CHAPTER 1 Geriatric Physical Therapy in the 21st Century 9 narrowly,to individuals aged 80 years and above hest leve d (rand 0 eeaepead make the search faster and more focused. Cumulative Index of Nursing and Allied Health se that focuses specif er pa foundational concep bership in a libr sional org subscribes to it.The CINAHL database is available fre Founda nal concepts and theories Physical Therap criteri o overlap with many journals indexed evidence from lo in both databases,those indexed in CINAHL but not PubMed tend t be smaller journals containing stu mor locate with few and far bet likely to be The ower on the pyrami t.The c for CINAHLo erformed less werful than PubMed. using unbiased and transparent methodol that Lin the an's spec EVaguestioi vides an utomatic ava pically a tw s:(1)finding nals(at least the volumes p Finding the Citations.The biomedical literature is inde canoed xed according to their citations (tit include t of jour on a ith the tion as well as information about how to access the full provide a link to PubMed directly from their websites. text of the article and whether access is free or requires Accessing PubMed through one of the linked librar ment PubMec sites allows an im ediate link to the full text of any ase t oduct of the Un are av y pa States National Library of Medicine (NLM)at the through Open Door as a member benefit National Institutes of Health (NIH).This database Staying Updated with Evidence.Practitioners(across ansive list of all hea care helds)are ofen unaware of new evd but to th r practic ,o 8n indexed in PubMed must meet high-quality standards. approach.Although both consumers and payers ex practice based on valid evidence,the Institute of Medi cine reports long e can ne free of ag times between publication of t new e ence an link to the publisher who controls access to the article if care practitioners should have a strategy to there is a publisher-controlled charge for access.PubMed regularly review current evidence in their specialty area utilizes a powerfu A simple review of the table of contents of core journals a sea h as n ne topic area ca the user maximize their efficiency and effectiveness usin In addition.choose one or two core iournals in a pro this database.The Medical Subject Heading terminology fessionally applicable subspecialty area (stroke,arthritis. (MeSH)used by PubMed also automatically searche s I teoporosis process to request words that are known synonyms(e.g.,a search of bigh the monthly table of contents of these joumnc CHAPTER 1 Geriatric Physical Therapy in the 21st Century 9 few and far between in geriatric physical therapy. The highest category of evidence (top of the pyramid) is a systematic review of the existing literature performed using unbiased and transparent methodology that directly addresses the clinician’s specific question. Searching the Literature for Best Evidence. Locating evidence is typically a two-step process: (1) finding the citation and (2) locating the full text of the reference. Finding the Citations. The biomedical literature is cataloged and indexed according to their citations (title, authors, and identifying information about the source). An abstract of the article is often provided with the cita￾tion as well as information about how to access the full text of the article and whether access is free or requires membership or payment of a fee. PubMed (pubmed. com) is generally the best database to use to search for biomedical evidence. PubMed is a product of the United States National Library of Medicine (NLM) at the National Institutes of Health (NIH). This database provides citations and abstracts from an expansive list of biomedical journals, most in English, but also including major non-English biomedical journals. All journals indexed in PubMed must meet high-quality standards, thus providing a certain level of comfort about using PubMed-indexed journals as trusted sources. The PubMed database can be searched online free of charge. PubMed provides a link to the full text or to a link to the publisher who controls access to the article if there is a publisher-controlled charge for access. PubMed utilizes a powerful search engine organized to easily narrow or expand a search as needed for efficiency. PubMed provides many free online tutorials that help the user maximize their efficiency and effectiveness using this database. The Medical Subject Heading terminology (MeSH) used by PubMed also automatically searches for words that are known synonyms (e.g., a search of high blood pressure also retrieves articles on hypertension). In the “advance search” mode, you can limit your search to studies focused on older adults (651) or, even more narrowly, to individuals aged 80 years and above. Or you can limit the search to studies in the highest level of the pyramid (randomized controlled trials, phase 3 or 4 clinical trials, systematic reviews). All these features make the search faster and more focused. Cumulative Index of Nursing and Allied Health Literature (CINAHL) is a database that focuses specifi￾cally on nursing and allied health. You must either pay to subscribe to CINAHL or gain access through mem￾bership in a library or a professional organization that subscribes to it. The CINAHL database is available free of charge to members of the American Physical Therapy Association (APTA). The criteria for being indexed in CINAHL are less stringent than PubMed. Thus, although there is an overlap with many journals indexed in both databases, those indexed in CINAHL but not PubMed tend to be smaller journals containing studies more likely to be located lower on the pyramid with a greater need to be assessed for design flaws that make findings suspect. The search engine for CINAHL is also less powerful than PubMed. Finding Full Text. Accessing through PubMed pro￾vides an automatic link to the full text if it is available free of charge. In this electronic era, most biomedical journals (at least the volumes published over the past decade or so) are accessed electronically either from the publisher or from companies that purchase the rights to include the journal’s holdings in a bundled set of jour￾nals made available to libraries and other entities for an annual fee. Frequently, university and medical libraries provide a link to PubMed directly from their websites. Accessing PubMed through one of the linked library websites allows an immediate link to the full text of any articles that are available to library patrons. Members of the APTA may similarly access a broad array of journals through Open Door as a member benefit. Staying Updated with Evidence. Practitioners (across all health care fields) are often unaware of new evidence applicable to their practice, or ignore new evidence because it is inconsistent with their accustomed approach. Although both consumers and payers expect practice based on valid evidence, the Institute of Medi￾cine reports long lag times between publication of important new evidence and the incorporation of evi￾dence into practice.14 All health care practitioners should have a strategy to regularly review current evidence in their specialty area. A simple review of the table of contents of core journals in the topic area can be useful. Core journals in geriatrics and geriatric physical therapy are listed in Box 1-2. In addition, choose one or two core journals in a pro￾fessionally applicable subspecialty area (stroke, arthritis, osteoporosis, etc.). It is a simple process to request the monthly table of contents of these journals; scan the Aggregation of clinically applicable studies Definitive testing of clinical applicability Initial testing of foundational concepts Foundational concepts and theories FIGURE 1-5 Pyramid depicting the organization of scientific evidence from low to high clinical applicability