best et al, 2014). This measurement indicates the number
CINAHL
Plus, Ovid
MEDLINE
and PsycINFO
child* protection
OR child* abuse OR
child* neglect OR
child* welfare
pregnan* OR
perinatal* OR
matern*
measure*
OR assess* OR
decision* OR decide
OR judgment* OR
criter* OR regist*
OR diagnos* OR
threshold OR harm
reduction OR
significant harm
OR prevent*
nurs* OR
midwi* OR
health visitor*
OR social work*
Figure 1. Search formula CINAHL Plus, Ovid MEDLINE and
PsycINFO (all circles are linked with the operator AND)
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): **-**
32 © 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): 29-34
of papers that must be read in order to find one paper for
inclusion (Terwee et al, 2009). Calculating NNR involved
dividing the total number of hits retrieved by the total
number of included studies on a database (Golder et al,
2008). Therefore, a low NNR score measured on a database
is an indication of high quality.
Identifying unique hits
Within the retrieved searches, unique hits were identified –
that is a relevant paper sourced from one database only. This
process was undertaken using a method of identifying the
database(s) in which each of the final nine papers for review
were located. The papers were then listed in chronological
order indicating the databases from which they were retrieved.
Results
A systematic search of the databases retrieved 866 papers.
Titles and abstracts were reviewed by the researcher using a
screening tool. A smaller number of papers were reviewed by
the research team and nine papers were identified for review.
Unique hits retrieved
Of the five databases, only two returned unique hits (Table
1). The search on Ovid MEDLINE returned the largest
number of unique hits retrieved (three papers) and CINAHL
Plus returned one unique paper. ASSIA, PsycINFO and Social
Care Online did not return any unique papers in this search.
Sensitivity and precision
The ability of each database to retrieve relevant items was
measured producing sensitivity scores. CINAHL Plus (36%)
recorded the highest sensitivity, followed by Ovid MEDLINE
(28%) and PsycINFO (14%). ASSIA and Social Care Online
both scored 0% indicating that they were ineffective for use
within this study and retrieved no relevant items. In general,
precision scores between all databases were extremely low.
CINAHL Plus had the highest precision score (4%) of all
the databases indicating that it was the most effective
database at avoiding retrieving irrelevant papers. However,
PsycINFO had a marginally lower precision score (3%) and
Ovid MEDLINE had a precision score of 2%. ASSIA, Social
Care Online and the hand search had poor precision scoring
between 0% and 1%. The NNR scores are a measure of how
many papers need to be read to retrieve one relevant hit on
each database. CINAHL Plus was found to be most effective
with a NNR score of 26%, followed by PsycINFO with a
NNR score of 36% and Ovid MEDLINE was the weakest
database with an NNR score of 45%. No relevant hits were
found in either ASSIA or Social Care Online.
Methodology of retrieved papers
The relevant papers retrieved comprised of qualitative studies
(using semi-structured interviews, 11%), surveys (22.4%),
mixed methods, including both qualitative and quantitative
methods (questionnaires, interviews and focus groups,
33.3%), and quantitative (surveys, 33.3%).
Discussion
Summary of approach
The systematic retrieval of papers from databases is an
important aspect of evidence-based practice (Taylor et
al, 2007). Consequently, it is essential that identification
of relevant databases and accurate search formulae and
filters are applied from inception. The development of
a sophisticated search formula was key to the retrieval
of relevant papers (Best et al, 2014). A search question
was established, a screening tool developed to determine
inclusion/exclusion of papers, the search strategy piloted to
determine the appropriateness and effectiveness of search
terms and modified when necessary. The database searches
were methodical and the initial search was repeated to ensure
it was up to date (Ramlaul, 2010). A preliminary search of
the databases provided a good indication of the relevant
information available and the correct search terms to be used.
Effectiveness of the databases
The study topic of child safeguarding in pregnancy from the
perspective of decisions made by social work and midwifery
staff indicated that databases had to be chosen which
encompassed research from both professional groups. In
general, the databases for social sciences were more difficult
to navigate than those aimed at professionals in healthcare
fields. This may be due to the variation in terminology
internationally and also due to the facilities on the databases
(McFadden et al, 2012). It could be assumed that the
databases predominately aimed at those in social sciences
– ASSIA and Social Care Online, in this instance – would
generate most of the relevant papers.
