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ACP Journal Club. CINAHL -- allied health and nursin

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Title: ACP Journal Club. CINAHL -- allied health and nursin


1
CHMC PGY-1 FP Residents
  • Evans Whitaker, MD, MLIS
  • Norris Medical Library
  • 2003 Zonal Ave.
  • Los Angeles, CA 90089-9130
  • ewhitake_at_usc.edu, 323 442 1128

2
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?

3
Outline for Today
  • Access to USC resources
  • Lightning tour of Norris Resources
  • EBM Primer and Sources
  • MEDLINE Ovid and a little PubMed
  • Miscellany

4
Access to USC Resources
5
USC Proxy Server
6
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.

7
Tour of Norris Homepage
8
Moving from Left to Rightthe Key Points
  • Journals
  • All USC eJournals lists every electronic
    journal in the USC system
  • Books/Multimedia
  • Databases
  • Ovid MEDLINE --
  • PubMed _at_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.

9
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

10
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 gt700 ebooks

11
Journals
  • Electronic journals
  • Two sources
  • All USC eJournals as it sounds
  • HELIX Medical library catalog

12
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

13
MEDLINE
  • Ovid MEDLINE
  • PubMed (use PubMed_at_USC to get full-text links)

14
EBM Resources
15
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

16
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

17
Background and Foreground
18
Background and Foreground
  • Relevant in choice of materials
  • Background
  • Texts, review articles might be best source
  • Foreground
  • Primary research literature is best source

19
Evidence Pyramid
Source http//library.downstate.edu/EBM2/2100.htm
20
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.

21
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22
PICO
  • Assists formulation of the clinical question.
  • Grown from the EBM movement of the last 15 years.

23
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24
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.

25
MEDLINE and its two avatars
26
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.

27
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)
28
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

29
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 _at_ Ovid (almost 400 books)

30
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

31
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

32
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 users terms into MeSH terms. User
    may choose MeSH terms, explode, focus, and apply
    sub-headings.
  • Combine concepts
  • Limit results as a last step

33
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

34
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.

35
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

36
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37
Miscellany
38
How to keep up with the information deluge.
  • eTOCS (JAMA)
  • MyNCBI and Ovid Personal Account
  • UpToDate-Whats New
  • Faculty of 1000 Medicine

39
How to organize what you have (or will) receive
  • EndNote/EndNoteWeb
  • RefWorks
  • others

40
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.

41
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.

42
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.

43
Final Exam
  • DIAGNOSIS
  • 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?

44
Thanks for your attention
  • Let us know if you have questions!!
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