in Evidence-biased Medicine ผศ. นพ. อนิรุธ ภัทรากาญจน์

Aims of Literature Search To solve clinical problems (EBM) To search for existing knowledge in order to conduct a research To update knowledge

ASK the right question ASK the right question ACQUIRE search for the best available evidence ACQUIRE search for the best available evidence APPRAISE the evidence APPRAISE the evidence APPLY ASSESS Professional experience Pathophysiolo gy Pharmacology Psychology Organizational issues Costs Politics etc “5A” of Evidence-Based Practice Decision making ASSESS problem ASSESS problem

General Search Strategy Search the best available database Define relevant, searchable terms Apply the evidence Design search strategy Relevant results? Summarize & Appraise the evidence GOOD Poor No Yes

Well-built Clinical Question : PICO P Patients or population I Intervention C Comparison O Outcome Type of question – – Therapy, etiology, prognosis, diagnosis, etc. Study design – – Descriptive, case-control, RCT, etc.

Example อยากทราบว่าในผู้ป่วยเด็กที่เป็น diabetic nephropathy จะมีอัตราการเกิด ESRD ต่างกัน หรือไม่ ระหว่างกลุ่มที่ได้รับ ACEI ร่วมกับ ARB เปรียบเทียบกับกลุ่มที่ได้รับ ACEI เพียงอย่างเดียว

Formulate the question Patients : children with diabetic nephropathy Intervention : ACEI+ARB Comparison : ACEI Outcome : ESRD Question : therapy Design : systematic review, RCT

Tools Hardware – – A computer with (good & fast) online access LAN, MODEM (ADSL, cable) Software – – Web browser Internet Explorer, FireFox, Opera – – Adobe Reader ® (latest version from adobe.com) – – Reference management softwares EndNote ®, ProCite®, Reference Manager ® Electronic databases – – On-line – – Off-li

Medical Clinical Evidence Sources Expert Standard textbooks Teaching documents Meeting presentation Proceedings of presentation Thesis Current contents References References of the references Index books   Science citation index   Index medicus (1879)   Excerpta medica (1948) Electronic databases

Search Exhaustively Electronic databases Printed journals, hand-search Unpublished articles Expert seeking Pharmaceutical companies data Grey literature General internet search engines: google, yahoo, msn, altavista, itools

Internet Search Engines General - Google - Yahoo - MSN - Live - Altavista - Excite - HotBot - Lycos - Go.com - Ask.com Special search engine - Clusty.com - Kartoo.net Metasearch engines - Gahooyoogle.com (search Yahoo, Google,all at once) - Arrowsearch.net - Copernic Agent

Electronic Databases Bibliographic databases Medline Embase Scopus Science Citation Index LILACS Open access databases Grey literature databases Web search engines Google Scholar Scirus

Bibliographic Database Medline   About 5,000 journals   Free access via PubMed     Now include “Oldmedline”   Oldest article in 1865 Trans Am Ophthalmol Soc   PubMed Central (   Free full-text   Mostly articles in English from North American region

Bibliographic Databases (Thai) Siriraj: Thai Medical Index ( Chula: Thai Index Medicus ( Other Thai databases – ศูนย์บริการความรู้ทางวิทยาศาสตร์และเทคโนโลยี – ศูนย์บริการความรู้ทางวิทยาศาสตร์และเทคโนโลยี ( – ห้องสมุดงานวิจัย สำนักงานคณะกรรมการวิจัยแห่งชาติ ( – ห้องสมุดงานวิจัย สำนักงานคณะกรรมการวิจัยแห่งชาติ (

Bibliographic Databases (Thai) Thai journal pointer – – Journal Link ( Thai journal citation index center (TCI) (

Pre-filtered Clinical Resources Cochrane library – – Online access: – – Offline access: CD updated quarterly ACP Journal Club (previous Best Evidence) – – Clinical Evidence – – Evidence-based Medicine (EBM Online) – –

Pre-filtered Clinical Resources UpToDate – – – – CD updated every 4 months

Multidisciplinary Clinical Resources Ovid.com MDConsult.com – – Full-text of “Clinics of North America” Journals – – Full-text of “Year Books” – – Not all have pdf files

Electronic Text Books Harrison Online – – – – (store)

What is PubMed? A web-based retrieval system developed by NCBI (a part of Entrez retrieval system) Free version of MEDLINE on the web NIH NLM NCBI National Institutes of Health National Library of Medicine National Center for Biotechnology Information

PubMed Database A database of bibliographic information drawn primarily from the life sciences literature PubMed contains links to – – Full-text articles at participating publishers' Web sites – – Other third party sites such as libraries and sequencing centers All citations in MEDLINE are assigned MeSH Terms and Publication Types from NLM's controlled vocabulary.

What Does MEDLINE Cover? Not only medicine – – medicine – – nursing – – dentistry – – veterinary medicine – – health care system – – preclinical sciences e.g., molecular biology

How Big is MEDLINE? > 5,000 biomedical journals > 16 million citations back to 1865 Published in the U.S. and 70 other countries. Coverage is worldwide, but most records are from English-language sources or have English abstracts MEDLINE contains citations, not full-text articles (PubMed provides links to full-text)

A basic search 1. Identify the key concepts for your search. Example: Find citations about bronchodilators for treating asthma in children. The key concepts are bronchodilators, asthma and children bronchodilators, asthma and childrenbronchodilators, asthma and children 2. Enter terms into the search box. 3. Press the Enter key or click Search.

