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1 in Evidence-Based Medicine รศ.นพ. อน ร ธ ภะทรากาญจน

2 Aims of Literature Search To solve clinical problems (EBM) To search for existing knowledge in order to conduct a research To update knowledge

3 5A of Evidence-Based Practice ASSESS problem ASSESS ASK the right question ACQUIRE search for the best available evidence APPRAISE the evidence APPLY Decision making Professional experience Pathophysiology Pharmacology Psychology Organizational issues Costs Politics etc

4 General Search Strategy Search the best available database Define relevant, searchable terms No Poor Design search strategy Relevant results? Yes Summarize & Appraise the evidence GOOD Apply the evidence

5 Well-built Clinical Question : PICO P I C O Type of question Patients or population Intervention Comparison Outcome Therapy, etiology, prognosis, diagnosis, etc. Study design Descriptive, case-control, RCT, etc.

6 Example ก ก diabetic nephropathy ก ก ESRD ก ก ACEI ก ARB ก ก ACEI

7 Formulate the question Patients : children with diabetic nephropathy Intervention : ACEI+ARB Comparison : ACEI Outcome : ESRD Question : therapy Design : systematic review, RCT

8 Tools Hardware A computer with (good & fast) online access LAN, MODEM (ADSL, cable) Software Web browser Internet Explorer, FireFox, Opera Adobe Reader (latest version from adobe.com) Reference management softwares EndNote, ProCite, Reference Manager Electronic databases On-line Off-line

9 Medical Clinical Evidence Sources Expert References Standard textbooks References of the references Teaching documents Index books Meeting presentation Science citation index Proceedings of presentation Index medicus (1879) Thesis Excerpta medica (1948) Current contents Electronic databases

10 Electronic databases Search Exhaustively Printed journals, hand-search Unpublished articles Expert seeking Pharmaceutical companies data Grey literature General internet search engines: google, yahoo, msn, altavista, itools

11 General go.com search.yippy.com Internet Search Engines Metasearch engines gahooyoogle.com copernic.com

12 Electronic Databases

13 Electronic Databases Bibliographic databases Medline Embase Scopus Science Citation Index LILACS Open access databases Grey literature databases Web search engines Google Scholar Scirus

14 Bibliographic Database Medline About 5,000 journals Free access via PubMed Now include Oldmedline Oldest article in 1865 Trans Am Ophthalmol Soc PubMed Central Free full-text Mostly articles in English from North American region

15 Bibliographic Databases (Thai) Thai Medical Index Thai Index Medicus ก ก ก ก

16 Bibliographic Databases (Thai) Journal Link Thai journal citation index center (TCI)

17 Pre-filtered Clinical Resources Cochrane library ACP Journal Club (previous Best Evidence) Clinical Evidence Evidence-based Medicine UpToDate update every 4 months

18 Multidisciplinary Clinical Resources Ovid MDConsult.com

19 Electronic Text Books Access Medicine

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21

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23 What is PubMed? A web-based retrieval system developed by NCBI (a part of Entrez retrieval system) Free version of MEDLINE on the web NIH NLM NCBI National Institutes of Health National Library of Medicine National Center for Biotechnology Information

24 PubMed Database A database of bibliographic information drawn primarily from the life sciences literature PubMed contains links to Full-text articles at participating publishers' Web sites sequencing centers Other third party sites such as libraries and sequencing centers All citations in MEDLINE are assigned MeSH Terms and Publication Types from NLM's controlled vocabulary.

25 What Does MEDLINE Cover? Not only medicine Medicine Nursing Dentistry Veterinary medicine Health care system Preclinical sciences e.g., molecular biology

26 How Big is MEDLINE? > 5,000 biomedical journals > 16 million citations back to 1865 Published in the U.S. and 70 other countries. Coverage is worldwide, but most records are from Englishlanguage sources or have English abstracts MEDLINE contains citations, not full-text articles (PubMed provides links to full-text)

27

28 A basic search 1. Identify the key concepts for your search. Example: Find citations about bronchodilators for treating asthma in children. The key concepts are bronchodilators, asthma and children 2. Enter terms into the search box. 3. Press the Enter key or click Search.

29 Combining search terms with Boolean operators AND retrieves results that include all the search terms. OR retrieves results that include at least one of the search terms. NOT excludes the retrieval of terms from your search.

30 Combining search terms with Boolean operators Examples Find citations on DNA that were authored by Dr. Crick in 1993: dna [mh] AND crick [au] AND 1993 [dp] Find citations on the effects of heat or humidity on multiple sclerosis: (heat OR humidity) AND multiple sclerosis Find citations about arthritis excluding the Publication Type Letter: arthritis NOT letter [pt]

31 Automatic term mapping (ATM) Untagged terms that are entered in the search box are matched (in this order) against MeSH (Medical Subject Headings) translation table Journals translation table Full Author translation table Author index Full Investigator (Collaborator) translation table Investigator (Collaborator) index

32 Automatic term mapping (ATM) To bypass ATM, using the following formats: Enclose the phrase in double quotes: kidney allograft Use a search tag: kidney allograft[tw] Use a hyphen: first-line Truncate: kidney allograft*

33 Truncating search terms Example flavor* Finds terms that begin with the root term flavor, such as flavored, flavorful, flavoring, etc.

34 MeSH NLM's controlled vocabulary thesaurus. Terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.

35 Example of MeSH

36 Example of MeSH

37 Example of MeSH

38

39 Search Field Descriptions and Tags

40 Search Field Descriptions and Tags Example Search for articles about influenza published in the New England Journal of Medicine influenza [mh] AND n engl j med [ta]

41 Searching by author Enter the author s name in the format of last name followed by initials. Omit punctuation. Examples smith ja jones k If only the author's last name is entered, tag the name with the author search field [au] Full author names may be searched for citations published from 2002

42 Searching by journal title Enter in the search box one of the following: full journal title (e.g., molecular biology of the cell) title abbreviation (e.g., mol biol cell) To find full journal names, use the Journals Database Use the Single Citation Matcher

43 Limits by dates, type of article, languages, species, gender, subsets, ages, text options, and specific search fields.

44 Combining searches using History Previous searches can be combined or used in subsequent searches

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46

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48 Summary Display

49 Abstract Display

50 Medline Display

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