However, this study showed the contrary, as no relevant
hits were identified on either database. It could be argued
that social science databases, ASSIA and Social Care Online
are less effective than their counterparts – Ovid MEDLINE,
PsycINFO and CINAHL Plus – possibly due to inconsistency
in language, as identifying papers depends upon how well
they are indexed within databases. The latter three databases
are aimed at the nursing (including midwifery) and allied
health professionals and index their papers using MeSH
headings, which are believed to produce greater specificity
than phrase searching used in ASSIA and Social Care Online
(McIntosh, 2011).
Databases Total Hits
Retrieved
Relevant
Hits
Retrieved
NNR Unique
Hits
Sensitivity
%
Precision
%
ASSIA 45 0 0* 00
CINAHL
Plus
267 10 26 1* 36 4
Ovid
MEDLINE
361 845 3* 28 2
PsycINFO 144 4 36 0* 14 3
Social Care
Online
43 0 0* 0 0
Hand
Search
6 6
Total 866 28*
Number asterisked (*) include total number of hits after duplicates removed
Table 1. Number needed to read (NNR) and unique hits
© 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34 33
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): 29-34
Measures of sensitivity, precision and NNR
The measure of sensitivity of a database is significantly
important to ensure that the papers retrieved from the
search are relevant (Haynes et al, 2005). Aiming for a high
sensitivity score may reduce the chance of missing papers that
are relevant (Pack, 2014). In this study, the highest sensitivity
score was calculated for CINAHL Plus and Ovid MEDLINE
scored marginally lower. PsycINFO scored disappointedly
lower in sensitivity. CINAHL Plus, which indexes
considerably fewer papers than PsycINFO, had the highest
sensitivity score and included papers from the midwifery
profession, but not social work, unlike its counterpart Ovid
MEDLINE, which source papers from both. The final two
databases – ASSIA and Social Care Online – had a sensitivity
score of 0%, indicating that they were ineffective for use
within this study. However, they are predominately social
work and social science based databases and the previous
three databases weighed heavily towards the medical and
midwifery professions. Although ASSIA does include social
service topics, it does not include midwifery, therefore, papers
may be retrieved connected with child safeguarding, but not
necessarily in pregnancy. Additionally, Social Care Online is
predominately aimed at practitioners and policy-makers with
the core material sourced from the UK, therefore restricting
its scope. Similarly to ASSIA, Social Care Online covers
child safeguarding but, again, does not include pregnancy
or maternity research. However, it would be advisable to
include both those databases to ensure that a comprehensive
search is undertaken (Kemp and Brustman, 1997). Similar to
CINAHL Plus, Ovid MEDLINE and PsycINFO, ASSIA is an
international database that indexes fewer journals than the
other databases but may be aimed at those in academia rather
than social work professionals (McFadden et al, 2012).
An effective literature search is reflected through the
precision scores of a particular database and the number of
relevant hits retrieved (Schardt et al, 2007). Precision within
this study was quite low, identifying many papers that were
not relevant to the study question (Gough et al, 2012). The
highest precision score was recorded on CINAHL Plus and
the lowest on Ovid MEDLINE. These higher precision scores
could be attributed to the scope of the journal coverage on
this specific topic area (Best et al, 2014).
The retrieval of papers that are not found on other
databases (unique hits) can give an indication of the best
choice of databases to use in the search. Two of the five
databases searched within this study retrieved a small
number of unique hits. Ovid MEDLINE recovered the
highest number of unique hits (3%) followed by CINAHL
Plus (1%). ASSIA, PsycINFO and Social Care Online failed
to retrieve any unique hits. The use of these latter databases
within future searches around the topic of professional
decision-making around child safeguarding in pregnancy
may be unproductive. It could have been presumed that
ASSIA and Social Care Online, both social science databases,
would retrieve some unique hits considering the study topic
but, in this instance, proved fruitless. As both database
searches use phrase searching, developing a standard
vocabulary for searching literature, consistent throughout
all databases and across HSC professions may be beneficial
(Curran et al, 2007).
