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

Objectives Define Evidence-Based Medicine (EBM) Define Evidence-Based Medicine (EBM) Based on a patient problem, construct a well- built clinical question Based on a patient problem, construct a well- built clinical question Identify searching strategies that could improve MEDLINE retrieval 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 * Clinical encounter * Focused clinical question * Focused clinical question * Search of “best evidence” * Search of “best evidence” * Determine the validity of the evidence Determine the validity of the evidence Extract the clinical message Extract the clinical message Incorporate patient values/preferences Incorporate patient values/preferences Make a clinical decision about care Make a clinical decision about care * What we will be talking about today.

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 Patient or Problem How would I describe a group of patients or problem similar to mine? How would I describe a group of patients or problem similar to mine? Intervention, Prognostic factor, Exposure Intervention, Prognostic factor, Exposure Which main intervention, prognostic factor, or exposure are you considering? Which main intervention, prognostic factor, or exposure are you considering? Comparison Comparison What is the main alternative to compare with the intervention? What is the main alternative to compare with the intervention? Outcome Outcome What will the exposure, intervention affect? 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? Patient or problem pediatric patients with strep throat Intervention, Prognostic factor, Exposure amoxicillin Comparisonpenicillin Outcomerelief of symptoms

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

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

Case Series and Case Reports

Case Control Studies

Cohort Studies

Randomized Controlled Trials

Systematic Reviews and Meta-Analysis

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

Clinical Encounter In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms? 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. Combining keywords using boolean operators (AND, OR, NOT) and applying limits. Using NLM’s controlled vocabulary (MeSH) and applying limits. Using NLM’s controlled vocabulary (MeSH) and applying limits. Using Clinical Queries filters. Using Clinical Queries filters.

Accessing PubMed Directly: Directly: From the library’s electronic webpage: From the library’s electronic webpage: Click on NLM PubMed link Click on NLM PubMed link An icon indicates MSC Library’s print holdings. An icon indicates MSC Library’s print holdings.