1. G. Biondi Zoccai – Ricerca in cardiologia What to expect? Core modules IntroductionIntroduction Finding out relevant literatureFinding out relevant literature General guidelines for literature appraisalGeneral guidelines for literature appraisal Abstract and Introduction appraisalAbstract and Introduction appraisal Methods and Results appraisal 1 - Patients and proceduresMethods and Results appraisal 1 - Patients and procedures Methods and Results appraisal 2 - Data collection/management and descriptive analysisMethods and Results appraisal 2 - Data collection/management and descriptive analysis Methods and Results appraisal 3 - Inferential analysisMethods and Results appraisal 3 - Inferential analysis Discussion and Conclusions appraisalDiscussion and Conclusions appraisal

2. G. Biondi Zoccai – Ricerca in cardiologia Resources for finding the literature Seniors, juniors, and colleaguesSeniors, juniors, and colleagues TextbooksTextbooks Medical journalsMedical journals World wide webWorld wide web

3. G. Biondi Zoccai – Ricerca in cardiologia What to choose? Simple and easy-going or … fast but tough?

4. G. Biondi Zoccai – Ricerca in cardiologia Seniors, juniors, and colleagues

5. G. Biondi Zoccai – Ricerca in cardiologia Textbooks

6. Medical journals

7. G. Biondi Zoccai – Ricerca in cardiologia World wide web

8. G. Biondi Zoccai – Ricerca in cardiologia 1st step: framing the question Population: who are the relevant patients?Population: who are the relevant patients? Intervention or exposure: what are the management strategies we want to appraise or the relevant harmful exposure we want to study?Intervention or exposure: what are the management strategies we want to appraise or the relevant harmful exposure we want to study? Outcome: what are the patient-relevant consequences of the exposure in which we are interested?Outcome: what are the patient-relevant consequences of the exposure in which we are interested?

9. G. Biondi Zoccai – Ricerca in cardiologia 2nd step: determining question 2nd step: determining question type Therapy: determining the effect of different treatments on improving patient function and avoiding adverse eventsTherapy: determining the effect of different treatments on improving patient function and avoiding adverse events Harm: ascertaining the effects of potentially harmful agents on patient function, morbidity, and mortalityHarm: ascertaining the effects of potentially harmful agents on patient function, morbidity, and mortality Diagnosis: establishing the power of an intervention to differentiate between those with and those without a target condition or diseaseDiagnosis: establishing the power of an intervention to differentiate between those with and those without a target condition or disease Prognosis: estimating the future course of a patient’s diseasePrognosis: estimating the future course of a patient’s disease

10. G. Biondi Zoccai – Ricerca in cardiologia 1st step: example All-purpose question: are coronary drug-eluting stents beneficial?All-purpose question: are coronary drug-eluting stents beneficial? Improved (searchable) question:Improved (searchable) question: Population: patients with acute or chronic coronary artery disease undergoing percutaneous revascularization Population: patients with acute or chronic coronary artery disease undergoing percutaneous revascularization Intervention: coronary stents eluting anti-proliferative drugs Intervention: coronary stents eluting anti-proliferative drugs Outcome: cardiac death, non-fatal myocardial infarction, or ischemia-driven target vessel revascularization Outcome: cardiac death, non-fatal myocardial infarction, or ischemia-driven target vessel revascularization

11. G. Biondi Zoccai – Ricerca in cardiologia 2nd step: example Therapy: which coronary device is more effective and safe?Therapy: which coronary device is more effective and safe? Harm: what is the risk of stent thrombosis with drug-eluting stents?Harm: what is the risk of stent thrombosis with drug-eluting stents? Diagnosis: can I recognize which angiographically- intermediate lesions are functionally (ie, clinically) significant?Diagnosis: can I recognize which angiographically- intermediate lesions are functionally (ie, clinically) significant? Prognosis: can I predict which patients are more likely to develop restenosis if treated with a bare-metal stent?Prognosis: can I predict which patients are more likely to develop restenosis if treated with a bare-metal stent?

12. G. Biondi Zoccai – Ricerca in cardiologia WWW resources BioMedCentral: www.biomedcentral.comBioMedCentral: www.biomedcentral.com Clinical Trial Results: www.clinicaltrialresults.org/Clinical Trial Results: www.clinicaltrialresults.org/ DARE: www.york.ac.uk/inst/crd/crddatabases.htmDARE: www.york.ac.uk/inst/crd/crddatabases.htm EMBASE: www.embase.comEMBASE: www.embase.com Google scholar: scholar.google.comGoogle scholar: scholar.google.com Medscape: www.medscape.comMedscape: www.medscape.com meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/ PubMed: www.pubmed.govPubMed: www.pubmed.gov The Cochrane Library: www.cochrane.orgThe Cochrane Library: www.cochrane.org UpToDate: www.uptodate.comUpToDate: www.uptodate.com WebMD: www.webmed.comWebMD: www.webmed.com Web of Science: isiknowledge.comWeb of Science: isiknowledge.com