In an almost alternative measurement to precision,
NNR refers to the number of papers that must be read to
find one relevant paper from a database search (Hersh,
2009). A low NNR is an indication of a good and efficient
search string narrowing the search of the literature, ensuring
that the task it less time-consuming for a busy professional
(Pillastrini et al, 2015). However, this depends upon the
correct use of language and indexing terms within those
databases (Stewart et al, 2014). The relevant papers retrieved
for final review included a wide range of research methods
confirming the validity of the search strategy and appraisal
of papers (McFadden et al, 2012).
Limitations of the review
Every good literature search and retrieval has its limitations
that must be acknowledged to assist future research in this
study area. Two of the databases in this study, ASSIA and
Social Care Online, were less than optimal for this topic area.
This was partly due to the limited number of journals they
index in comparison with the more medically-based journal
databases CINAHL Plus, PsycINFO and Ovid MEDLINE.
On reflection, it may have been beneficial to add a further
social science database to the search to test its effectiveness,
but the results might still have been limited in comparison
with those found on more sophisticated databases with
advanced indexing facilities and superior user interface.
Implications for practice
Literature searching is a common core skill that HSC
professionals are expected to be able to conduct with
confidence and skill. This paper provides a new insight for
those in management, policy-making, midwifery, nursing and
social work with further methods for undertaking a robust
literature search, which can inform practice and policy to
improve services. Employers and professional bodies need to
ensure that employees have access to regulated training in
literature searching skills for staff undertaking research and
clinical projects designed to improve maternal and child care.
Conclusion
There are increasing demands on the interdisciplinary team
to remain updated with research developments in their fields
of practice. The task of locating relevant research now relies
substantially on the quality of bibliographic databases. This
study highlighted low precision in searching five databases
on this topic, despite a detailed search formula and the
expertise of a specialist librarian. The ‘information age’
requires investment in systems that are efficient as well as
effective if professionals are to make the most use of available
knowledge and increase their chances of retrieving relevant
literature in an efficient manner. Support from leaders in the
HSC organisations and professions to develop the quality
of databases is a priority. The development of expertise in
identifying relevant research and education on the most
robust methods of database searching is a priority if the high
ideals of evidence-based practice are to become a reality.
34 © 2016 The Royal College of Midwives. Evidence Based Midwifery 14(1): 29-34
Mc Elhinney H, Taylor B, Sinclair M, Holman MR. (2016) Sensitivity and specificity of electronic databases: the example
of searching for evidence on child protection issues related to pregnant women. Evidence Based Midwifery 14(1): 29-34
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References
... Various risk factors leading to referrals of unborn babies have been reported within previous research (Mc Elhinney et al., 2016;Mc Elhinney et al., 2019). Such risk factors included domestic violence (Ayerle et al., 2012), drug use (Latuskie et al., 2019), alcohol use (McGrory et al., 2019, mental wellbeing (Rusanen et al., 2018), age of the pregnant woman (Ayerle et al., 2012), feelings about the pregnancy (Ayerle et al., 2012) antenatal care (Willinck and Schubert, 2000) and the pregnant woman's childhood experiences (Broadhurst and Mason, 2013). ...
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A newborn baby is vulnerable to abuse and neglect, and the professional role may involve assessment before the baby is born. The aim of this paper is to explore the perspectives and experiences of midwives and child protection social workers regarding the protection of unborn babies within Northern Ireland. Data were gathered using four focus groups (14 midwives and 16 child protection social workers) within one Health and Social Care Trust. The data were analysed in terms of understanding risk factors and forming a professional judgement. The mental wellbeing of the pregnant woman, drug use, alcohol use, domestic violence, the pregnant woman's childhood experiences, gestation period and antenatal care attendance were the main risks identified. Observations, engaging with the pregnant woman and using ‘soft intelligence’ were key aspects in forming a professional judgement. The appraisal of the ability of the pregnant woman to recognise danger was an important moderating factor, and perhaps formed part of a professional judgement heuristic to assist in making sense of wide‐ranging information about diverse risks. ‘Explore[s] the perspectives and experiences of midwives and child protection social workers regarding the protection of unborn babies within Northern Ireland’ Key Practitioner Messages • Identified risk factors included mental wellbeing, age, feelings about the pregnancy, drug and alcohol use, domestic violence, the pregnant woman's childhood experiences, gestation period and antenatal care attendance. • Pregnant women were unable to recognise the dangers in misusing illegal or prescription drugs, excessive alcohol consumption and initiating/maintaining relationships with sex offenders. • Key skills in forming a professional judgement involved engagement with the pregnant woman, professionals' experience and observations, and the use of ‘soft intelligence’.
