Searching for Evidence-BasedMedicine in EmbaseYour host: Ann-Marie Roche Your presenter: Ian CrowlesmithWelcome to our Emb...
• Web delivery• Elsevier / otherpublisher’scontent• Workflow & contentexpansion• New UI and enhanceddiscoverability large...
• Webinar control panel:• ‘chat’ or ‘ask a question’ for questionsand comments• Option for full screen view• Q&A after pre...
• Searching for evidence: 4 case studiesDrugs & diseasesDiagnostic testsMedical devicesProcess of care• Focus on:Goals and...
 GoalTo locate the highest quality of evidence available,with the best balance of sensitivity and specificity.Goals & met...
PICO (a reminder)P = PatientI = InterventionC = Comparison / ControlO = Outcome
Therapy vs DiagnosisTherapyDiseased patient↓Intervention↓Has the patient improved?DiagnosisSuspicion of disease↓Diagnostic...
Therapeutic trials / Diagnostic testsSeries of patientsIndex group Control groupIntervention ControlOutcome OutcomeIndex t...
Levels of evidenceSource: Robin Harbour & Juliet Miller (SIGN), BMJ 2001;323:334.1Parachutes reduce the risk of injuryafte...
Levels of evidence in Embase check tags study types topic terms reviews of the evidenceSee also: Embase Indexing Guide...
Levels of evidence: check tagsCheck tag Year Scope note (Used for …)randomizedcontrolledtrial1993 … original reports of cl...
Levels of evidence: study types case control study cohort analysis comparative study controlled study longitudinal st...
Levels of evidence: study types
Levels of evidence: topic termsTopic terms were introduced in Emtree in 2011Emtree (from two hierarchical views)
Reviewing the evidenceCheck tag Year Scope notesystematicreview2004 Used for studies that systematically summarize all rel...
Case studiesType Search questionDrugs & diseases Evaluate the evidence for suicide risk in childrentreated for depression ...
Case study (1): Drugs & diseasesAim: Evaluate the evidence that children treated fordepression using serotonin reuptake in...
1. Emtree to disease search => depression/exp/dm_dt (= drug therapy)2. Limits => [child]/lim OR [adolescent]/lim3. Emtree ...
Case study (1): Drugs & diseases
Case study (2): Diagnostic testsAim: How accurately does HPV testing predictcervical cancer in adult women?P = cervical ca...
1. Disease search => uterine-cervix-cancer/dm_di (= diagnosis)2. Limits => female/de AND adult/de3. Emtree => human-papill...
Case study (2): Diagnostic tests
Case study (3): Medical devicesAim: What are the pro’s and con’s for metal-on-metalhip implants vs other types in differen...
1. Emtree => hip-prosthesis/exp2. Metal-on-metal (after reviewing Quick search / autocomplete)Avoid relying on metal-on-me...
Case study (3): Medical devices
Case study (4): Process of careAim: How does the application of telemedicine fordiabetes compare with implementation for o...
1. Emtree => telemedicine (identify telehealth)2. Filter => diseases to compare areas of application; select diabetes3. Ed...
Case study (4): Process of care
Searching for EBM: summaryWhen searching for evidence onEmbase, the results can alwaysbe summarized according to thelevels...
Thank you• Q&A will be sent to you by email.• For more information and questions, please visitwww.elsevier.com/online-tool...
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Embase - Searching for Evidence Based Medicine - May 22 2013

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In our Embase webinar, Ian Crowlesmith searched for evidence in 4 case studies: Drugs & diseases; Diagnostic tests; Medical devices and Process of care
He also focused on: Goals and methods; Levels of evidence and Other search tips

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  • Embase is developed and maintained by Elsevier and to briefly put it into context, Elsevier is serving 3 main areas of interest to you, Biology, Chemistry and Medicine. Embase is one of the products serving your needs in the area of medicine, we have Reaxys and Reaxys Medicinal Chemistry serving the needs of chemists, and Pharmapendium, giving searchable access to all FDA and EMA approval documentation. In the biology space, we have our new target finding and validation tool, Target Insights and Pathway Studio, our biology information solution which helps you to make connections, analyse data and explore perspectives. ScienceDirectprovides full text access to over 10 million journal articles and is continuously looking for new and novel ways to enable further understanding of the scientific literature through applications and new article formats and Scopus is our all science database, also serving needs in these three areas. Quosa is a literature management tool customized for your organisation. And so to todays Embase session…
  • Embase - Searching for Evidence Based Medicine - May 22 2013

    1. 1. Searching for Evidence-BasedMedicine in EmbaseYour host: Ann-Marie Roche Your presenter: Ian CrowlesmithWelcome to our Embase webinar!
