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Medical Literature as a Resource for Evidence-Based Medicine. An Overview.

Medical Literature as a Resource for Evidence-Based Medicine. An Overview. Jarmila Potomková potomkov@tunw.upol.cz Palacky University Medical Library Vladimír Mihál mihalv@fnol.cz Professor of Pediatrics & Vice-Dean Palacky University Faculty of Medicine. Winter Semester List of Topics.

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Medical Literature as a Resource for Evidence-Based Medicine. An Overview.

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  1. Medical Literature as a Resource for Evidence-Based Medicine.An Overview. Jarmila Potomková potomkov@tunw.upol.cz Palacky University Medical Library Vladimír Mihál mihalv@fnol.cz Professor of Pediatrics & Vice-Dean Palacky University Faculty of Medicine

  2. Winter SemesterList 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. • MEDLINE - sample searches. Search strategy tips, Boolean operators, working with search results. MeSH, links to fulltext articles.

  3. Topic 1:AGENDA • 1A: Searching for „evidence“ • What is evidence-based medicine? • 1B: Clinical questions • Background vs. Foreground questions • 1C: Searching tips: • Books • Search engines • Google www.google.com (various doucments) • Scholar Google www.scholar.google.com (journal articles) • Scirus www.scirus.com (various SCIENTIFIC documents) • Databases • MEDLINE (journal articles bibliographic records)

  4. 1A: Searching for „evidence“ What is evidence-based medicine?

  5. EBM : Definition • Tutorial for self-study http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htm • Decision-making process in healthcare • Clinical expertise (=education + cumulated experience + clinical skills) • Patient values(=personal + unique concerns, expectations, responsibility for own health etc.) • Best (external) evidence (clinically relevant published research + sound methodology).

  6. EBM : Lifelong Process • The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning; • Caring for patients creates the need for clinically important information about • Diagnosis • Prognosis • Therapy • and other clinical and health care issues.

  7. EBM: Role of Literature • Evidence-based medicine "converts reading and appraising the biomedical literature into the pragmatic process of • using the literature to benefit individual patients, while simultaneously • expanding the clinician's knowledge base." Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education. American Journal of Medicine 1997;102(5):427-32.

  8. EBM: Why? • The total sum of medical information doubles in approximately 3.5 years • It has been estimated that from 1948 through 1994, the total sum of health-care knowledge increased 1,342 times. „Health interventions – eg. treatment (medical, surgical, pharmaceutical, etc.) must be designed to provide benefit to a patient.“ Kirkwood B, Making public health interventions more evidence based. BMJ 2004;328:966-967. 

  9. 1B: Clinical Questions Two „Layers“ Background & Foreground Questions

  10. Clinical Question for Today A role of vaccination to prevent [recurrent] otitis media in children. Author: Prof. V. Mihál, MD, PhD. PU Medical Faculty Vice-Dean, Head of Pediatric Department

  11. Two „Layers“ of Clinical QuestionsBackground (General) Questions „Background" questions ask for general knowledge about a disease or disease process • 2 essential components: • A question root (who, what, when, etc.) • A disorder, test, treatment, or other aspect of healthcare Example:What is otitis media ? What is it caused by? What are typical symptoms? Which body organ is affected? Which population is most frequently affected and when? • Need for basic information, • Not to make a clinical decision about a specific disorder.

  12. Foreground (Specific) Questions • „Foreground" questions ask for specific knowledge about managing patients with a disease. • 3 or 4 essential components • Patient and/or problem • Intervention (diagnosis, treatment…..) • Comparative intervention (optional, include if relevant) • Clinical outcome (cured disease, relief, alleviation, prognosis……) Example: In young children with recurrent of acute otitis media (AOM), should doctors recommend vaccination to reduce frequency of AOM episodes?

  13. Foreground QuestionsStructure • Patient and/or problem Children (young)/recurrent acute otitis media • Intervention Drug therapy: analgesics, antibotics • Comparative intervention Drug therapy + vaccination • Clinical outcome Prevention, reduction of AOM episodes

  14. 1C: Searching Tips BooksSearch engines Googlewww.google.com (mixed documents) Scholar Googlewww.scholar.google.com (journal articles) Sciruswww.scirus.com (various SCIENTIFIC documents)

  15. Searching Tips: Books • Online library catalogs Example:[US]National Library of Medicine LocatorPlus www.locatorplus.gov • Online medical textbooks (some free) Example: The Merck Manuals: • Merck Manual of Diagnosis & Therapy • Merck Manual – Home Edition.„A trusted source for medical information available free online“ • eMedicineHealth : Dictionary www.merckmanual.com • Google Book Search http://books.google.com

  16. LocatorPlus Advanced Menu Search

  17. LocatorPlus Search Results

  18. LocatorPlus Search ResultsHoldings View Detailed View

  19. LocatorPlus Advanced Menu Search„AND“ Search

  20. Searching Tips: Books • Online library catalogs Example:[US]National Library of Medicine LocatorPlus www.locatorplus.gov • Online medical textbooks (some free) Example: The Merck Manuals: • Merck Manual of Diagnosis & Therapy • Merck Manual – Home Edition.„A trusted source for medical information available free online“ www.merckmanual.com • eMedicineHealth : Medical Dictionary www.emedicinehealth.com • Google Book Search http://books.google.com

  21. Merck Manual of Diagnosis and Therapy : Otitis mediaSearch

  22. Merck Manual – Home EditionConsumer Information • Simple descriptions for laypeople + medical school beginners • Pronunciations of some medical terms.

  23. Searching Tips: Books • Online library catalogs Example:[US]National Library of Medicine LocatorPlus www.locatorplus.gov • Online medical textbooks (some free) Example: The Merck Manuals: • Merck Manual of Diagnosis & Therapy • Merck Manual – Home Edition.„A trusted source for medical information available free online“ www.merckmanual.com • Google Book Search http://books.google.com

  24. Google Book SearchAdvancedTitle Search

  25. Advanced Book SearchTitle Search Results

  26. Google Book SearchAdvancedText Search

  27. Text Search Results742 books on ……..date ………

  28. 1C: Searching Tips Books Search engines Googlewww.google.com (mixed documents) Scholar Google www.scholar.google.com (journal articles) Scirus www.scirus.com (various SCIENTIFIC documents)

  29. Self-study Assignment 1 • Identify types of first 40 documents, eg. • Company websites • Journal articles • Fulltext version • Bibliographic record only • Bibliographic record + abstract • Database • Educational material (universities, professional societies) • Patents • Patient information • Library catalogs • Business information (eg.pharmaceutical companies) • Others (specify)

  30. Self-study Assignment 1Notes

  31. References Bordley DR. Evidence-based medicine: a powerful educational tool for clerkship education. American Journal of Medicine 1997; 102(5):427-32. Kirkwood B, Making public health interventions more evidence based. British Medical Journal 2004;328:966-967. 

  32. Study Materials • http://knihovna.upol.cz/lf

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