Professional Documents
Culture Documents
An Overview.
List of Topics
Medical literature as a resource for evidence based medicine. An overview. Biomedical literature resources and hierarchy of evidence. MEDLINE - the most important biomedical database. PubMed online training. Sample searches. Search strategy tips, Boolean operators, working with search results. MeSH, links to fulltext articles.
Topic 1: AGENDA
What is evidence-based medicine? Background vs. Foreground questions Books Search engines
Google www.google.com (various doucments) Scholar Google www.scholar.google.com (journal articles) Scirus www.scirus.com (various SCIENTIFIC documents) MEDLINE (journal articles bibliographic records) 3
Databases
To keep up-to-date
Need to read 6,000 articles each day
Traditional Approaches
Self-reported reading time per week. (University setting)
Medical students 60 min. Interns none Senior residents 10 min. Fellows 45 min. Attendings graduating Post 1975 60 min. Pre 1975 30 min.
There is simply no way we can keep up to date in medicine using traditional approaches!
Diagnosis Prognosis Therapy and other clinical and health care issues.
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Evidence-based medicine "converts reading and appraising the biomedical literature into the pragmatic process of
using the literature to benefit individual patients, while simultaneously expanding the clinician's knowledge base."
Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education. American Journal of Medicine 1997;102(5):427-32.
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Clinical Expertise
Patient Preference
Patients
Ask Questions
Appraise
Searching
Validity
Results
Applicability
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Foreground questions Specific knowledge Have 4 parts: Patient/problem Intervention Comparison intervention Clinical outcomes
Background or Foreground?
What is asthma?
Background or Foreground?
What is asthma? (B)
What are the newest medication for asthma? (B) Does atrovent used acutely make you feel better? (F) Is prednisone helpful in asthma? (F or B) Foreground if compare to other drugs Background if interested in how it works
3 or 4 essential components
Example: In young children with recurrent of acute otitis media (AOM), should doctors recommend vaccination to reduce frequency of AOM episodes?
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Patient and/or problem Intervention (diagnosis, treatment..) Comparative intervention (optional, include if relevant) Clinical outcome (cured disease, relief, alleviation, prognosis)
Intervention
Be specific
Outcome
Be precise What are the outcome of interest
In patients with does the use of asthma discharged inhaled and both home from the oral corticosteroids emergency department
In children under 6 months (P), how does sleeping on back (I) compared to sleeping on the stomach (C) in terms of risk of SIDS (O)?
In children with acute asthma exacerbation (P), will the addition of atrovent (I) to albuterol (C) decrease the rate of hospitalization (O)?
Searching Superhero
Best Bets
Books
Scirus www.scirus.com
(various SCIENTIFIC
documents)
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www.locatorplus.gov
eMedicineHealth : Dictionary
www.merckmanual.com
Google Book Search http://books.google.com
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www.locatorplus.gov
www.merckmanual.com
www.emedicinehealth.com
Google Book Search http://books.google.com
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www.locatorplus.gov
www.merckmanual.com
Google Book Search http://books.google.com
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Scholar Google www.scholar.google.com (journal articles) Scirus www.scirus.com (various SCIENTIFIC documents)
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Levels of Evidences
(I-1) a well done systematic review of 2 or more RCTs (I-2) a RCT (II-1) a cohort study (II-2) a case-control study (II-3) a dramatic uncontrolled experiment (III) respected authorities, expert committees, etc.. (IV) ...someone once told me....
http://www.phru.org/casp/
See also AAFP
If your question is about Intervention/Therapy Diagnosis/Screening To assess the accuracy of the test To assess effect of test on health outcome Prognosis Etiology/Risk factors
Pre-appraised Resources
Cochrane
http://www.cochrane.org/cochrane/revabstr/mainindex.htm Very high quality reviews Mostly questions of therapy
PEM database
http://researchinpem.homestead.com/homepage.html Not pre-appraised
Pre-appraised Resources
Best Evidence Topics
http://www.bestbets.org Developed in the ED of Manchester Royal Infirmary in UK Usually EM topics Free
Ovid
What is MEDLINE?
MEDLINE is a DATABASE
MEDLINE is produced by the National Library of Medicine MEDLINE is available free via Pubmed MEDLINE is sold to many vendors, like Ovid, who search the DATA in MEDLINE through different search engines
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