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PubMed and Beyond: Clinical Resources from the National Library of Medicine Kate Flewelling, MLIS National Network of Libraries of Medicine, Middle Atlantic Region Updated: 7/24/14
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Objectives Find patient education information using MedlinePlus, NIHSeniorHealth and Genetics Home Reference. List 2 ways clinicians can promote MedlinePlus to patients. Access drug information using Drug Information Portal. Find clinical trials by condition and limit to those with results in ClinicalTrials.gov. Find Systematic Reviews in PubMed Health and PubMed/MEDLINE.
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Resources for Clinicians Patient Education Drug Information Clinical Effectiveness and Clinical Guidelines Research
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PATIENT EDUCATION
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E-Patients Over half of US adults have looked online for health information in the past year. 35% of US adults have used the Internet to self-diagnosis, but only half of them talked to a clinician about what they found online. 54% of those 65+ are online—and over half of them have looked up health information online in the past year. Source: Pew Internet and American Life Project (2013) http://www.pewinternet.org/
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MedlinePlus http://medlineplus.gov/ http://medlineplus.gov/
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MedlinePlus In a Nutshell Over 900 health topics in English and Spanish Drug and herbal supplement information Videos and animations Surgery videos Health Check tools Easy-to-read Materials Multiple Languages Medical Dictionary & Encyclopedia Health News
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900 Topics! Caregivers Prescription Drug Abuse Elder Abuse Tick Bites Gay, Lesbian, Bisexual and Transgender Health Self-Harm Coping with Chronic Illness Osteoporosis Food Allergy Cardiac Rehabilitation Ostomy
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Post-traumatic stress disorder
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Health Topic: PTSD
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MedlinePlus en español
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NIH MedlinePlus magazine http://www.nlm.nih.gov/medlineplus/magazine/ Bulk orders: http://www.vitalitycommunications.com/medlineplus/libraries.php http://www.vitalitycommunications.com/medlineplus/libraries.php
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Link MedlinePlus to EHRs! http://www.nlm.nih.gov/medlineplus/connect/overview.html
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MedlinePlus Connect
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MedlinePlus Connect returns targeted MedlinePlus.gov information Delivers tailored information for a patient’s specific diagnosis, medication or lab test Responds to code-based requests used by health IT systems Problem codes (diagnoses): ICD-9-CM and SNOMED CT® Medications: RXCUI and NDC Lab tests: LOINC® Genetics information: Some requests provide responses from GHR Supports HL7 Infobutton standard Context-sensitive standard for the exchange of information between EHRs and other clinical information systems
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How It Works EHR/Health IT System Problem, medication, or lab code-based request MedlinePlus Connect Consumer health information targeted response Patient portalClinical system
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Web Service AND Web Application Web Service returns information and links in XML Health IT system has flexibility in controlling the display of information to the user Web application returns formatted Web page with tailored MedlinePlus content This is an interim page in between the health IT system and full pages on MedlinePlus.gov Explore demos of MedlinePlus Connect: http://apps.nlm.nih.gov/medlineplus/services/servicedemo.cfm http://apps.nlm.nih.gov/medlineplus/services/demo.html
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Why MedlinePlus Connect? MedlinePlus Connect outreach identified as an NN/LM national initiative HHSinnovates Award in March 2011 It is free and easy to implement It can be used alone or in conjunction with other patient education services Helps meet the patient-specific education criteria objective for meaningful use
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Health Care Organizations & EHRs Health care: Cleveland Clinic Institute for Family Health Ohio State University Wexner Medical Center University of Utah (Geisinger Health System) EHR and Health IT systems: Epic, Procentive, ComChart, Dexter-Solutions, Aetna Easy to implement. It’s a one-time change on the back end of the system
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Find Details from Link on Home Page http://www.nlm.nih.gov/medlineplus/connect/overview.html
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Genetics Home Reference http://ghr.nlm.nih.gov/ http://ghr.nlm.nih.gov/
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Resource for genetic conditions, including rare diseases
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Information Rx http://informationrx.org/ http://informationrx.org/ Refer people to MedlinePlus and Genetics Home Reference Order special prescription pads and other materials Help people: better understand health information enhance conversations between healthcare providers and patients encourage the use of evidence- based health information on the Internet
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NIHSeniorHealth http://nihseniorhealth.gov http://nihseniorhealth.gov Joint project of NLM and National Institute on Aging senior-friendly format 64 health topics 150 health videos
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Information specific for older adults
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DRUG INFORMATION
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Drug Information Portal http://druginfo.nlm.nih.gov/ http://druginfo.nlm.nih.gov/
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Drug Information Portal: Haldol
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Resources by audience
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DailyMed http://dailymed.nlm.nih.gov http://dailymed.nlm.nih.gov Manufacturer’s Label Indications and Usage Contraindications Warnings Dosage and Administration Patient Counseling Information
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Pillbox http://pillbox.nlm.nih.gov/ http://pillbox.nlm.nih.gov/ Pillbox enables rapid identification of unknown solid-dosage medications (tablets/capsules) based on physical characteristics and high-resolution images. Once a medication is identified, Pillbox provides links to drug information and drug labels.
