Douglas J. Federman, MD Division of General Internal Medicine University of Toledo, College of Medicine

Goals Identify sources of medical information List resources that are appropriate for the task List strategies to improve the sensitivity and specificity of searches

Personal entertainment purchasing – compare prices – find unusual items search for information about yourself – as a physician – as a professor – as a residency program NEJM January 7, 2010

Evidence-based Medicine (EBM) 1. Ask an answerable question 2. Search the literature 3. Assess the validity 4. Apply the results 5. Assess your own skills

Answerable Questions: PICO 1. Person 2. Intervention 3. Comparison 4. Outcome

Example Will a PSA measurement benefit my patients? In asymptomatic, white men does the measurement of a PSA increase life expectancy when compared to watchful waiting?

EBM Failures – 8 Themes Skills in searching Access to information (likely improved since publication) Clinical question tracking Time Clinical question priority Personal initiative Team dynamics Institutional culture Academic Medicine 2005; 80(2)

Choose the Right Tool for the Job: In the Office 56% of searches were performed on Google, 9% Pubmed, 4% Google Scholar, 3.5% Yahoo [NEJM 354(1)] NEJM Case studies, students found results 58% with Google [BMJ 333(7579)]

Choose the Right Tool for the Job: In the Office Brief, time constrained Quick, single answer searches Online textbooks, AFP, Stat!Ref, MD-Consult, UptoDate, DynaMed, eMedicine, POEMS, Cochrane database Many require a subscription, but your hospital or university often has a subscription Internet search engines are quick, and the answer is frequently in the top 10 items

Research Goal – comprehensive search Combine sources such as PubMed, Embase, Cochrane database, citation search Use multiple modalities computer, bibliography, communication with authors and experts, clinicaltrials.gov Use a librarian! Example – meta-analyses

Google Google search Probabilistic – sites can pay for high ranking, clients can cheat Google scholar Alternatives – Bing, Ask, AltaVista, Yahoo, Dogpile…

Google- Tips Learn the advanced interface, if available Shortcuts: Order matters, use the most important one first ‘+’ to force a term in ‘-’ to exclude a term “quoted phrases” [ ] is not equal to [2004 OR 2005] or [ ] Wildcard [Obama voted * on the * bill] [site: or [site:.gov] Google help pages or GoogleGuide.com

Internet Search Engines Advantages Disadvantages Quick No special terms High # of hits Usually effective Non-specific results Sifting good/bad results High # of hits Not limited to journals (scholar is better for this)

Medline: The journal subset of PubMed/NLM 1950-Present ~5280 journals >19,000,000 articles Organized by MeSH

Use their tutorial!

Medline - Reference Structure MeSH Mapping of text to MeSH Free text as effective as MeSH search for most users. Other databases that lease the data may give better yields

Medline Search from the hospital or campus to maximize full-text retrieval For non-critical searches (an article, not all articles) consider MDConsult, Google Scholar, or follow a reference from UpToDate which will lead to a full text article on the first try

Medline - Title Search Add [ti] to your search term Looks in title or abstract for that exact term Will not look for matching MeSH terms or synonyms Combine terms using OR (AND is assumed) e.g. (cardiac[ti] OR heart[ti] OR coronary[ti]) Note the parentheses are important here

Medline - Author Search Search as they are listed in citations: Lastname F[au] Lastname FM[au] Use the Single Citation Matcher

What to do when your search fails? Too few articles – broadening Use “OR” with synonyms and word variations Look for “Related Articles” Look at the MeSH terms from the relevant articles Ugh! – search the MeSH database from the Advanced Search page

What to do when your search fails? Too many articles – narrowing Add more terms (always start simple) Use Limits/Filters Core Clinical Journals or Abridged Index Medicus Look for more specific terms in the MeSH of relevant articles

Quick links to quickly practice EBM

Pubmed Features Full text links for many articles Save searches to repeat in the future Export citations to or a text file which can be imported into a citation manager directly Many other databases for researchers Genomes (sequences, domains, maps…) Proteins Chemicals

Summary Practice practicing EBM Ask questions that will focus your literature search using the for components Person Intervention Comparison Outcome Search the literature using the tool you are most comfortable with. There is little evidence for a specific tool unless you are performing a comprehensive search for research.

Summary Selecting tools with full text resources will improve speed of your tasks Take home: 2 sites for help