Problem-based Learning & Finding the Evidence: Case #14: Priscilla Archuleta

As great as these tools are, they don't have everything you need.  In fact, it took years for Up to Date to include the psychiatric related issues.  So, what do you do?  Obviously, try another resource and fortunately, we have several decision support tools you could use along with textbooks.

Search Tips - the Need for Synonyms

You might be surprised that some of the resources have nothing on Medi-Cal.  The information is often there, but this is one case where figuring out synonyms are helpful.  For this case, you need to remember these big resources have a national perspective and Medi-Cal is a California specific label.  Try searching with the nationally used term Medicaid instead.  This may be why you might not find anything in some of the resources.

Domain Search

So, if you don't know who has the info, is there a better way to find good information that doesn't start with Wikipedia?  The answer, of course, is Yes.  

With a little reasoning, you can make some broad assumptions about the type of organizations that might provide information - is it a general "organization" - either locally or nationally focused; or perhaps you know a "government" group that should have some information. The way to convey this to Google is to specify it with site: plus the organization (org) or government (gov) domain.

For example, what information do we have about 5150 for San Diego.  How would you create the search?  

Is it something like:

5150 involuntary psychiatric hold San Diego site:org  (results include some interesting local created documents and ppt slides)  or 

5150 involuntary psychiatric hold San Diego site:gov 

Don't forget this is a good way to find important organizations covering a topic or government agencies that might be helpful.  You can use more of an URL address if you know it.  For example, 

schizophrenia site:nih.gov  

This gives you resources from the National Institutes of Health - or more specifically, the National Institute for Mental Health.

This works for almost any search engine.

Finding Resources to Address Cultural Aspects within Psychiatric Medicine

Finding resources that really address these types of questions can be difficult.  An internet search can be very messy and good information may be difficult to find.  What else can you do?  Well, try the resources that are more academic, but where to start? If you have already checked Access Medicine or Up to Date and need more, here are some suggestions.  

1. UC Library Search:  What resources does the Library have (textbooks, articles, gov. docs) that might address in a broader perspective mental illness - particularly a psychiatric emergency - and culturally competent care.  In a search of UC Library Search (our new discovery tool), the terms psychiatric emergency culture might get you some interesting results.
    
2. PubMed:  Since PubMed is a familiar search tool, what does it have on this topic?  From previous searches, I know that in a medical search tool like this, the word culture may not get me to the cultural articles I would want - (culture often means lab results).  Also, it might be a good time for using synonyms - would you search hispanic or latino or latina or other term?  
   
   This time, doing a MeSH (medical subject headings) search is in order because of all of the noise with culture.  I think it will help you make sure you're really getting good articles and fewer to sort through.  (Link below to the PubMed MeSH tutorial.)
   1. Once in PubMed, go right to the MeSH database - the link is right on the front page under "Explore."
   2. Search for culture in the MeSH Browser. You really just need the MeSH term for culture - so add that to the search box.
      Culture  (you could use both culture and ethnology )
      
       
   3. Next, just add the 2 other terms to the search box and PubMed will take care of matching the rest.
      Latina  (or hispanic) 
      Schizophrenia  
      
       
3. PscydINFO:  PsycINFO is another possible source.  It is not as familiar to most of you as PubMed, but it is really the go-to resource when searching for psychiatric related topics.
   1. Use keyword terms.  We could get more technical and use their "descriptors, but start with the keywords.  I think they will work just fine here.
      Culture 
      (hispanic* OR latino*) (with keywords, you do need synonymous terms like this and the * takes care of the plural vs. singular versions of these terms)
      Schizophrenia
   2. Check out the results.  I found these to be close to what I was hoping for.  You might too.
      

 Hopefully, you have found a few things to round out your look up topic.

Searching Through Titles

Option #1:  Tell PubMed Your Term Should be in the Title

A quick way to find highly relevant articles in PubMed is to find articles with the term or phrase you need in the title.  PubMed lets you do this in a couple of ways and additionally. 

The way to tell PubMed to search for your terms in the title is to use a field search operator [titile] or use the shorter version [ti].  For example, psychiatric emergenc*[ti]   (the * will tell PubMed to find emergency as well as emergencies)

Option #2

For those who don't want to remember to use the search field operators, check out the options on the Advanced search screen.  Use the Builder to set up your options.  Type psychiatric emergenc* (the * tells PubMed to find emergency as well as emergengies) in the box and pick Title from drop-down list before clicking ADD to add it to the Query box.

Add additional terms that might be helpful - e.g., management, preparing,   

MedlinePlus is a great place to find consumer-friendly materials along with directories, a dictionary & encyclopedia, and more.  This is a great tool for your patients or for finding information appropriate for your patients.  They are not a bad place to start expanding your understanding of a topic or locating a helpful graphic, but may not be the best resource for your PBL references unless you are citing an image.

Does your patient or her family need Spanish-language materials?  You might find some good resources here.

Take a look and see what you find for Medicaid.