Evidence-Based Medicine in PubMed

1. Evidence-Based Medicine in PubMed PubMed for Trainers, Spring 2014 U.S. National Library of Medicine (NLM) and NLM Training Center

2. Objectives • To explore MeSH vocabulary and PubMed features that facilitate finding evidence-based research • Define the term “evidence based medicine” • Identify and discuss publication types and research design vocabulary available in MeSH • Introduce and examine three PubMed topic-specific searches: clinical queries; systematic reviews; and comparative effectiveness research • Introduce PubMed Health

3. What is Evidence-Based Medicine? • The use of the current best evidence in making clinical decisions See Sackett, D. Evidence-based Medicine - What it is and what it isn't. BMJ 1996; 312:71-72. http://www.bmj.com/cgi/content/full/312/7023/71

4. “The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.” (Sackett D, 2002)

5. What do we mean by “Evidence-Based Medicine” in the context of PubMed? Identifying the best available evidence in the literature to inform clinical decision making using: • Study characteristics (i.e., research design and methods) • Reviews (including systematic reviews) of the literature

7. Publication Types Describe the item being indexed rather than its topic.   There are 3 main categories: • Publication Components, e.g., English Abstract • Publication Formats, e.g., Lectures, Letter • Study Characteristics, e.g., Clinical Trial, Twin Study

8. Study Characteristics (PTs) Case Reports Clinical Conference Clinical Trial + Comparative Study Consensus Development Conference + Evaluation Studies In Vitro Meta-Analysis Multicenter Study Scientific Integrity Review Twin Study Validation Studies

9. Study Characteristics (PTs) Clinical Trial Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Controlled Clinical Trial Multicenter Study Randomized Controlled Trial

10. Clinical Trial Phases • Phase I Is it safe? • Phase II What’s the right dose? • Phase III How good is it compared to the standard treatment? • Phase IV Does it have any rare or long term adverse effects?

11. Publication Type vs. Method “as Topic”

12. Research Design MeSH Headings:Investigative Techniques (examples) • Double-blind method (1990, Aug 1977) • Matched-Pair Analysis (1992) • Patient selection (1995) • Random allocation (1991, 1978) http://www.ncbi.nlm.nih.gov/mesh?term=Investigative%20Techniques

13. MeSH Pop Quiz!

14. Exercise Construct a PubMed search strategy to find studies comparing treatments for sleep apnea. HINT: You’re looking for a PT.

15. Clinical Queries

16. Clinical Queries: Clinical Study Categories

17. Clinical Queries: Clinical Study Categories

18. Systematic Reviews Defined (by NLM) • One or more questions are posed. • Study results are collected. • Criteria are used to include or exclude studies. • Data extracted from the selected studies are combined and compared. • Conclusions are made. http://www.nlm.nih.gov/pubs/techbull/jf02/jf02_systematic_reviews.html

20. PubMed Systematic Review query also includes: • meta-analyses • reviews of clinical trials • evidence-based medicine • consensus development conferences • guidelines, and • citations to articles from journals specializing in clinical review studies. Filter strategy: http://www.nlm.nih.gov/bsd/pubmed_subsets/sysreviews_strategy.html

21. Exercise: Clinical Queries • Using the Clinical Queries page, find studies exploring the effect of weight loss on obstructive sleep apnea • Look at the Systematic Reviews and click See all to view them in PubMed

22. Comparative Effectiveness effectiveness [sb] http://www.nlm.nih.gov/nichsr/cer/cerqueries.html

23. PubMed CER Searches Conceptual Structure Comparative OR Effective Clinical Studies RCTs Outcomes Cohort Administrative Data/Registries/ EHRs Observational Studies Comparative OR Effective Outcomes Systematic Reviews Systematic Reviews Modeling Simulations Health Disparities Costs & Cost Analysis AND OR “About” CER ALL of the Above http://www.nlm.nih.gov/nichsr/cer/CER_search_strategies.html

24. Exercise: Comparative Effectiveness Research • Use the comparative effectiveness search page to search for weight loss on obstructive sleep apnea • Look at results for Observational Studies • Look at results for Systematic Reviews, Simulations, Models • Compare your results for CER search on Systematic Reviews with the Clinical Queries Systematic Reviews search results http://www.nlm.nih.gov/nichsr/cer/cerqueries.html

25. My NCBI Tip: Custom Filters

26. My NCBI Tip: Custom Filters

27. Another EBM Resource: http://www.ncbi.nlm.nih.gov/pubmedhealth/ Full-text online collection of systematic reviews (or summaries) Curated Some not in PubMed

28. More about Comparative Effectiveness Research • Webinar: Comparative Effectiveness Research (from the Pacific Northwest RML): https://webmeeting.nih.gov/p77505591/ • Finding Evidence for Comparing Medical Interventions (AHRQ Guide on comparative effectiveness reviews)http://www.ncbi.nlm.nih.gov/pubmed/21433408 • Systematic Review Workshop: The Nuts and Bolts for Librarians (3-day workshop)http://www.hsls.pitt.edu/systematicreview/

29. More about Evidence-Based Medicine • Online tutorial: http://guides.mclibrary.duke.edu/ebmtutorial • Work by Dr. John Ioannidis (see profile in the Atlantic http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/ and/or search PubMed for ioannidisjp)

30. Summary • Vocabulary • Study Characteristics (PTs) • Investigative Techniques headings • PubMed Clinical and Special Queries • Clinical Study Categories (Clinical Queries page) • Systematic Reviews (Clinical Queries page) • Comparative Effectiveness (NICHSR Web site) • PubMed Health for full-text systematic reviews