Using PubMed to search for Evidence-Based Medicine Reference Section Conrado F. Asenjo Library UPR-MSC

Objectives Define Evidence-Based Medicine (EBM) Based on a patient problem, construct a well-built clinical question Identify searching strategies that could improve MEDLINE retrieval

Define Evidence-Based Medicine (EBM)

Based on a patient problem, construct a well-built clinical question

Identify searching strategies that could improve MEDLINE retrieval

Evidence-Based Medicine Judicious incorporation of the best available evidence, in conjunction with the values and preferences of those involved and with the circumstances of care in clinical decision-making. Evidence along is not enough.

Steps of EBM Clinical encounter * Focused clinical question * Search of “best evidence” * Determine the validity of the evidence Extract the clinical message Incorporate patient values/preferences Make a clinical decision about care * What we will be talking about today.

Clinical encounter *

Focused clinical question *

Search of “best evidence” *

Determine the validity of the evidence

Extract the clinical message

Incorporate patient values/preferences

Make a clinical decision about care

Clinical Encounter- Carlitos Carlitos is an active 5 year old boy. His mother brought him in for a check-up because Carlitos has had a fever and a sore throat for several days. You suspect Strep and take a throat culture. The standard treatment for Streptococcal Pharyngitis is oral Penicillin three times a day. However, for Carlitos and his mother, you are concerned about compliance and the expense of this medication. You recall that a drug representative recently told you that a daily dose of amoxicillin is just as good as penicillin, but costs less. You want to review the literature before you decide on amoxicillin for Carlitos and possibly changing your standard practice.

Anatomy of a Focused Clinical Question Patient or Problem How would I describe a group of patients or problem similar to mine? Intervention, Prognostic factor, Exposure Which main intervention, prognostic factor, or exposure are you considering? Comparison What is the main alternative to compare with the intervention? Outcome What will the exposure, intervention affect?

Patient or Problem

How would I describe a group of patients or problem similar to mine?

Intervention, Prognostic factor, Exposure

Which main intervention, prognostic factor, or exposure are you considering?

Comparison

What is the main alternative to compare with the intervention?

Outcome

What will the exposure, intervention affect?

Focused Clinical Question In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms? relief of symptoms Outcome penicillin Comparison amoxicillin Intervention, Prognostic factor, Exposure pediatric patients with strep throat Patient or problem

Most common types of questions Diagnosis - how to select and interpret diagnostic tests Therapy - how to select treatments, expected outcomes, quality of life. Prognosis - how to estimate the patient's likely clinical course over time Harm/Etiology - how to identify causes for disease

Diagnosis - how to select and interpret diagnostic tests

Therapy - how to select treatments, expected outcomes, quality of life.

Prognosis - how to estimate the patient's likely clinical course over time

Harm/Etiology - how to identify causes for disease

Type of Study Meta-Analysis Systematic Reviews Randomized Controlled Trials Cohort Studies Cross Sectional Studies Case Control Studies Case Series/ Case Reports Animal Research In vitro (‘test tube’) research

Case Series and Case Reports

Case Control Studies

Cohort Studies

Randomized Controlled Trials

Systematic Reviews and Meta-Analysis

Preferred Study Designs RCT>cohort study > case control > case series Prevention RCT>cohort>case-control>case series Etiology Longitudinal cohort study>case control>case series Prognosis RCT>cohort>case control>case series Therapy Cross-sectional study (compared with a gold standard) Diagnosis

Clinical Encounter Focused Clinical Question: In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms? This is a therapy question , and the best evidence would be a randomized controlled trial .

Focused Clinical Question: In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms?

This is a therapy question , and the best evidence would be a randomized controlled trial .

PubMed- Search Strategies Combining keywords using boolean operators (AND, OR, NOT) and applying limits. Using NLM’s controlled vocabulary (MeSH ) and applying limits. Using Clinical Queries filters.

Combining keywords using boolean operators (AND, OR, NOT) and applying limits.

Using NLM’s controlled vocabulary (MeSH ) and applying limits.

Using Clinical Queries filters.

Accessing PubMed Directly: http://www.pubmed.gov From the library’s electronic webpage: http://rcm-library.rcm.upr.edu Click on NLM PubMed link An icon indicates MSC Library’s print holdings.

Directly: http://www.pubmed.gov

From the library’s electronic webpage: http://rcm-library.rcm.upr.edu

Click on NLM PubMed link

An icon indicates MSC Library’s print holdings.