Académique Documents
Professionnel Documents
Culture Documents
List of Topics
Medical literature as a resource for evidence
based medicine. An overview. Biomedical
literature resources and hierarchy of evidence.
MEDLINE - the most important biomedical
database. PubMed online training. Sample
searches. Search strategy tips, Boolean
operators, working with search results. MeSH,
links to fulltext articles.
Topic 1: AGENDA
Books
Search engines
Databases
What is evidence-based
medicine?
To keep up-to-date
Need to read 6,000 articles each day
Motivation: EBM
Successes
Theophylline and asthma
We were doing the wrong thing
Littenberg, 1988
Traditional Approaches
Self-reported reading time per week.
(University setting)
Medical students
60 min.
Interns
none
Senior residents
10 min.
Fellows
45 min.
Attendings graduating
Post 1975
60 min.
Pre 1975
30 min.
Diagnosis
Prognosis
Therapy
and other clinical and health care issues.
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Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education.
11
American Journal of Medicine 1997;102(5):427-32.
Motivation: EBM
Successes
Theophylline and asthma
We were doing the wrong thing
Littenberg, 1988
Research Evidence
Decision Making
Clinical Expertise
Patient Preference
Patients
Appraise
Ask Questions
Searching
Validity
Results
Applicability
1B: Clinical
Questions
Two Layers
Background & Foreground Questions
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Foreground questions
Specific knowledge
Have 4 parts:
Patient/problem
Intervention
Comparison
intervention
Clinical outcomes
Background or Foreground?
What is asthma?
Is prednisone helpful in asthma?
What are the newest medication for
asthma?
Does atrovent used acutely make you
feel better?
Background or Foreground?
What is asthma? (B)
What are the newest medication for asthma?
(B)
Does atrovent used acutely make you feel
better? (F)
Is prednisone helpful in asthma? (F or B)
Foreground if compare to other drugs
Background if interested in how it works
Foreground (Specific)
Questions
3 or 4 essential components
Example:
In young children with recurrent of acute otitis
media (AOM), should doctors recommend
vaccination to reduce frequency of AOM episodes?
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Intervention
Be specific
Outcome
Be precise
What are the outcome of interest
Searching Superhero
Best Bets
1C: Searching
Tips
Books
Search engines
Scirus
documents)
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eMedicineHealth : Dictionary
www.merckmanual.com
http://books.google.com
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29
www.merckmanual.com
www.emedicinehealth.com
http://books.google.com
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31
32
www.merckmanual.com
http://books.google.com
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34
35
Books
1C: Searching
Tips
Search engines
www.google.com
(mixed documents
documents)
36
Levels of Evidences
(I-1) a well done systematic review of 2 or
more RCTs
(I-2) a RCT
(II-1) a cohort study
(II-2) a case-control study
(II-3) a dramatic uncontrolled experiment
(III) respected authorities, expert committees,
etc..
(IV) ...someone once told me....
http://www.phru.org/casp/
See also AAFP
Look for a
Intervention/Therapy
Diagnosis/Screening
To assess the accuracy of the test
Cohort study
Prognosis
Longitudinal cohort
Etiology/Risk factors
Pre-appraised Resources
Cochrane
http://www.cochrane.org/cochrane/revabstr/mainindex.htm
Very high quality reviews
Mostly questions of therapy
PEM database
http://researchinpem.homestead.com/homepage.html
Not pre-appraised
Pre-appraised Resources
Best Evidence Topics
http://www.bestbets.org
Developed in the ED of Manchester Royal
Infirmary in UK
Usually EM topics
Free
Ovid
What is MEDLINE?
MEDLINE is a DATABASE
MEDLINE is produced by the National
Library of Medicine
MEDLINE is available free via Pubmed
MEDLINE is sold to many vendors, like
Ovid, who search the DATA in MEDLINE
through different search engines
Database Producer
Vendors
Medline
Ovid
EMBASE
Pubmed
CINAHL
Dialog
LEXIS/NEXIS
Personal PC
Library PC
Self-study Assignment 1
Notes
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