13. G. Biondi Zoccai – Ricerca in cardiologia WWW resources BioMedCentral: www.biomedcentral.comBioMedCentral: www.biomedcentral.com Clinical Trial Results: www.clinicaltrialresults.org/Clinical Trial Results: www.clinicaltrialresults.org/ DARE: www.york.ac.uk/inst/crd/crddatabases.htmDARE: www.york.ac.uk/inst/crd/crddatabases.htm EMBASE: www.embase.comEMBASE: www.embase.com Google scholar: scholar.google.comGoogle scholar: scholar.google.com Medscape: www.medscape.comMedscape: www.medscape.com meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/ PubMed: www.pubmed.govPubMed: www.pubmed.gov The Cochrane Library: www.cochrane.orgThe Cochrane Library: www.cochrane.org UpToDate: www.uptodate.comUpToDate: www.uptodate.com WebMD: www.webmed.comWebMD: www.webmed.com Web of Science: isiknowledge.comWeb of Science: isiknowledge.com

14. G. Biondi Zoccai – Ricerca in cardiologia BioMedCentral

15. BioMedCentral

16. BioMedCentral BioMedCentral is provided by a private UK company (the same that provides mRCT)BioMedCentral is provided by a private UK company (the same that provides mRCT) It mostly contains open access journals or conference proceedingsIt mostly contains open access journals or conference proceedings It may be a useful and cheap (it’s free!) starting point, but to date its content is limitedIt may be a useful and cheap (it’s free!) starting point, but to date its content is limited In the future however it should vastly expandIn the future however it should vastly expand

17. G. Biondi Zoccai – Ricerca in cardiologia Clinical Trial Results

18. G. Biondi Zoccai – Ricerca in cardiologia Clinical Trial Results CTR is provided for free by C.M. Gibson (the inventor of the TIMI frame count and TIMI myocardial perfusion grade)CTR is provided for free by C.M. Gibson (the inventor of the TIMI frame count and TIMI myocardial perfusion grade) It contains pre-publication data from recent clinical trialsIt contains pre-publication data from recent clinical trials However, it is not comprehensive and its scope largely reflects the interests of its developer (ie acute coronary syndromes)However, it is not comprehensive and its scope largely reflects the interests of its developer (ie acute coronary syndromes)

19. G. Biondi Zoccai – Ricerca in cardiologia DARE

20. DARE The Database of Abstracts of Reviews of Effectiveness is provided for free by the University of YorkThe Database of Abstracts of Reviews of Effectiveness is provided for free by the University of York It contains titles and abstracts of systematic reviews of effectivenessIt contains titles and abstracts of systematic reviews of effectiveness Each item contained (ie systematic reviews) is a very good starting point to get info on a topicEach item contained (ie systematic reviews) is a very good starting point to get info on a topic However, some hits are obsolete and no papers on prognosis, diagnosis, or pathophysiology are included to dateHowever, some hits are obsolete and no papers on prognosis, diagnosis, or pathophysiology are included to date

21. G. Biondi Zoccai – Ricerca in cardiologia EMBASE

22. EMBASE EMBASE is a comprehensive archiving site, provided for a fee by ElsevierEMBASE is a comprehensive archiving site, provided for a fee by Elsevier Its scope is similar but greater and largely non- overlapping with MEDLINE/PubMedIts scope is similar but greater and largely non- overlapping with MEDLINE/PubMed It may be useful for sophisticated researchers and systematic reviewersIt may be useful for sophisticated researchers and systematic reviewers However, it’s expensive and rarely needed, as most important papers will be already in MEDLINE/ PubMedHowever, it’s expensive and rarely needed, as most important papers will be already in MEDLINE/ PubMed

23. G. Biondi Zoccai – Ricerca in cardiologia MEDSCAPE

24. MEDSCAPE A freely surfable website providing disparate content, owned by the WebMD companyA freely surfable website providing disparate content, owned by the WebMD company The Cardiology section is often updated and may provide recent data on trials or other newsThe Cardiology section is often updated and may provide recent data on trials or other news It is not developed or maintained systematically, and thus lacks comprehensivenessIt is not developed or maintained systematically, and thus lacks comprehensiveness

25. G. Biondi Zoccai – Ricerca in cardiologia mRCT

26. mRCT The meta Register of Controlled Trials is a freely searchable website containing data on registered trialsThe meta Register of Controlled Trials is a freely searchable website containing data on registered trials It is provided by the owner of BioMedCentralIt is provided by the owner of BioMedCentral It’s a good source on recent or ongoing (thus unpublished) trialsIt’s a good source on recent or ongoing (thus unpublished) trials While interesting for the clinical researcher or meta-analyst, it’s scope is limited to RCTWhile interesting for the clinical researcher or meta-analyst, it’s scope is limited to RCT

