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in Evidence-biased Medicine

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Title: in Evidence-biased Medicine


1
in Evidence-biased Medicine
Literature Search
  • ??.??. ?????? ???????????

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
ASK the right question
Professional experience Pathophysiology Pharmacolo
gy Psychology Organizational issues Costs Politics
etc
ACQUIRE search for the best available evidence
APPRAISE the evidence
ASSESS
Decision making
APPLY
4
General Search Strategy
Search the best available database
Define relevant, searchable terms
Design search strategy
No
Relevant results?
Yes
Summarize Appraise the evidence
Poor
GOOD
Apply the evidence
5
Well-built Clinical Question PICO
  • P Patients or population
  • I Intervention
  • C Comparison
  • O Outcome
  • Type of question
  • Therapy, etiology, prognosis, diagnosis, etc.
  • Study design
  • Descriptive, case-control, RCT, etc.

6
Example
  • ??????????????????????????????? diabetic
    nephropathy ???????????????? ESRD ??????????????
    ????????????????????? ACEI ??????? ARB
    ???????????????????????????? ACEI ???????????????

7
Formulate the question
  • Patients children with diabetic nephropathy
  • Intervention ACEIARB
  • 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-li

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

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  • Unpublished articles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

11
Internet Search Engines
  • General
  • - Google
  • - Yahoo
  • - MSN
  • - Live
  • - Altavista
  • - Excite
  • - HotBot
  • - Lycos
  • - Go.com
  • - Ask.com
  • Special search engine
  • - Clusty.com
  • - Kartoo.net
  • Metasearch engines
  • - Gahooyoogle.com
  • (search Yahoo,
  • Google,all at once)
  • - Arrowsearch.net
  • - Copernic Agent

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
  • http//www.ncbi.nlm.nih.gov/pubmed/
  • Now include Oldmedline
  • Oldest article in 1865 Trans Am Ophthalmol Soc
  • PubMed Central (http//www.ncbi.nlm.nih.gov/pmc/)
  • Free full-text
  • Mostly articles in English from North American
    region

15
Bibliographic Databases (Thai)
  • Siriraj Thai Medical Index (http//www.medlib.si.
    mahidol.ac.th/)
  • Chula Thai Index Medicus (http//www.library.md.c
    hula.ac.th/)
  • Other Thai databases
  • ????????????????????????????????????????????
    (http//www.stks.or.th/web/)
  • ???????????????? ???????????????????????????????
    (http//www.riclib.nrct.go.th/)

16
Bibliographic Databases (Thai)
  • Thai journal pointer
  • Journal Link (www.journallink.or.th)
  • Thai journal citation index center (TCI)
  • (www.kmutt.ac.th/jif/public_html/)

17
Pre-filtered Clinical Resources
  • Cochrane library
  • Online access http//www.thecochranelibrary.com/v
    iew/0/index.html
  • Offline access CD updated quarterly
  • ACP Journal Club (previous Best Evidence)
  • www.acpjc.org
  • Clinical Evidence
  • www.clinicalevidence.com
  • Evidence-based Medicine (EBM Online)
  • http//ebm.bmj.com/

18
Pre-filtered Clinical Resources
  • UpToDate
  • www.uptodate.com
  • CD updated every 4 months

19
Multidisciplinary Clinical Resources
  • Ovid.com
  • MDConsult.com
  • Full-text of Clinics of North America Journals
  • Full-text of Year Books
  • Not all have pdf files

20
Electronic Text Books
  • Harrison Online
  • www.harrisonsonline.com
  • www.harrisonsmed.com (store)

21
PubMed
22
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24
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
National Institutes of Health
NLM
National Library of Medicine
National Center for Biotechnology Information
NCBI
25
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
  • 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.

26
What Does MEDLINE Cover?
  • Not only medicine
  • medicine
  • nursing
  • dentistry
  • veterinary medicine
  • health care system
  • preclinical sciences e.g., molecular biology

27
How Big is MEDLINE?
  • gt 5,000 biomedical journals
  • gt 16 million citations back to 1865
  • Published in the U.S. and 70 other countries.
  • Coverage is worldwide, but most records are from
    English-language sources or have English
    abstracts
  • MEDLINE contains citations, not full-text
    articles (PubMed provides links to full-text)

28
Searching PubMed
29
A basic search
  • 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
  • Enter terms into the search box.
  • Press the Enter key or click Search.

30
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.

31
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

32
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

33
Automatic term mapping (ATM)
  • To bypass ATM, using the following formats
  • Enclose the phrase in double quotes kidney
    allograft
  • Use a search tag kidney allografttw
  • Use a hyphen first-line
  • Truncate kidney allograft

34
Truncating search terms
  • Example flavor
  • Finds terms that begin with the root term flavor,
    such as flavored, flavorful, flavoring, etc.

35
MeSH
  • NLM's controlled vocabulary thesaurus.
  • Terms naming descriptors in a hierarchical
    structure that permits searching at various
    levels of specificity.

36
Example of MeSH
37
Example of MeSH
38
Example of MeSH
39
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40
Search Field Descriptions and Tags
41
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

42
Searching by author
  • Enter the authors 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

43
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
    (http//www.ncbi.nlm.nih.gov/corehtml/query/static
    /citmatch.html )

44
Limits
  • by dates, type of article, languages, species,
    gender, subsets, ages, text options, and specific
    search fields.
  • http//www.ncbi.nlm.nih.gov/pubmed/

45
Combining searches using History
  • Previous searches can be combined or used in
    subsequent searches
  • http//www.ncbi.nlm.nih.gov/pubmed/

46
PubMed Results
47
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49
Summary Display
50
Abstract Display
51
Medline Display
52
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53
??????????? file ??????????? medline
????????????????????????? reference manager
54
??????????? article ??????????????
???????????????? clipboard
55
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58
Search Strategy Tips
  • Identify the key concepts.
  • Determine alternative terms for these concepts,
    if needed.
  • Refine your search to dates, study groups, etc.,
    as appropriate.
  • Practice helps. Strategies and styles will differ
    according to personal choice and professional
    discipline.

59
  • ??????????? 5 ????? ????????? UTI ????????????
    ?????????????????? phimosis ?? imaging studies
    ???????? ???????????????????????? steroid cream
    ????????????????????? ?????????????????????

60
  • Patients infants with phimosis
  • Intervention circumcision
  • Comparison no circumcision
  • Outcome Urinary tract infection
  • Question therapy
  • Design systematic review, RCT

61
  • Patients infants with phimosis
  • Intervention steroid
  • Comparison no intervention
  • Outcome retractable prepuce
  • Question therapy
  • Design systematic review, RCT
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