... Doctoral work by Hart (2001) and later Hodson (2011) aimed to better understand social work practice in the perinatal period. This is important, since the lack of a shared, established and accessible evidence base for pre-birth social work assessment (Critchley, 2018;Mc Elhinney, Taylor, Sinclair, & Holman, 2016) may provide one explanation for the differential rates of child protection intervention in the lives of newborn babies (Broadhurst et al., 2018). There has been little research to uncover what actually happens between practitioners and families in the context of prenatal assessment of risk to an unborn baby. ...
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Recent research has highlighted the increasing trends in newborn and very young children entering child welfare processes and care proceedings in a number of countries. Furthermore, differential responses to risk within young families across different geographical locations and communities in the same child protection system have been found. Safe care arrangements for newborn babies may include placement with kinship carers or with foster carers not previously known to the family. The distinctive needs of the increasing population of infants in the care system are only beginning to be fully recognized. The short‐ and long‐term impact of contested infant removals on birth mothers has been powerfully highlighted, although the impact on fathers remains under‐reported. There has been limited research evidence available on how decisions about the care arrangements for newborn babies are reached. In this paper, the author draws on data from an ethnographic study of pre‐birth child protection in order to explore how social workers understand and frame risk to infants when assessing families during pregnancy. Data from interviews with practitioners reveal the extent to which their conceptualizations of and anxiety about risks to unborn babies shape plans for the future care of infants.
... • searching bibliographic databases to identify relevant research (Bates et al., 2017;Campbell et al., 2018;McElhinney et al., 2016;McFadden et al., 2012;McGinn, Taylor, McColgan, McQuilkin et al., 2016;Stevenson et al., 2016;Taylor et al., 2003; • appraising research quality ; and • undertaking a narrative synthesis of key findings (Agnew et al., 2010;Hagan et al., 2014;Killick et al., 2015;McFadden et al., 2015;McGinn, Taylor, McColgan, Lagdon et al., 2016). ...
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P urpose: The purpose of this article is to enhance understanding of the increasing importance of service user and carer involvement in social work research. The paper outlines actions taken to develop knowledge and skills at post-qualifying level. M ethod: In 2016 three postgraduate modules on research methods and evidence-into-practice for service users and carers were created and taught jointly with existing parallel post-qualifying modules for experienced social workers. Over a three-year period 2016–2019 modular assessments; pre and post-testing of knowledge and self-efficacy; regular participant feedback sheets; and end-of-course reflections were undertaken. R esults: Qualitative feedback indicated that the classroom experience was regarded positively. Valuable literature reviews and projects were produced which have the potential to contribute to transferring knowledge into practice. Though small in scale and using non-validated tools, increased mean scores were recorded on both Test of Knowledge (3.97; p <.001) and Self Efficacy (478.8 (p <.001) showing promise. Formal measures, exam results, and informal feedback demonstrate the success of the initiative as a means of enhancing a wider understanding of user participation in the research process. Discussion Demonstrating how well-equipped service users and carers are to be more effective on research advisory panels and grant committees will take more time. Conclusion Providing teaching on research methods for service users jointly with experienced social workers shows potential for developing coproduction of social care research and translating evidence into practice.
... On the other hand, the "AND" Boolean operator was used to combine terms under 2 or three PIO concepts to obtain citations with all of the specified keywords (CDR, 2009;Higgins and Green, 2011). According to Mc Elhinney et al. (2016), using ...
