Post on 18-Dec-2015
CHMC PGY-1 FP Residents
Evans Whitaker, MD, MLISNorris Medical Library2003 Zonal Ave.Los Angeles, CA 90089-9130ewhitake@usc.edu, 323 442 1128
Background questions USC grad? Familiar with Norris home page? Are you comfortable with electronic
resources – ebooks, ejournals? How comfortable are you with EBM? What did you think of the UMASS EBM
online tutorial/quiz? Are you comfortable with MEDLINE
searching? What interface have you used (PubMed, Ovid)? Do you know what MeSH means?
Have you used EndNote or RefWorks?
Outline for Today
I. Access to USC resourcesII. Lightning tour of Norris ResourcesIII. EBM Primer and SourcesIV. MEDLINE – Ovid and a little PubMedV. Miscellany
Access to USC Resources
USC Proxy Server
General Information For biomedical information make Norris
Medical Library your home base (http://www.usc.edu/nml ) -- bookmark it!
By beginning your information seeking at the Norris homepage you will have full-text access to everything to which USC subscribes.
Tour of Norris Homepage
Moving from Left to Right…the Key Points
• Journals– All USC eJournals – lists every electronic journal in the USC system
• Books/Multimedia• Databases
– Ovid MEDLINE -- – PubMed @USC --– Other USC Databases – A-Z
• ERIC – education database• PsycInfo• Sociological Abstracts• Wilson Education Full Text
• Key Resources for: “portal” for selected sources for various groups• eResources Search eResources database drop down box choose Education.
This leads to a hodge-podge of ebooks, databases, websites, etc.– Research and Development Resource Base (http://128.100.115.20/) bibliographic database,
source of Continuing Education & Knowledge Translation, Interprofessional Literature, and Faculty Development.
• Catalogs– HELIX -- Norris Medical and Wilson Dental Libraries– ADVOCAT -- USC Law Library– HOMER -- All other USC libraries
• Quicklinks -- many common resources listed in drop down menu.• HELP – leads to phone, IM, and email connections to medical librarians. We can help with
devising searches, finding information sources, troubleshooting, etc. IM and phone hours are M-F 9-5. There is one working day turnaround on email questions.
Clinical Information Resources
Designed for rapid information finding, fast enough for clinical work
UpToDate ACP Pier Essential Evidence, nee InfoRetriever Clinical Evidence (evidence based) Epocrates – pharmacy, drug interactions LexiComp – pharmacy, drug interactions
Books
Electronic books will be the most practical for you…
Two sources: HELIX – the Norris Library Catalog (best
for known book Multi Ebook Search (from the QuickLinks
menu) searches within >700 ebooks
Journals
Electronic journals Two sources
All USC eJournals – as it sounds HELIX – Medical library catalog
EBM Resources OVID
Cochrane Database of Systematic Reviews ACP Journal Club Database of Abstracts of Reviews of Evidence
(DARE) Clinical Evidence (search for title) National Guideline Clearinghouse TripDatabase SumSearch User's Guides to the Medical Literature “How to Read a Paper”
MEDLINE
Ovid MEDLINE PubMed (use PubMed@USC to get
full-text links)
EBM Resources
Evidence-Based Medicine Simple concept – “use the best information
available to take care of your patients” It is a formalization of good practices in
information finding, evaluation, and application
EBM has appeared on the scene in the last 15 years or so due to a combination of factors – computers and changing healthcare environment.
Process begins and ends with the patient
EBM step by step
5 Steps Formulate search (PICO, searchable
question) Track down the best information (in Evaluate results (Assess methodology
and statistics) Apply results to practice Reevaluate effectiveness
Background and Foreground
Background and Foreground
Relevant in choice of materials Background
Texts, review articles might be best source
Foreground Primary research literature is best source
Evidence Pyramid
Source: http://library.downstate.edu/EBM2/2100.htm
The Evidence Pyramid
Those layers nearest the top are the preferred information in EBM
Many questions in medicine do not have answers, many do not have systematic reviews, meta analyses, RCTs, or even cohort studies.
Means we have to make use of the best available information.
PICO
Assists formulation of the clinical question.
Grown from the EBM movement of the last 15 years.
P Population, Patient, or Problem
I Intervention or Exposure
C Comparison (optional)
O Outcomes
Question type
Population Intervention/
Exposure Outcome
Best Feasible
Study Design
Suitable Databases
Best Single MEDLINE Search
Term for Appropriate Study
Type Diagnosis In patients
with lung cancer
What is the test performance of CT scan
For detecting mediastinal metastatic disease
Cross sectional analytical study
Best Evidence, UpToDate, MEDLINE
Sensitivity as a MeSH or key or title word
Treatment In patients with HTN and DMII
Does a target BP of 80 compared to a DBP target of 90
Lower risk of stroke, MI, cardiovascular death, and all-cause mortality
RCT or systematic review of RCTs
Cochrane, Best Evidence, UpToDate, MEDLINE
Meta-analysis or Clinical trial or Randomized Control Trial as “publication types”
Prognosis In young men with atypical chest pain
Sent home from the ER, in the next 72 hours
Suffer appreciable rates of unstable angina, heart failure or arrhythmia, MI or sudden death
Cohort study
Best Evidence, UpToDate, MEDLINE
Explode cohort studies as MeSH term
Harm In men Does vasectomy
Cause testicular cancer
Cohort study, population- based case- control trial
Best Evidence, UpToDate, MEDLINE
“Risk” as MeSH or as title or keyword
Adapted from: Guyatt, G., Rennie, D. (eds.). 2002. User’s guides to the medical literature. NY: JAMA, p. 43.
Evaluate Results
I am no biostatistician, I have used the simplified approach of Trisha Greenhalgh, MD when I have had to analyze a paper.