    2. 2. • Web delivery• Elsevier / otherpublisher’scontent• Workflow & contentexpansion• New UI and enhanceddiscoverability largest chemistryresource• Enhance pre-clinicalproposition; launch ofMetabolizing Enzymes &Efficacy modulesBiology Chemistry MedicineElsevier coverage
    3. 3. • Webinar control panel:• ‘chat’ or ‘ask a question’ for questionsand comments• Option for full screen view• Q&A after presentationNeed to know
    4. 4. • Searching for evidence: 4 case studiesDrugs & diseasesDiagnostic testsMedical devicesProcess of care• Focus on:Goals and methodsLevels of evidenceOther search tipsAgenda
    5. 5.  GoalTo locate the highest quality of evidence available,with the best balance of sensitivity and specificity.Goals & methods MethodsSystematic search of the literature using predefinedinclusion / exclusion criteria (PICO) Not included• Comparison with multiple data sources (e.g. MEDLINE)• Analytical methods for evaluating evidence (e.g. GRADE)
    6. 6. PICO (a reminder)P = PatientI = InterventionC = Comparison / ControlO = Outcome
    7. 7. Therapy vs DiagnosisTherapyDiseased patient↓Intervention↓Has the patient improved?DiagnosisSuspicion of disease↓Diagnostic test↓Is the patient diseased?
    8. 8. Therapeutic trials / Diagnostic testsSeries of patientsIndex group Control groupIntervention ControlOutcome OutcomeIndex test Reference standardCross classificationSingle patient group
    9. 9. Levels of evidenceSource: Robin Harbour & Juliet Miller (SIGN), BMJ 2001;323:334.1Parachutes reduce the risk of injuryafter gravitational challenge, but theireffectiveness has not been provedwith randomised controlled trialsSource: Gordon Smith & Jill Pell, BMJ 2003;327:1459Ref: Nursetopia.netOxford Centre for Evidence-based Medicine - Levels of Evidence (Mar 2009)
    10. 10. Levels of evidence in Embase check tags study types topic terms reviews of the evidenceSee also: Embase Indexing Guide 2012 (via Embase.com/info)
    11. 11. Levels of evidence: check tagsCheck tag Year Scope note (Used for …)randomizedcontrolledtrial1993 … original reports of clinical trials using a control group (e.g. placebo, sham orno treatment, standard intervention) for comparison with the experimentalintervention, with random allocation of subjects to experimental and controlgroupscontrolledclinical trial2007 … original studies with a control group, i.e. in which previously defined groupsare compared with each other. Also used for studies with control material orcontrol procedures. Retrospective studies may also be includedmulticenterstudy1993 … original reports of clinical trials performed at two or more medical centersclinical trial * 1974 ... original reports of prospective clinical studies in which the (comparative)efficacy of one or more medical interventions in humans is evaluated; alsoused for prospective clinical veterinary trials in which the (comparative)efficacy of one or more medical interventions in animals is evaluatedmajor clinicalstudy1974 … original items reporting clinical work on greater than 50 patientsclinical article 1974 … original items reporting clinical work on 5-50 patientscase report 1974 … original items reporting clinical work on not more than 4 individual cases* check tags for phases 1-4 clinical trials are also available
    12. 12. Levels of evidence: study types case control study cohort analysis comparative study controlled study longitudinal study prospective study retrospective studyEmtree examples
    13. 13. Levels of evidence: study types
    14. 14. Levels of evidence: topic termsTopic terms were introduced in Emtree in 2011Emtree (from two hierarchical views)
    15. 15. Reviewing the evidenceCheck tag Year Scope notesystematicreview2004 Used for studies that systematically summarize all relevantevidence pertaining to a defined health question, andincluding items identified as such by the authormetaanalysis1987 Used for original reports evaluating medical interventions bythe statistical analysis of a large collection of analysis resultsfrom individual studies, for the purpose of integrating thefindings; not limited to clinical trialsRelated topic terms (2011)systematic review (topic)meta analysis (topic)Practice guidelines
    16. 16. Case studiesType Search questionDrugs & diseases Evaluate the evidence for suicide risk in childrentreated for depression with SSRIsDiagnostic tests How accurately does HPV testing predict cervicalcancer in adult women?Medical devices What are the pro’s and con’s for metal-on-metal hipimplants vs other types of hip prosthesis?Process of care Since the last Cochrane review in 2007, have therebeen any significant updates regarding the applicationof telemedicine for diabetes?
