1. CHMC PGY-1 FP Residents Evans Whitaker, MD, MLIS Norris Medical Library 2003 Zonal Ave. Los Angeles, CA 90089-9130 ewhitake@usc.eduewhitake@usc.edu, 323 442 1128

2. Background questions  USC grad? Familiar with Norris home page?  Are you comfortable with electronic resources – ebooks, ejournals?  How comfortable are you with EBM?  What did you think of the UMASS EBM online tutorial/quiz?UMASS EBM  Are you comfortable with MEDLINE searching? What interface have you used (PubMed, Ovid)? Do you know what MeSH means?  Have you used EndNote or RefWorks?

3. Outline for Today I.Access to USC resources II.Lightning tour of Norris Resources III.EBM Primer and Sources IV.MEDLINE – Ovid and a little PubMed V.Miscellany

4. Access to USC Resources

5. USC Proxy Server

6. General Information  For biomedical information make Norris Medical Library your home base (http://www.usc.edu/nml ) -- bookmark it!http://www.usc.edu/nml  By beginning your information seeking at the Norris homepage you will have full-text access to everything to which USC subscribes.

7. Tour of Norris Homepage

8. Moving from Left to Right… the Key Points Journals –All USC eJournals – lists every electronic journal in the USC system Books/Multimedia Databases –Ovid MEDLINE -- –PubMed @USC -- –Other USC Databases – A-Z ERIC – education database PsycInfo Sociological Abstracts Wilson Education Full Text Key Resources for: “portal” for selected sources for various groups eResources  Search eResources database  drop down box  choose Education. This leads to a hodge-podge of ebooks, databases, websites, etc. –Research and Development Resource Base (http://128.100.115.20/) bibliographic database, source of Continuing Education & Knowledge Translation, Interprofessional Literature, and Faculty Development.http://128.100.115.20/ Catalogs –HELIX -- Norris Medical and Wilson Dental Libraries –ADVOCAT -- USC Law Library –HOMER -- All other USC libraries Quicklinks -- many common resources listed in drop down menu. HELP – leads to phone, IM, and email connections to medical librarians. We can help with devising searches, finding information sources, troubleshooting, etc. IM and phone hours are M-F 9-5. There is one working day turnaround on email questions.

9. Clinical Information Resources Designed for rapid information finding, fast enough for clinical work  UpToDate UpToDate  ACP Pier  Essential Evidence, nee InfoRetriever  Clinical Evidence (evidence based)  Epocrates – pharmacy, drug interactions  LexiComp – pharmacy, drug interactions

10. Books  Electronic books will be the most practical for you…  Two sources: HELIX – the Norris Library Catalog (best for known book Multi Ebook Search (from the QuickLinks menu) searches within >700 ebooks

11. Journals  Electronic journals  Two sources All USC eJournals – as it sounds HELIX – Medical library catalog

12. EBM Resources  OVID OVID Cochrane Database of Systematic Reviews ACP Journal Club Database of Abstracts of Reviews of Evidence (DARE)  Clinical Evidence (search for title)  National Guideline Clearinghouse National Guideline Clearinghouse  TripDatabase TripDatabase  SumSearch SumSearch  User's Guides to the Medical Literature User's Guides to the Medical Literature  “How to Read a Paper” “How to Read a Paper”

13. MEDLINE  Ovid MEDLINE Ovid MEDLINE  PubMed (use PubMed@USC to get full-text links)

14. EBM Resources

15. Evidence-Based Medicine  Simple concept – “use the best information available to take care of your patients”  It is a formalization of good practices in information finding, evaluation, and application  EBM has appeared on the scene in the last 15 years or so due to a combination of factors – computers and changing healthcare environment.  Process begins and ends with the patient

16. EBM step by step  5 Steps Formulate search (PICO, searchable question) Track down the best information (in Evaluate results (Assess methodology and statistics) Apply results to practice Reevaluate effectiveness

17. Background and Foreground

18.  Relevant in choice of materials  Background Texts, review articles might be best source  Foreground Primary research literature is best source

19. Evidence Pyramid Source: http://library.downstate.edu/EBM2/2100.htm

20. The Evidence Pyramid  Those layers nearest the top are the preferred information in EBM  Many questions in medicine do not have answers, many do not have systematic reviews, meta analyses, RCTs, or even cohort studies.  Means we have to make use of the best available information.

22. PICO  Assists formulation of the clinical question.  Grown from the EBM movement of the last 15 years. PPopulation, Patient, or Problem IIntervention or Exposure CComparison (optional) OOutcomes

24. Evaluate Results  I am no biostatistician, I have used the simplified approach of Trisha Greenhalgh, MD when I have had to analyze a paper.Trisha Greenhalgh,  Her common sense recommendations are (at least somewhat) realistic for a practicing primary care physician.