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Background The incidence and prevalence of tuberculosis (TB) are socially patterned, with persons of lower socioeconomic position (SEP) disproportionately affected. Sub-Saharan Africa, a region with only 11% of the world population accounts for 25% of all new TB cases annually and has 16 of the 30 high burden TB countries. A systematic review (SR) was conducted to identify and synthesize evidence on the association between TB and SEP (measured by educational level, occupation and income) in Sub-Saharan Africa. Methods A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE and Web of Science databases for English language studies published between 2000 and 2019, reporting odds ratio (OR) and relative risk (RR) for TB in populations in Sub Saharan Africa, grouped by income, education level and occupation. An individual reviewer screened studies and extracted relevant data. The included studies were appraised for quality and study results were analyzed and summarized by narrative synthesis. Results A total of 2,452 studies were identified by the search process. Of these, 10 studies with 23 measures of association satisfied the eligibility criteria and were included in the systematic review. All included studies reported education measures whereas 7 and 2 studies reported occupation and income measures respectively. Persons with lower education status and those earning low income were identified to have an increased risk of TB as compared to those in the high SEP groups. The association between TB and occupation measures was inconsistent and study comparability was affected by heterogeneity of occupational measures across all studies. Conclusion The risk of TB in sub-Saharan Africa was associated with low SEP, with inconsistencies observed for occupational measures.
... On the other hand, the "AND" Boolean operator was used to combine terms under 2 or three PIO concepts to obtain citations with all of the specified keywords (CDR, 2009;Higgins and Green, 2011). According to Mc Elhinney et al. (2016), using ...
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Full-text available
Background The incidence and prevalence of tuberculosis (TB) are socially patterned, with persons of lower socioeconomic position (SEP) disproportionately affected. Sub-Saharan Africa, a region with only 11% of the world population accounts for 25% of all new TB cases annually and has 16 of the 30 high burden TB countries. A systematic review (SR) was conducted to identify and synthesize evidence on the association between TB and SEP (measured by educational level, occupation and income) in Sub-Saharan Africa. Methods A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE and Web of Science databases for English language studies published between 2000 and 2019, reporting odds ratio (OR) and relative risk (RR) for TB in populations in Sub Saharan Africa, grouped by income, education level and occupation. An individual reviewer screened studies and extracted relevant data. The included studies were appraised for quality and study results were analyzed and summarized by narrative synthesis. Results A total of 2,452 studies were identified by the search process. Of these, 10 studies with 23 measures of association satisfied the eligibility criteria and were included in the systematic review. All included studies reported education measures whereas 7 and 2 studies reported occupation and income measures respectively. Persons with lower education status and those earning low income were identified to have an increased risk of TB as compared to those in the high SEP groups. The association between TB and occupation measures was inconsistent and study comparability was affected by heterogeneity of occupational measures across all studies. Conclusion The risk of TB in sub-Saharan Africa was associated with low SEP, with inconsistencies observed for occupational measures.
... The overall approach to the literature review encompassed rigorous searching of bibliographic databases (Best, Taylor, Manktelow, & McQuilkin, 2014;Campbell, Taylor, Bates, & O'Connor-Bones, 2018;Mc Elhinney, Taylor, Sinclair, & Holman, 2016;McFadden, Taylor, Campbell, & McQuilkin, 2012;McGinn, Taylor, McColgan, & McQuilkin, 2016) supplemented by citation searching to identify relevant studies; quality appraisal of included studies; and a narrative synthesis based on themes in the papers retrieved. ...
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Protecting an unborn baby from abuse and neglect presents particular challenges for professionals due to the uncertainties about appraising future harm and functioning of family relationships. This systematic narrative review synthesises studies of professional decision making by health and social care professionals regarding child protection of an unborn baby. Five bibliographic databases (ASSIA, CINAHL Plus, Ovid MEDLINE, PsycINFO, Social Care Online) were searched using an explicit and robust search; papers identified as relevant were appraised for quality and combined using a narrative synthesis based on the main themes in the papers. Ten papers met the inclusion criteria, including qualitative studies, surveys and randomised trials of the effectiveness of decision support tools. The papers identified the following case risk factors relating to risks to an unborn baby: alcohol abuse; ante-natal care; previous children in care; domestic violence; drug abuse; lack of education; employment issues; unrealistic expectations of the baby; housing issues; learning disability; feelings about pregnancy; low socio-economic status; mental illness; mother’s childhood experiences; lack of parenting capacity; physical disability. There were several papers on developing risk assessment tools. A few papers focused on risk assessment and decision processes including engagement with pregnant women. There was some discussion of psychosocial supports for risks in pregnancy. There is useful published material on the range of risk factors, and more limited material on the development of assessment tools and on decision processes. The psychosocial supports that might be provided to the pregnant woman as decision options is an area for future research.