27. G. Biondi Zoccai – Ricerca in cardiologia PubMed

28. PubMed PubMed is the web (and free) version of MEDLINE (provided by the US National Library of Medicine)PubMed is the web (and free) version of MEDLINE (provided by the US National Library of Medicine) It contains data on articles printed every day in several thousands medical journals around the world, even if there is some bias toward US and English publicationsIt contains data on articles printed every day in several thousands medical journals around the world, even if there is some bias toward US and English publications It is reasonably comprehensive and sophisticated, especially for the expert userIt is reasonably comprehensive and sophisticated, especially for the expert user Nonetheless, many papers can still be missed by the MEDLINE indexers, and using PubMed requires some expertiseNonetheless, many papers can still be missed by the MEDLINE indexers, and using PubMed requires some expertise

29. G. Biondi Zoccai – Ricerca in cardiologia PubMed: tips and tricks There are 4 basic ways to search PubMed: 1. Free text searches 2. Searches with descriptors (Medical Subject Headings, MeSH) 3. Clinical queries (specific filters for studies or topics) 4. Limits (enable the searcher to select several characteristics, such as language, article type, study type, and so forth) The ideal search combines one or more of such instruments to obtain precise and concise answers to the clinical question

30. G. Biondi Zoccai – Ricerca in cardiologia Free text searches

31. G. Biondi Zoccai – Ricerca in cardiologia MeSH

32. Limits

33. Clinical queries

34. G. Biondi Zoccai – Ricerca in cardiologia History

35. Tutorials

36. Scholar Google

37. G. Biondi Zoccai – Ricerca in cardiologia Scholar Google Scholar Google is provided for free by the Google companyScholar Google is provided for free by the Google company It contains citations and direct links to abstracts or full text articlesIt contains citations and direct links to abstracts or full text articles In addition, it enables citation analysis, thus forward and backward snowballingIn addition, it enables citation analysis, thus forward and backward snowballing It’s not yet very structered, and highly relevant citations might not be included or missed because buried among thousands of non-relevant onesIt’s not yet very structered, and highly relevant citations might not be included or missed because buried among thousands of non-relevant ones

38. G. Biondi Zoccai – Ricerca in cardiologia The Cochrane Collaboration

39. G. Biondi Zoccai – Ricerca in cardiologia The Cochrane Collaboration The Cochrane Collaboration provides abstracts of systematic reviews for free and full texts and additional services for a feeThe Cochrane Collaboration provides abstracts of systematic reviews for free and full texts and additional services for a fee It contains the most rigorous systematic reviews available to date on treatmentIt contains the most rigorous systematic reviews available to date on treatment No comprehensive systematic reviews are yet available for other topicsNo comprehensive systematic reviews are yet available for other topics Many reviews, while highly valid and pertinent, might be outdated because of infrequent updatesMany reviews, while highly valid and pertinent, might be outdated because of infrequent updates

40. G. Biondi Zoccai – Ricerca in cardiologia UpToDate

41. UpToDate UpToDate is provided for a fee by an American companyUpToDate is provided for a fee by an American company It provides qualitative reviews of most topics, with the specific features that reviews are updated very frequentlyIt provides qualitative reviews of most topics, with the specific features that reviews are updated very frequently No strict methodology for review production or update is enforcedNo strict methodology for review production or update is enforced In addition, it might seem superficial and not detailed enough for experts of a topicIn addition, it might seem superficial and not detailed enough for experts of a topic

42. G. Biondi Zoccai – Ricerca in cardiologia WebMD

43. WebMD WebMD is a comprehensive website for healthcare professional, that can be accessed upon fee subscriptionWebMD is a comprehensive website for healthcare professional, that can be accessed upon fee subscription It is relatively comprehensive but unstructuredIt is relatively comprehensive but unstructured Resembles (albeit with less cardiology focus) www.medscape.com, www.theheart.org, and www.tctmd.comResembles (albeit with less cardiology focus) www.medscape.com, www.theheart.org, and www.tctmd.com www.medscape.comwww.theheart.org www.tctmd.com www.medscape.comwww.theheart.org www.tctmd.com

44. G. Biondi Zoccai – Ricerca in cardiologia Web of Science

45. G. Biondi Zoccai – Ricerca in cardiologia Web of Science Provided for an expensive fee by Thompson-Institute for Scientific Indexing, is the basis for the computation of impact factors and citation indexesProvided for an expensive fee by Thompson-Institute for Scientific Indexing, is the basis for the computation of impact factors and citation indexes Contains titles and abstracts from several thousands journalsContains titles and abstracts from several thousands journals In addition, it enables forward and backward snowballingIn addition, it enables forward and backward snowballing However, it lacks the comprehensiveness of EMBASE or PubMedHowever, it lacks the comprehensiveness of EMBASE or PubMed

46. G. Biondi Zoccai – Ricerca in cardiologia Take home messages The most important tips to remember when looking for scientific literature are:

47. G. Biondi Zoccai – Ricerca in cardiologia Take home messages The most important tips to remember when looking for scientific literature are: 1 – begin with a broad search: it you find too much, you can always refine the search later on you can always refine the search later on

48. G. Biondi Zoccai – Ricerca in cardiologia Take home messages The most important tips to remember when looking for scientific literature are: 1 – begin with a broad search: it you find too much, you can always refine the search later on you can always refine the search later on 2 – use as starting points authoritative investigators, seminal papers and/or clear-cut key-words seminal papers and/or clear-cut key-words