25. MEDLINE and its two avatars

26. Ovid and PubMed  Ovid commercial product that includes multiple databases, and the option of subscribing to full text of books and journals.  PubMed US governmental bibliographic database collaboration of National Library of Medicine (NLM), National Center for Biotechnology Information (NCBI), and the National Institutes of Health (NIH). It is free to use and is the only database of its size and scope in the world.

27. PubMed and MEDLINE OvidSP -- different interface and search engine, same contents as MEDLINE. MEDLINE is a subset of PubMed. The 2+ million article difference includes articles both articles that are being processed and will move into MEDLINE, and articles which will never be included in MEDLINE (e.g., outside the scope of the database). (18.6/16.8 as of 08/14/08)

28. Pros and Cons of Ovid MEDLINE  Pros Easier to learn than PubMed Automatic “mapping” of search terms works better than PubMed Basic search can be used at the speed of clinical medicine Basic and Advanced search modes work well together  Cons Expensive After leaving an academic medical center unlikely to have access

29. What Else is in Ovid?  EBM (the three below and others) Cochrane Database of Systematic Reviews DARE (Database of Abstracts of Reviews of Effects) ACP Journal Club  CINAHL -- allied health and nursing database  Ovid Healthstar – “contains citations to the published literature on health services, technology, administration, and research.”  Health and Psychosocial Instruments (HAPI) -- information on measurement tools for healthcare  Books @ Ovid (almost 400 books)

30. How to search OvidSP Basic  “Natural language” search engine  Keep “include related terms” checked  Can combine and limit searches  Good for a few good articles  Useful as a way to find “the right words” for Ovid Advanced Search  Can use at the speed of clinical medicine

31. OvidSP Basic – things to know and tips  A good place to start  Searches yield 500 or more hits  “Good stuff” in the first 20-30. If nothing relevant is found in that group, reformulate search or move on to Advanced  Based on our experience at NML, use keywords without AND, OR, or punctuation. Seems to retrieve the smallest, most focused set of results

32. Advanced Ovid Search  Default at Norris Medical Library.  Resembles previous versions of Ovid.  Steps in a search: Enter search concepts one at a time. Ovid translates the user’s terms into MeSH terms. User may choose MeSH terms, explode, focus, and apply sub-headings. Combine concepts Limit results as a last step

33. Advanced Ovid Search -Tips  Subheadings narrow searches.  Do not use subheadings unless they match your needs.  Do not overuse subheadings – not all concepts need them, and few concepts need more than one or two.  Limits narrow searches.  Do not overuse limits, try to apply them once at the end of devising your search.  Learn to use the MeSH tree and “scope notes”

34. Formulate your question  Many of the same concepts that apply to EBM also apply to Ovid searching.  First, you identify the “information need”.  Define “the clinical question”.  Define the “searchable clinical question”, identify constituent parts of CQ, remove extraneous details.  Choose the most appropriate information source in which to begin your search – it might be a book!  Enter your search terms.  Review results and reformulate search if necessary.

35. Searches to try….  Basic “ice cream headache”  Basic and Advanced “selenium and prostate cancer prevention”  Advanced “use of antibiotics for common cold”  Others of our devising

37. Miscellany

38. How to keep up with the information deluge….  eTOCS (JAMA)  MyNCBI and Ovid Personal Account  UpToDate-”What’s New”  Faculty of 1000 – Medicine Faculty of 1000 – Medicine

39. How to organize what you have (or will) receive  EndNote/EndNoteWeb EndNote/EndNoteWeb  RefWorks RefWorks  others

40. The “elephant in the room”  GoogleScholar -- Advanced Preferences GoogleScholar  GS is good for preliminary exploration of an unfamiliar topic. Yields good terms to use in more valid and authoritative search engines.  GS will also occasionally find full text of an article in a journal to which USC does not subscribe.

41. Scirus.com  A search engine devoted to scientific websites. Easy to use. Higher overall quality of sites than GS.  Can set preferences to link to USC full-text  “Independent” product of publishing giant Elsevier. I have not seen evidence of bias.  Worth a look when exploring a topic.

42. Tips  Norris as home page, use proxy server.  Sign up for a free account with Ovid to save searches and annotate articles.  Sign up for a free MyNCBI account, you can save PubMed searches, collect articles, and have alerts emailed to you about new articles from saved searches.  Sign up for free eTOCS for those journals whose contents you want to scan regularly.  Sign up for free Web-of-Knowledge/EndNote accounts. This is a nice way to store, organize, and use citations found in your research. Consider Connotea as well.  Consider classes at your local library in PubMed, OvidSP, EndNote, etc.

43. Final Exam DIAGNOSIS  1. MRI for breast cancer screening, should this be our method of choice?  2. PSA variations – PSA velocity, PSA density, free PSA ratios – do these add value to prostate cancer screening? TREATMENT  3. Low back pain patients -- how effective (to decrease pain) are chiropractic and acupuncture therapies? Are there studies that compare these modalities?  4.Operative vs. non-operative treatment for acute Achilles tendon ruptures – which is better?

44. Thanks for your attention  Let us know if you have questions!!