Evidence-Based Medicine in PubMed PubMed for Trainers, Summer 2016 U.S. National Library of Medicine (NLM) and NN/LM Training Office

Objectives To explore MeSH vocabulary and PubMed features that facilitate finding evidence from research Attempt to define “evidence” in the context of literature searching for clinical medicine Explain how research design is described in MeSH (and therefore, MEDLINE) Introduce and examine three PubMed searches that are based on research design: clinical queries; systematic reviews; and comparative effectiveness research Introduce PubMed Health for finding review literature Revised June 2016

What is Evidence-Based Medicine? “integrating individual clinical expertise with the best available external clinical evidence from systematic research” See Sackett, D. Evidence-based Medicine - What it is and what it isn't. BMJ 1996; 312: Revised June 2016

The Evidence Pyramid Revised June 2016

What do we mean by “Evidence-Based Medicine” in the context of PubMed? Identifying the best available evidence in the literature to inform clinical decision making using MeSH vocabulary and PubMed features. Revised June 2016

Evidence-Based Medicine MeSH Vocabulary Revised June 2016

MeSH used to describe research design and methodology Study Characteristics (PTs) Investigative Techniques (MHs)

Publication Types Describe the item being indexed rather than its topic. There are 3 main categories: Publication Components, e.g., English Abstract Publication Formats, e.g., Lectures, Letter Study Characteristics, e.g., Clinical Trial, Twin Study Revised June 2016

Study Characteristics (PTs ) Case Reports Clinical Conference Clinical Study + Comparative Study Consensus Development Conference + Evaluation Studies Meta-Analysis Multicenter Study Scientific Integrity Review Twin Study Validation Studies Revised June 2016

Study Characteristics (PTs) in 2016 MeSH: Clinical Study Clinical Trial Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Controlled Clinical Trial Randomized Controlled Trial Observational Study Revised June 2016

Clinical Trial Phases Phase I Is it safe? Phase II What’s the right dose? Phase III How good is it compared to the standard treatment? Phase IV Does it have any rare or long term adverse effects? Revised June 2016

Study Characteristics (PTs) in 2016 MeSH: Clinical Study Clinical Trial Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Controlled Clinical Trial Randomized Controlled Trial Observational Study Revised June 2016

Publication Type vs. Method “as topic” Revised June 2016

Research Design MeSH Headings: Investigative Techniques (examples) Cohort Studies (1989) Cross-Over Studies (1995) Double-blind method (1990, Aug 1977) Matched-Pair Analysis (1992) Random allocation (1991, 1978) Revised June 2016

MeSH Pop Quiz! Revised June 2016

Exercise Construct a PubMed search strategy to find studies comparing treatments for multiple sclerosis. Revised June 2016 HINT: You’re looking for a PT.

Evidence-Based Medicine PubMed Tools Revised June 2016

Clinical Queries

Clinical Queries: Clinical Study Categories

Revised June 2016

Systematic Reviews Defined (by NLM) 1. One or more questions are posed. 2. Studies’ results are collected. 3. Criteria are used to include or exclude studies. 4. Data extracted from the selected studies are combined and compared. 5. Conclusions are made. Revised June 2016

PubMed Systematic Review query also includes: meta-analyses reviews of clinical trials evidence-based medicine consensus development conferences guidelines, and citations to articles from journals specializing in clinical review studies. Filter strategy: Revised June 2016

Exercise: Clinical Queries Using the Clinical Queries page, find studies exploring vitamin D and multiple sclerosisClinical Queries Look at the Systematic Reviews and click See all to view them in PubMed Revised June 2016

Comparative Effectiveness effectiveness [sb] Revised June 2016

RCTs PubMed CER Searches Conceptual Structure Outcomes ALL of the Above Systematic Reviews Cohort Administrative Data/Registries/ EHRs Health Disparities Simulations Modeling Comparative OR Effective Costs & Cost Analysis Outcomes “About” CER AND OR Clinical Studies Observational Studies Systematic Reviews Comparative OR Effective Revised June 2016

Exercise: Comparative Effectiveness Research Use the comparative effectiveness search page to search for vitamin D and multiple sclerosiscomparative effectiveness search page Look at results for Observational Studies Look at results for Systematic Reviews, Simulations, Models Compare your results for CER search on Systematic Reviews with the Clinical Queries Systematic Reviews search results Revised June 2016

Full-text online collection of systematic reviews (or summaries) Curated Some not in PubMed Another EBM Resource: Revised June 2016

Your Turn Revised June 2016 Which is the better way of diagnosing kidney stones in the emergency room, ultrasound or CT scan?

Your Turn Revised June 2016 What is the efficacy of prophylactic mastectomy?

Your Turn Revised June 2016 What are the best strategies for treating high blood pressure in African Americans?

Your Turn Revised June 2016 What would be the better treatment for patients over 80 who need hip surgery? The sliding hip screw or intramedullary nail? How long is their recovery and quality of life differential between both procedures?

Evidence-Based Medicine My NCBI Tricks and Tips Revised June 2016

My NCBI Tip: Filters Revised June 2016

My NCBI Tip: Custom Filters Revised June 2016

My NCBI Tip: Custom Filters Revised June 2016

More about Comparative Effectiveness Research Webinar: Comparative Effectiveness Research (from the Pacific Northwest RML): Finding Evidence for Comparing Medical Interventions (AHRQ Guide on comparative effectiveness reviews) Systematic Review Workshop: The Nuts and Bolts for Librarians (3-day workshop) Revised June 2016

More about Evidence-Based Medicine Online tutorial: Work by Dr. John Ioannidis (see profile in the Atlantic 0/11/lies-damned-lies-and-medical-science/8269/ and/or search PubMed for ioannidis jp) 0/11/lies-damned-lies-and-medical-science/8269/ Revised June 2016

Summary Vocabulary Study Characteristics (PTs) Investigative Techniques headings PubMed Clinical and Special Queries Clinical Study Categories (Clinical Queries page) Systematic Reviews (Clinical Queries page) Comparative Effectiveness (NICHSR Web site) PubMed Health for systematic reviews Revised June 2016