Combining search terms with Boolean operators AND retrieves results that include all the search terms. AND retrieves results that include all the search terms. OR retrieves results that include at least one of the search terms. OR retrieves results that include at least one of the search terms. NOT excludes the retrieval of terms from your search. NOT excludes the retrieval of terms from your search.

Combining search terms with Boolean operators Examples Examples – Find citations on DNA that were authored by Dr. Crick in 1993: dna [mh] AND crick [au] AND 1993 [dp] dna [mh] AND crick [au] AND 1993 [dp]dna [mh] AND crick [au] AND 1993 [dp] – Find citations on the effects of heat or humidity on multiple sclerosis: (heat OR humidity) AND multiple sclerosis (heat OR humidity) AND multiple sclerosis(heat OR humidity) AND multiple sclerosis – Find citations about arthritis excluding the Publication Type Letter: arthritis NOT letter [pt] arthritis NOT letter [pt]arthritis NOT letter [pt]

Automatic term mapping (ATM) Untagged terms that are entered in the search box are matched (in this order) against Untagged terms that are entered in the search box are matched (in this order) against – MeSH (Medical Subject Headings) translation table MeSH – Journals translation table – Full Author translation table – Author index – Full Investigator (Collaborator) translation table – Investigator (Collaborator) index

Automatic term mapping (ATM) To bypass ATM, using the following formats: To bypass ATM, using the following formats: – Enclose the phrase in double quotes: “kidney allograft” “kidney allograft”“kidney allograft” – Use a search tag: kidney allograft[tw] – Use a hyphen: first-line – Truncate: kidney allograft*

Truncating search terms Example flavor* Example flavor*flavor* Finds terms that begin with the root term flavor, such as flavored, flavorful, flavoring, etc.

MeSH NLM's controlled vocabulary thesaurus. NLM's controlled vocabulary thesaurus. Terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity. Terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.

Example of MeSH

Search Field Descriptions and Tags

Example – – Search for articles about influenza published in the New England Journal of Medicine – – influenza [mh] AND n engl j med [ta]

Searching by author Enter the author’s name in the format of last name followed by initials. Omit punctuation. Enter the author’s name in the format of last name followed by initials. Omit punctuation. – Examples smith ja jones k smith jajones ksmith jajones k If only the author's last name is entered, tag the name with the author search field [au] If only the author's last name is entered, tag the name with the author search field [au] Full author names may be searched for citations published from 2002 Full author names may be searched for citations published from 2002

Searching by journal title Enter in the search box one of the following: Enter in the search box one of the following: – full journal title (e.g., molecular biology of the cell) – title abbreviation (e.g., mol biol cell) To find full journal names, use the Journals database To find full journal names, use the Journals databaseJournals databaseJournals database Use the Single Citation Matcher ( ) Use the Single Citation Matcher ( )Single Citation Matcherhttp:// Citation Matcherhttp://

Limits by dates, type of article, languages, species, gender, subsets, ages, text options, and specific search fields. by dates, type of article, languages, species, gender, subsets, ages, text options, and specific search fields.type of articlelanguagesspeciesgender subsetsagestext optionsspecific search fieldstype of articlelanguagesspeciesgender subsetsagestext optionsspecific search fields

Combining searches using History Previous searches can be combined or used in subsequent searches Previous searches can be combined or used in subsequent searches

Summary Display

Abstract Display

Medline Display

เพื่อบันทึก file ในรูปแบบของ medline ในกรณีที่ต้องการทำงานส่วน reference manager

เพื่อบันทึก article ที่คัดเลือกไว้ เก็บรวบรวมในส่วน clipboard

Search Strategy Tips Identify the key concepts. Determine alternative terms for these concepts, if needed. Refine your search to dates, study groups, etc., as appropriate. Practice helps. Strategies and styles will differ according to personal choice and professional discipline.

เด็กชายอายุ 5 เดือน มีประวัติ UTI พัฒนาการ ปกติ ตรวจร่างกายพบเพียง phimosis ผล imaging studies เป็นปกติ มารดาได้รับ คำแนะนำให้ใช้ steroid cream ทาหนังหุ้ม ปลายให้ทารก จึงมาขอคำแนะนำจากท่าน เด็กชายอายุ 5 เดือน มีประวัติ UTI พัฒนาการ ปกติ ตรวจร่างกายพบเพียง phimosis ผล imaging studies เป็นปกติ มารดาได้รับ คำแนะนำให้ใช้ steroid cream ทาหนังหุ้ม ปลายให้ทารก จึงมาขอคำแนะนำจากท่าน

Patients : infants with phimosis Intervention : circumcision Comparison : no circumcision Outcome : Urinary tract infection Question : therapy Design : systematic review, RCT

Patients : infants with phimosis Intervention : steroid Comparison : no intervention Outcome : retractable prepuce Question : therapy Design : systematic review, RCT