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1 Medical Literature as a Resource for Evidence-Based Medicine. An Overview. Jarmila Potomková Palacky University Medical Library.

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Presentation on theme: "1 Medical Literature as a Resource for Evidence-Based Medicine. An Overview. Jarmila Potomková Palacky University Medical Library."— Presentation transcript:

1 1 Medical Literature as a Resource for Evidence-Based Medicine. An Overview. Jarmila Potomková potomkov@tunw.upol.cz Palacky University Medical Library Vladimír Mihál mihalv@fnol.cz Professor of Pediatrics & Vice-Dean Palacky University Faculty of Medicine

2 2 Winter Semester List of Topics 1. Medical literature as a resource for evidence based medicine. An overview. 2. Biomedical literature resources and hierarchy of evidence. 3. MEDLINE - the most important biomedical database. PubMed online training. 4. MEDLINE - sample searches. Search strategy tips, Boolean operators, working with search results. MeSH, links to fulltext articles.

3 3 Topic 1: AGENDA  1A: Searching for „evidence“ What is evidence-based medicine?  1B: Clinical questions Background vs. Foreground questions  1C: Searching tips: Books Search engines  Google www.google.com (various doucments)www.google.com  Scholar Google www.scholar.google.com (journal articles)www.scholar.google.com  Scirus www.scirus.com (various SCIENTIFIC documents)www.scirus.com Databases  MEDLINE (journal articles bibliographic records)

4 4 1A: Searching for „evidence“ What is evidence-based medicine?

5 5 EBM : Definition  Tutorial for self-study http://www.hsl.unc.edu/services/tutorials/e bm/welcome.htm  Decision-making process in healthcare Clinical expertise (=education + cumulated experience + clinical skills) Patient values (=personal + unique concerns, expectations, responsibility for own health etc.) Best (external) evidence (clinically relevant published research + sound methodology).

6 6 EBM : Lifelong Process  The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning;  Caring for patients creates the need for clinically important information about Diagnosis Prognosis Therapy and other clinical and health care issues.

7 7 EBM: Role of Literature  Evidence-based medicine "converts reading and appraising the biomedical literature into the pragmatic process of using the literature to benefit individual patients, while simultaneously expanding the clinician's knowledge base." Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education. American Journal of Medicine 1997;102(5):427-32.

8 8 EBM: Why?  The total sum of medical information doubles in approximately 3.5 years  It has been estimated that from 1948 through 1994, the total sum of health-care knowledge increased 1,342 times. „Health interventions – eg. treatment (medical, surgical, pharmaceutical, etc.) must be designed to provide benefit to a patient.“ Kirkwood B, Making public health interventions more evidence based. BMJ 2004;328:966-967.

9 9 1B: Clinical Questions Two „Layers“ Background & Foreground Questions

10 10 Clinical Question for Today A role of vaccination to prevent [recurrent] otitis media in children. Author: Prof. V. Mihál, MD, PhD. PU Medical Faculty Vice-Dean, Head of Pediatric Department

11 11 Two „Layers“ of Clinical Questions Background (General) Questions „Background" questions ask for general knowledge about a disease or disease process  2 essential components: A question root (who, what, when, etc.) A disorder, test, treatment, or other aspect of healthcare Example: What is otitis media ? What is it caused by? What are typical symptoms? Which body organ is affected? Which population is most frequently affected and when?  Need for basic information,  Not to make a clinical decision about a specific disorder.

12 12 Foreground (Specific) Questions  „Foreground" questions ask for specific knowledge about managing patients with a disease.  3 or 4 essential components Patient and/or problem Intervention (diagnosis, treatment…..) Comparative intervention (optional, include if relevant) Clinical outcome (cured disease, relief, alleviation, prognosis……) Example: In young children with recurrent of acute otitis media (AOM), should doctors recommend vaccination to reduce frequency of AOM episodes?

13 13 Foreground Questions Structure Patient and/or problem Children (young)/recurrent acute otitis media Intervention Drug therapy: analgesics, antibotics Comparative intervention Drug therapy + vaccination Clinical outcome Prevention, reduction of AOM episodes

14 14 1C: Searching Tips Books Search engines Google www.google.com (mixed documents ) www.google.com Scholar Google www.scholar.google.comwww.scholar.google.com (journal articles) Scirus www.scirus.com (various SCIENTIFIC documents)www.scirus.com

15 15 Searching Tips: Books  Online library catalogs Example: [ US] National Library of Medicine LocatorPlus www.locatorplus.gov  Online medical textbooks (some free) Example: The Merck Manuals: Merck Manual of Diagnosis & Therapy Merck Manual – Home Edition. „ A trusted source for medical information available free online “ eMedicineHealth : Dictionary www.merckmanual.com  Google Book Search http://books.google.com

16 16 LocatorPlus Advanced Menu Search

17 17 LocatorPlus Search Results

18 18 LocatorPlus Search Results Holdings View Detailed View

19 19 LocatorPlus Advanced Menu Search „AND“ Search

20 20 Searching Tips: Books  Online library catalogs Example: [ US] National Library of Medicine LocatorPlus www.locatorplus.gov  Online medical textbooks (some free) Example: The Merck Manuals: Merck Manual of Diagnosis & Therapy Merck Manual – Home Edition. „ A trusted source for medical information available free online “ www.merckmanual.com eMedicineHealth : Medical Dictionary www.emedicinehealth.com  Google Book Search http://books.google.com

21 21 Merck Manual of Diagnosis and Therapy : Otitis media Search

22 22 Merck Manual – Home Edition Consumer Information  Simple descriptions for laypeople + medical school beginners  Pronunciations of some medical terms.

23 23 Searching Tips: Books  Online library catalogs Example: [ US] National Library of Medicine LocatorPlus www.locatorplus.gov  Online medical textbooks (some free) Example: The Merck Manuals: Merck Manual of Diagnosis & Therapy Merck Manual – Home Edition. „ A trusted source for medical information available free online “ www.merckmanual.com  Google Book Search http://books.google.com

24 24 Google Book Search Advanced Title Search

25 25 Advanced Book Search Title Search Results

26 26 Google Book Search Advanced Text Search

27 27 Text Search Results 742 books on ……..date ………

28 28 1C: Searching Tips Books Search engines Google www.google.com (mixed documents ) www.google.com Scholar Google www.scholar.google.com (journal articles)www.scholar.google.com Scirus www.scirus.com (various SCIENTIFIC documents)www.scirus.com

29 29

30 30

31 31 Self-study Assignment 1  Identify types of first 40 documents, eg. Company websites Journal articles  Fulltext version  Bibliographic record only  Bibliographic record + abstract Database Educational material (universities, professional societies) Patents Patient information Library catalogs Business information (eg.pharmaceutical companies) Others (specify)

32 32 Self-study Assignment 1 Notes

33 33 References Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education. American Journal of Medicine 1997; 102(5):427-32. Kirkwood B, Making public health interventions more evidence based. British Medical Journal 2004;328:966-967.

34 34 Study Materials  http://knihovna.upol.cz/lf

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