    17. 17. Case study (1): Drugs & diseasesAim: Evaluate the evidence that children treated fordepression using serotonin reuptake inhibitors are atincreased risk of suicideP = depression (treatment) in childrenI = serotonin (re)uptake inhibitors / SSRIsC = controlled studies vs alternative/no treatmentO = (risk of) suicide(review levels of evidence)
    18. 18. 1. Emtree to disease search => depression/exp/dm_dt (= drug therapy)2. Limits => [child]/lim OR [adolescent]/lim3. Emtree to drug search => serotonin-uptake-inhibitor/exp/dd_dt(via synonym search for SSRI)4. 1 AND 2 AND 35. Emtree => suicide/exp6. 4 AND 57. Filter => view & select levels of evidenceCase study (1): Drugs & diseases
    19. 19. Case study (1): Drugs & diseases
    20. 20. Case study (2): Diagnostic testsAim: How accurately does HPV testing predictcervical cancer in adult women?P = cervical cancer (diagnosis), women (adult)I = human papilloma virusC = biopsy (or other reference standard)O = diagnostic test accuracy (study)(review levels of evidence)
    21. 21. 1. Disease search => uterine-cervix-cancer/dm_di (= diagnosis)2. Limits => female/de AND adult/de3. Emtree => human-papilloma-virus (or papilloma-virus)4. 1 AND 2 AND 35. Filter => “diagnostic test accuracy study’6. Filter => view & select levels of evidenceCase study (2): Diagnostic tests
    22. 22. Case study (2): Diagnostic tests
    23. 23. Case study (3): Medical devicesAim: What are the pro’s and con’s for metal-on-metalhip implants vs other types in different patient groups?P = human (unspecified)I = metal-on-metal hip prosthesesC = comparison (studies)O = treatment outcome(review levels of evidence)
    24. 24. 1. Emtree => hip-prosthesis/exp2. Metal-on-metal (after reviewing Quick search / autocomplete)Avoid relying on metal-on-metal joint prosthesis, introduced 20133. 1 AND 24. Filter => select comparative-study, intermethod-comparison5. Edit => replace by compar* (compare free text vs Emtree results)6. Emtree => treatment outcome7. Filter => view & select levels of evidenceCase study (3): Medical devices
    25. 25. Case study (3): Medical devices
    26. 26. Case study (4): Process of careAim: How does the application of telemedicine fordiabetes compare with implementation for otherdiseases? Have there been any significant updatessince the last Cochrane review in 2007?P = diabetesI = telemedicineC = other delivery mechanismsO = systematic reviews, meta analyses, RCTs(review levels of evidence)
    27. 27. 1. Emtree => telemedicine (identify telehealth)2. Filter => diseases to compare areas of application; select diabetes3. Edit => convert diabetes-mellitus to major term4. Limit => Cochrane reviews (via copy to Advanced Search / EBM limit)5. Limit => Systematic Review, RCTs6. Filter set #3 to view levels of evidence directlyCase study (4): Process of care
    28. 28. Case study (4): Process of care
    29. 29. Searching for EBM: summaryWhen searching for evidence onEmbase, the results can alwaysbe summarized according to thelevels of evidence available
    30. 30. Thank you• Q&A will be sent to you by email.• For more information and questions, please visitwww.elsevier.com/online-tools/embase/customer-support.• Our next Embase webinar is on June 26 – Tips and tricks fortrainers (10AM CET).Please fill out the surveythat appears on yourscreen after leaving thewebinar.

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