Article
Skills of the 'information age' need to be applied to social work. Conceptual and practical aspects of using online bibliographic databases to identify research were explored using multi-professional decision-making in child protection as a case study. Five databases (Social Science Citation Index, Scopus, Medline, Social Work Abstracts and Cochrane Central Register of Controlled Trials) were searched for relevant studies, retrieving 6,934 records of which fifty-eight studies were identified as relevant. The usefulness of specific search terms and the process of learning from the terminology of previous searches are illustrated, as well as the value of software to manage retrieved studies. Scopus had the highest sensitivity (retrieving the highest number of relevant articles) and retrieved the most articles not retrieved by any other database (exclusiveness). All databases had low precision on this topic, despite extensive efforts in selecting search terms. Cumulative knowledge about search strategies and empirical comparison of database utility helps to increase the efficiency of systematic literature searching. Such endeavours encourage and support professionals to use the best available evidence to inform practice and policy.
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Purpose The growing range and complexity of community care services require robust approaches to ensuring quality. Method This review collated studies on the use of standards in regulating community health and social care using Social Care Online, MEDLINE and CINAHL databases. Studies were appraised by two reviewers and synthesized by study themes. Results Sixteen studies were synthesized under three themes: • standards in quality assurance and quality improvement; • effectiveness of standards; and • design of regulatory standards. Standards facilitate providers in self-regulation and enable regulators to support and monitor improvement. Effectiveness of standards depends on their language and interpretation, and on organizational factors. There was little evidence of scales within quality standards. Discussion There is continuing debate about self-regulation versus external regulation. Social care service regulation requires more research. Conclusion Regulatory organizations should take note of wider initiatives toward evidence-based practice in the design of quality standards.
Article
Background: Students and clinicians are challenged to locate evidence to answer clinical questions. Searching experiences include frustration with words to query databases, lack of searching skills, lack of confidence in nursing databases, and questioning how many databases to search. To implement practice change based on best available evidence, search strategies need to be efficient and effective. Method: We replicated the systematic review by Stillwell, Vermeesch, and Scott, which used a specific search, with a sensitive search to compare search strategies to answer the clinical question. Results: The specific search produced 5,108 articles, with eight being relevant; whereas the sensitive search produced 11,362 articles with nine being relevant. Conclusion: The sensitive search located the same eight studies and one additional study. If PubMed instead of MEDLINE had been used in the specific search, the results would have been identical. [J Nurs Educ. 2020;59(1):22-25.].
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Lecturers/instructors-request a free digital inspection copy here The #1 resource for carrying out educational research In order to carry out high-quality educational research, every aspect of the process needs careful consideration. This all-encompassing textbook gives a considered overview of principles that underpin research, key qualitative and quantitative methods for research design, data collection and analysis.
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The aim of this study was to construct PubMed search strings that could efficiently retrieve studies on manual therapy (MT), especially for time-constrained clinicians. Our experts chose 11 Medical Subject Heading terms describing MT along with 84 additional potential terms. For each term that was able to retrieve more than 100 abstracts, we systematically extracted a sample of abstracts from which we estimated the proportion of studies potentially relevant to MT. We then constructed 2 search strings: 1 narrow (threshold of pertinent articles ≥40%) and 1 expanded (including all terms for which a proportion had been calculated). We tested these search strings against articles on 2 conditions relevant to MT (thoracic and temporomandibular pain). We calculated the number of abstracts needed to read (NNR) to identify 1 potentially pertinent article in the context of these conditions. Finally, we evaluated the efficiency of the proposed PubMed search strings to identify relevant articles included in a systematic review on spinal manipulative therapy for chronic low back pain. Fifty-five search terms were able to extract more than 100 citations. The NNR to find 1 potentially pertinent article using the narrow string was 1.2 for thoracic pain and 1.3 for temporomandibular pain, and the NNR for the expanded string was 1.9 and 1.6, respectively. The narrow search strategy retrieved all the randomized controlled trials included in the systematic review selected for comparison. The proposed PubMed search strings may help health care professionals locate potentially pertinent articles and review a large number of MT studies efficiently to better implement evidence-based practice. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
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Consolidating existing knowledge in Design Science, this book proposes a new research method to aid the exploration of design and problem solving within business, science and technology. It seeks to overcome a dichotomy that exists in the field between theory and practice to enable researches to find solutions to problems, rather than focusing on the explanation and exploration of the problems themselves. Currently, researches concentrate on to describing, exploring, explaining and predicting phenomena, and little attention is devoted to prescribing solutions. Herbert Simon proposes the need to develop a Science of the Artificial (Design Science), arguing that our reality is much more artificial than natural. However, the research conducted on the Design Science premises has so far been scattered and erratic in different fields of research, such as management, systems information and engineering. This book aims to address this issue by bringing these fields together and emphasising the need for solutions. This book provides a valuable resource to students and researchers of research methods, information systems, management and management science, and production and operations management.