Her common sense recommendations are (at least somewhat) realistic for a practicing primary care physician.
MEDLINE and its two avatars
Ovid and PubMed Ovid
commercial product that includes multiple databases, and the option of subscribing to full text of books and journals.
PubMed US governmental bibliographic database collaboration of National Library of Medicine
(NLM), National Center for Biotechnology Information (NCBI), and the National Institutes of Health (NIH). It is free to use and is the only database of its size and scope in the world.
PubMed and MEDLINE
• OvidSP -- different interface and search engine, same contents as MEDLINE.
MEDLINE is a subset of PubMed.
The 2+ million article difference includes articles both articles that are being processed and will move into MEDLINE, and articles which will never be included in MEDLINE (e.g., outside the scope of the database).
(18.6/16.8 as of 08/14/08)
Pros and Cons of Ovid MEDLINE
Pros Easier to learn than PubMed Automatic “mapping” of search terms works
better than PubMed Basic search can be used at the speed of clinical
medicine Basic and Advanced search modes work well
together
Cons Expensive After leaving an academic medical center unlikely
to have access
What Else is in Ovid? EBM (the three below and others)
Cochrane Database of Systematic Reviews DARE (Database of Abstracts of Reviews of Effects) ACP Journal Club
CINAHL -- allied health and nursing database Ovid Healthstar – “contains citations to the
published literature on health services, technology, administration, and research.”
Health and Psychosocial Instruments (HAPI) -- information on measurement tools for healthcare
Books @ Ovid (almost 400 books)
How to search OvidSP Basic
“Natural language” search engine Keep “include related terms” checked Can combine and limit searches Good for a few good articles Useful as a way to find “the right
words” for Ovid Advanced Search Can use at the speed of clinical
medicine
OvidSP Basic – things to know and tips
A good place to start Searches yield 500 or more hits “Good stuff” in the first 20-30. If nothing
relevant is found in that group, reformulate search or move on to Advanced
Based on our experience at NML, use keywords without AND, OR, or punctuation. Seems to retrieve the smallest, most focused set of results
Advanced Ovid Search
Default at Norris Medical Library. Resembles previous versions of Ovid. Steps in a search:
Enter search concepts one at a time. Ovid translates the user’s terms into MeSH terms. User may choose MeSH terms, explode, focus, and apply sub-headings.
Combine concepts Limit results as a last step
Advanced Ovid Search -Tips Subheadings narrow searches. Do not use subheadings unless they match your
needs. Do not overuse subheadings – not all concepts
need them, and few concepts need more than one or two.
Limits narrow searches. Do not overuse limits, try to apply them once at
the end of devising your search. Learn to use the MeSH tree and “scope notes”
Formulate your question Many of the same concepts that apply to EBM also
apply to Ovid searching. First, you identify the “information need”. Define “the clinical question”. Define the “searchable clinical question”, identify
constituent parts of CQ, remove extraneous details. Choose the most appropriate information source in
which to begin your search – it might be a book! Enter your search terms. Review results and reformulate search if necessary.
Searches to try….
Basic “ice cream headache” Basic and Advanced “selenium and
prostate cancer prevention” Advanced “use of antibiotics for
common cold” Others of our devising
Identify, clarify your information need
Formulate the question
Break question into concepts
Enter term for Concept II
Combine concepts with AND or OR
Search
Print, save, email move results to
citation manager
Select best MeSH term
Verify “Explode”Consider “Focus”Consider Subheadings
Select best MeSH term
Verify ExplodeConsider FocusConsider Subheadings
Limite.g. humans, English, age, publication type
Evaluate ResultsIf necessary,
reformulate search
6 Steps to Better Ovid Advanced Searches
1.
2.
3.
4.
5.
6.
Enter term for Concept I
Enter one concept per line, until all entered Remember scope notes and MeSH treeExplode allFocus – use sparinglySubheadings - only use when exactly match your searchLimit last
No
tes:
Miscellany
How to keep up with the information deluge….
eTOCS (JAMA) MyNCBI and Ovid Personal Account UpToDate-”What’s New” Faculty of 1000 – Medicine
How to organize what you have (or will) receive
EndNote/EndNoteWeb RefWorks others
The “elephant in the room”
GoogleScholar -- Advanced Preferences GS is good for preliminary exploration of
an unfamiliar topic. Yields good terms to use in more valid and authoritative search engines.
GS will also occasionally find full text of an article in a journal to which USC does not subscribe.
Scirus.com A search engine devoted to scientific
websites. Easy to use. Higher overall quality of sites than GS.
Can set preferences to link to USC full-text
“Independent” product of publishing giant Elsevier. I have not seen evidence of bias.
Worth a look when exploring a topic.
Tips
Norris as home page, use proxy server. Sign up for a free account with Ovid to save searches and
annotate articles. Sign up for a free MyNCBI account, you can save PubMed
searches, collect articles, and have alerts emailed to you about new articles from saved searches.
Sign up for free eTOCS for those journals whose contents you want to scan regularly.
Sign up for free Web-of-Knowledge/EndNote accounts. This is a nice way to store, organize, and use citations found in your research. Consider Connotea as well.
Consider classes at your local library in PubMed, OvidSP, EndNote, etc.
Final ExamDIAGNOSIS 1. MRI for breast cancer screening, should this be our
method of choice? 2. PSA variations – PSA velocity, PSA density, free PSA
ratios – do these add value to prostate cancer screening?
TREATMENT 3. Low back pain patients -- how effective (to decrease
pain) are chiropractic and acupuncture therapies? Are there studies that compare these modalities?
4.Operative vs. non-operative treatment for acute Achilles tendon ruptures – which is better?
Thanks for your attention
Let us know if you have questions!!