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Exercises Part 1
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CLINICAL EFFECTIVENESS AND CLINICAL GUIDELINES
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PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth http://www.ncbi.nlm.nih.gov/pubmedhealth Clinical effectiveness research Summaries for practitioners and consumers Systematic Reviews
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Critical assessment and evaluation of all research studies that address a particular clinical issue Studies are searched for and included in the review using a set of specific criteria May include a quantitative pooling of data, called a meta- analysis. Example: Scientists collected all the published studies that compared types of treatment for prostate cancer that had not spread beyond the prostate gland. They compiled the results of these studies in a comparative effectiveness review, which is a type of systematic review. Source: Agency for Health Care Research and Quality http://1.usa.gov/1gFJZnw
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Contents Abstracts (short technical summaries) of systematic reviews in DARE, the Database of Abstracts of Reviews of Effects—many of them include a critical summary of the review Plain language summaries and abstracts of reviews from the Cochrane Collaboration Full texts of reviews from a growing group of public agencies Information developed by public agencies for consumers and clinicians that is based on systematic reviews More info: http://1.usa.gov/1iKAAA8
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Sources Cochrane Collaboration-Plain Language Summaries National Institute for Health and Care Excellence (NICE) (UK) Agency for Healthcare Research and Quality (US) National Cancer Institute-PDQ (Physician Data Query) Dept. of Veterans Affairs- Evidence-based Synthesis Program Canadian Agency for Drugs and Technologies in Health. Over 30,000 systematic reviews from last 10 years
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Search Results example 1
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Search results example 2
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Filters
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Caution Searching functionality needs work Expect enhancements over time Be as specific as possible-use words such as Prevention, Screening, Treatment, Management
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National Guideline Clearinghouse http://guidelines.gov/ http://guidelines.gov/ Search evidence-based guidelines from a variety of sources Compare Guidelines side by side Save your favorite guidelines and organizations.
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Examples-Organizations American Academy of Child and Adolescent Psychiatry American Psychiatric Association American College of Physicians Department of Veterans Affairs Health Care for the Homeless (HCH) Clinician's Network National Collaborating Centre for Mental Health (UK) American Geriatrics Society
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Inclusion criteria as of June 2104 Documentation will need to be provided showing that the guideline is based upon a systematic review of the evidence. Documentation must contain an assessment of the benefits and harms of the recommended care and alternative care options. Source: http://www.guideline.gov/faq.aspx#Inclusion
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Advanced search
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Compare guidelines
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My NGC
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RESEARCH
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ClinicalTrials.gov
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Sample Uses of ClinicalTrials.gov Access information about specific trial o Find trials for potential participants o Track progress and protocol changes o See results (if available) Assess available evidence relevant to a specific clinical topic Assess nature of current and past research Review methodologies used in clinical trials
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PUBMED Find Literature Fast
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PubMed http://www.pubmed.gov / http://www.pubmed.gov /
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What is PubMed? The world’s premiere biomedical bibliographic database Online access to the MEDLINE database Contains more that 22 million citations to journal articles in these major content areas: Biomedical Sciences Nursing, Dentistry, Pharmacy and Allied Health Veterinary Medicine Preclinical sciences
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3 ways to speed up your search 1.Use clinical queries to limit to clinical research areas 2.Use filters to limit your search quickly 3.Once you have one good article, click Related Citations to see more like it.
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Clinical Queries Evidence-based search filters Systematic Reviews Therapy Etiology Prognosis Diagnosis Clinical Prediction Guides
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PubMed Clinical Queries Available from the PubMed Home page Therapy Diagnosis Etiology Prognosis Clinical Prediction Guides Search filters: http://1.usa.gov/1bj4De4 Systematic Review Search filter: http://1.usa.gov/184vDzf
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Medical Genetics Available from PubMed Clinical Queries Developed in conjunction with the staff of GeneReviews: Genetic Disease Online Reviews at GeneTests, University of Washington, Seattle Topics: Diagnosis Differential Diagnosis Clinical Description Management Genetic Counseling Molecular Genetics Genetics Testing All
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Example: Sickle Cell Disease
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PubMed Search Tips and Tricks Designed to be easy to use A few tricks make it even more powerful Tutorials help you master the skills to become an efficient, expert searcher
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A PubMed Subject Search Be specific Don’t use punctuation (quotation marks) Don’t worry about capitalization
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Examples Use key words for main concepts Leave out words like the, of, for The word “and” is a Boolean operator; it is assumed and automatic Author and journal key words work too!
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Automatic Term Mapping (ATM) PubMed uses Automatic Term Mapping which recognizes thousands of concepts and maps to an appropriate term. ATM checks these tables: Subjects (MeSH – Medical Subject Headings ) Journal Titles Authors
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Search Details Show Mapping
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Phrase Searching aids drugs breast feeding = 418 (processed using ATM, many relevant results) “aids drugs” AND “breast feeding” = 3 (very limiting; okay for specific items)
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Related citations
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Show Additional Filters for more options
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Filter to Free Full Text
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Abstract View
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Save time with preformulated PubMed searches and filters!
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PubMed Special Queries http://www.nlm.nih.gov/bsd/special_queries.html http://www.nlm.nih.gov/bsd/special_queries.html MedlinePlus: Searches on Health Topics http://www.nlm.nih.gov/medlineplus
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Where to find other PubMed searches? Everywhere in the NLM-universe! Genetics Home Reference Conditions Drug Information Portal ClinicalTrials.gov
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Genetics Home Reference-PubMed Searches http://ghr.nlm.nih.gov/ http://ghr.nlm.nih.gov/
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Drug Information Portal http://druginfo.nlm.nih.gov/ http://druginfo.nlm.nih.gov/
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ClinicalTrials.gov http://clinicaltrials.gov/ http://clinicaltrials.gov/ Study Records Link to Publications (when available)
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Exercises Part 2
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Questions?
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Thank You! This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276- 2011-00003-C with the University of Pittsburgh, Health Sciences Library System. Kate Flewelling, MLIS National Network of Libraries of Medicine, Middle Atlantic Region http://nnlm.gov/mar/ flewkate@pitt.edu http://guides.nnlm.gov/mar_clinical
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