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Online information seeking has become normative practice among both academics and the general population. This study appraised the performance of eight databases to retrieve research pertaining to the influence of social networking sites on the mental health of young people. A total of 43 empirical studies on young people’s use of social networking sites and the mental health implications were retrieved. Scopus and SSCI had the highest sensitivity with PsycINFO having the highest precision. Effective searching requires large generic databases, supplemented by subject-specific catalogues. The methodology developed here may provide inexperienced searchers,such as undergraduate students, with a framework to define a realistic scale of searching to undertake for a particular literature review or similar project.
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Background Systematic reviews often investigate the effectiveness of interventions for one sex. However, identifying interventions with data presented according to the sex of study participants can be challenging due to suboptimal indexing in bibliographic databases and poor reporting in titles and abstracts. The purposes of this study were to develop a highly sensitive search filter to identify literature relevant to men's health and to assess the performance of a range of sex-specific search terms used individually and in various combinations. Methods Comprehensive electronic searches were undertaken across a range of databases to inform a series of systematic reviews investigating obesity management for men. The included studies formed a reference standard set. A set of sex-specific search terms, identified from database-specific controlled vocabularies and from natural language used in the titles and abstracts of relevant papers, was investigated in MEDLINE and Embase. Sensitivity, precision, number needed to read (NNR) and percent reduction in results compared to searching without sex-specific terms were calculated. Results The reference standard set comprised 57 papers in MEDLINE and 63 in Embase. Seven sex-specific search terms were identified. Searching without sex-specific terms returned 31,897 results in MEDLINE and 37,351 in Embase and identified 84% (MEDLINE) and 83% (Embase) of the reference standard sets. The best performing individual sex-specific term achieved 100%/98% sensitivity (MEDLINE/Embase), NNR 544/609 (MEDLINE/Embase) and reduced the number of results by 18%/17% (MEDLINE/Embase), relative to searching without sex-specific terms. The best performing filter, compromising different combinations of controlled vocabulary terms and natural language, achieved higher sensitivity (MEDLINE and Embase 100%), greater reduction in number of results (MEDLINE/Embase 24%/20%) and greater reduction in NNR (MEDLINE/Embase 506/578) than the best performing individual sex-specific term. Conclusions The proposed MEDLINE and Embase filters achieved high sensitivity and a reduction in the number of search results and NNR, indicating that they are useful tools for efficient, comprehensive literature searching but their performance is partially dependent on the appropriate use of database controlled vocabularies and index terms.
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This exciting new book equips radiography students and practitioners with the key skills and strategies required to undertake research within medical imaging and radiotherapy and to disseminate the research findings effectively. Quantitative and qualitative research methods are covered, with guidance provided on the entire research process, from literature researching, information management and literature evaluation through to data collection, data analysis, and writing up. Attention is drawn to sampling errors and other potential sources of bias, and the conduct of randomized controlled trials, systematic reviews, and meta-analyses are clearly explained. Specific instruction is given on the structure and presentation of dissertations, writing journal articles for publication, and the dissemination of research findings at conferences. Information on patient and public involvement in research and research funding bodies are also provided with advice on how to maximize the likelihood of success when submitting applications for funding.
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Social workers play a crucial part in contemporary society by ensuring that individuals are able to address, overcome, and manage obstacles in their daily lives. In an effort to better serve their clients, many practitioners have turned to evidence-based practice. Evidence Discovery and Assessment in Social Work Practice provides practitioners with the tools necessary to locate, analyze, and apply the latest empirical research findings in the field to their individual practice. This premier reference work provides insights and support to professionals and researchers working in the fields of social work, counseling, psychotherapy, case management, and psychology. https://www.igi-global.com/book/evidence-discovery-assessment-social-work/110005