1. Evidence-Based Medicine in PubMed PubMed for Trainers, Winter 2015 U.S. National Library of Medicine (NLM) and NLM Training Center

2. Objectives To explore MeSH vocabulary and PubMed features that facilitate finding evidence-based research Define the term “evidence based medicine” Identify and discuss publication types and research design vocabulary available in MeSH Introduce and examine three PubMed topic-specific searches: clinical queries; systematic reviews; and comparative effectiveness research Introduce PubMed Health 2 Revised February 2015

3. What is Evidence-Based Medicine? 3 “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; 312:71-72. http://www.bmj.com/cgi/content/full/312/7023/71 http://www.bmj.com/cgi/content/full/312/7023/71 Revised February 2015

4. The Evidence Pyramid Revised February 2015 4

5. 5 “The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.” (Sackett D, 2002) Revised February 2015

6. 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. 6 Revised February 2015

7. Evidence-Based Medicine MeSH Vocabulary Revised February 2015 7

8. 8 Useful MeSH terms used to describe research design and methodology Study Characteristics (PTs) Investigative Techniques (MHs)

9. Publication Types 9 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 February 2015

10. Study Characteristics (PTs) 10 Case Reports Clinical Conference Clinical Trial + Comparative Study Consensus Development Conference + Evaluation Studies In Vitro Meta-Analysis Multicenter Study Scientific Integrity Review Twin Study Validation Studies Revised February 2015

11. 11 Study Characteristics (PTs) Clinical Trial Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Controlled Clinical Trial Multicenter Study Observational Study Randomized Controlled Trial Pragmatic Clinical Trial Revised February 2015

12. Clinical Trial Phases 12 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 February 2015

13. Publication Type vs. Method “as Topic” 13 Revised February 2015

14. Research Design MeSH Headings: Investigative Techniques (examples) Double-blind method (1990, Aug 1977) Cohort Studies (1989) Matched-Pair Analysis (1992) Patient selection (1995) Random allocation (1991, 1978) 14 http://www.ncbi.nlm.nih.gov/mesh?term=Investigative%20Techniques Revised February 2015

15. MeSH Pop Quiz! 15 Revised February 2015

16. Exercise 16 Construct a PubMed search strategy to find studies comparing treatments for sleep apnea. Revised February 2015 HINT: You’re looking for a PT.

17. Evidence-Based Medicine PubMed Tools Revised February 2015 17

18. Clinical Queries 18 Revised February 2015

19. Clinical Queries: Clinical Study Categories 19 Revised February 2015

20. Clinical Queries: Clinical Study Categories 20 Revised February 2015

21. 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. http://www.nlm.nih.gov/pubs/techbull/jf02/jf02_systematic_reviews.html 21 Revised February 2015

22. 22 Revised February 2015

23. 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. 23 Filter strategy: http://www.nlm.nih.gov/bsd/pubmed_subsets/sysreviews_strategy.htmlhttp://www.nlm.nih.gov/bsd/pubmed_subsets/sysreviews_strategy.html Revised February 2015

24. Exercise: Clinical Queries 24 Using the Clinical Queries page, find studies exploring the effect of weight loss on obstructive sleep apneaClinical Queries Look at the Systematic Reviews and click See all to view them in PubMed Revised February 2015

25. Comparative Effectiveness 25 effectiveness [sb] http://www.nlm.nih.gov/nichsr/cer/cerqueries.html Revised February 2015

26. 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 26 http://www.nlm.nih.gov/nichsr/cer/CER_search_strategies.html Revised February 2015

27. Exercise: Comparative Effectiveness Research 27 Use the comparative effectiveness search page to search for weight loss on obstructive sleep apneacomparative 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 http://www.nlm.nih.gov/nichsr/cer/cerqueries.html Revised February 2015

28. Full-text online collection of systematic reviews (or summaries) Curated Some not in PubMed http://www.ncbi.nlm.nih.gov/pubmedhealth/ 28 Another EBM Resource: Revised February 2015

29. Your Turn Revised February 2015 29 Which is the better way of diagnosing kidney stones in the emergency room, ultrasound or CT scan?

30. Your Turn Revised February 2015 30 What is the efficacy of prophylactic mastectomy?

31. Your Turn Revised February 2015 31 What are the best strategies for treating high blood pressure in African Americans?

32. Your Turn Revised February 2015 32 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?

33. Evidence-Based Medicine My NCBI Tricks and Tips Revised February 2015 33

34. My NCBI Tip: Filters Revised February 2015 34

35. My NCBI Tip: Custom Filters Revised February 2015 35

36. My NCBI Tip: Custom Filters Revised February 2015 36

37. More about Comparative Effectiveness Research 37 Webinar: Comparative Effectiveness Research (from the Pacific Northwest RML): https://webmeeting.nih.gov/p77505591/ https://webmeeting.nih.gov/p77505591/ Finding Evidence for Comparing Medical Interventions (AHRQ Guide on comparative effectiveness reviews) http://www.ncbi.nlm.nih.gov/pubmed/21433408 http://www.ncbi.nlm.nih.gov/pubmed/21433408 Systematic Review Workshop: The Nuts and Bolts for Librarians (3-day workshop) http://www.hsls.pitt.edu/systematicreview/ http://www.hsls.pitt.edu/systematicreview/ Revised February 2015

38. More about Evidence-Based Medicine 38 Online tutorial: http://guides.mclibrary.duke.edu/ebmtutorial http://guides.mclibrary.duke.edu/ebmtutorial Work by Dr. John Ioannidis (see profile in the Atlantic http://www.theatlantic.com/magazine/archive/201 0/11/lies-damned-lies-and-medical-science/8269/ and/or search PubMed for ioannidis jp) http://www.theatlantic.com/magazine/archive/201 0/11/lies-damned-lies-and-medical-science/8269/ Revised February 2015

39. Summary 39 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 full-text systematic reviews Revised February 2015