searching the medical information

What is available on the Internet?

Information to download using file transfer protocol

Presented in different formats (docs, pictures, data)

Medical papers Medical information, photos, pictures

Searching data Personal email Mailing list Attachments

Electronic mails to communicate with other people

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World wide web (WWW), surfing websites/pages Internet Relay Chat (IRC) E-conference / video conferencing Newsgroups /Usenet
EBM Searching

Getting connected

Company access

Corporate account Local Area Network Telephony, Satellite / broadband / cable tv

Personal access

Using Internet Service Providers

CBN, Centrin, AT&T, Telkomnet etc

Personal equipments
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Web surfing

More than 10 millions computers connected to the Net -> Internet .. Once connected to the Net, the whole sites is assessable free or with passwords Web browser

Internet Explorer, Netscape, Opera, etc

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Sites -> URL -> http://www.ika-fkui.com Security issues !!

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The patient situation, population, or problem of interest. The main intervention, defined very broadly, including an exposure, a diagnostic test, a prognostic factor, a treatment, a patient perception, and so forth. A comparison intervention or exposure, if relevant. The clinical outcomes of interest, including a time horizon if relevant.
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Medical information . (3)

How to find current best evidence, formulate .

the key question to seek an answer the best answer to the clinical problem that you currently have stored in your brain (being as quantitative as possible) the evidence resources (both traditional and avant garde) that you would consult to find best current answers.
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Clinical problem Define important, searchable question

General search strategy

Select most likely resource

Select second most likely resource

Design search strategy

Summarized the evidence Apply the evidence Poor yield

Design search strategy

Summarized the evidence

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EBM Searching

Convert your question to a search strategy

How?

Asking Answerable Clinical Questions

Patient (For which patient/population or problem do you need information?)
Intervention (What medical event do you need to study the effect of?) Comparison (What is the evidence that the proposed intervention produces better or worse results than no intervention at all, or a different type of intervention?) Outcome (What is the effect of the intervention?)

Where to find the evidence for your question?

Books Library databases Online bibliographic databases Cohrane Database of Systematic Reviews

Searching for the Evidence

US National Library of Medicine: 24,000 journals 4,000 indexed in MEDLINE Science Citation Index (SCI): 5,600 leading journals in different fields of science Current Contents/Clinical Medicine: 1150 journals

Search strategies for MEDLINE

Thesaurus searching Textword searching

Define keywords
MeSH terms

Textwords

Non-Hodgkins Lymphoma Non-Hodgkin Lymphoma Lymphoma, non-Hodgkin Lymphoma, non-Hodgkins

Important keywords not included in the MeSH tesaurus

Check whether your keywords are listed in MeSH

Consider text words when a MeSH term does not exist for your concept

Boolean operators

AND OR NOT

Strategy of using Boolean operators: first increase sensitivity, then specificity

1. 2. 3. 4. 5. 6.

7.
8. 9. 10.

One keyword concerning the patient Another keyword concerning the patient #1 OR #2 One keyword concerning the intervention Another keyword concerning the intervention #4 OR #5 One keyword concerning the outcome Another keyword concerning the outcome #7 OR #8 #3 AND #6 AND #9

Sensitivity and Specificity

Sensitivity likelihood of retrieving relevant items Specificity likelihood of excluding irrelevant items

How to increase sensitivity?

1.
2. 3. 4.

Expand your search using (broader terms in) the thesaurus. Use a textword search of the database. Use truncation and wildcards to catch spelling variants. Use Boolean OR to make sure you have included all alteratives for the terms you are after.

Truncation
vaccin* vaccine, vaccines, vaccination seizure$ singular and plural

Wildcards
gyn?ecology gynaecology, gynecology randomi?* randomisation, randomization, randomised, ...

How to increase specificity?

1.

2.

3. 4.

Use thesaurus to identify more specific headings. Use more specific terms in textword search. Use Boolean AND. Limit the search by publication type, year of publication, patients age, etc.

Limits

Type of publication Age group Gender Year of publication Language

Identify the type of article

Diagnosis Prognosis Therapy/prevention Harm/etiology

Identify the type of research that is most likely to answer your question
Question Study design Chances for finding a systematic review?

Diagnosis
Prognosis Etiology/harm

cross-sectional
cohort 1) cohort 2) case-control

Therapy/prevention

1) randomized control trial 2) non-randomized control trial 3) cohort 4) case-control

qualitative studies

Patients' experiences

Samples of Medical Information Search Engines

BMJ Free Medical Journals SumSearch

Cat Maker, software :

appraising an article critically, Make a report (CAT)

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EBM Links :
Clinical Governance & Evidence Based Medicine Resources http://www.chi.nhs.uk/eng/cgr/index.shtml

This site provides links to web sites, articles and books relating to evidence-based practise.

Bandolier www.jr2.ox.ac.uk/Bandolier/

Bandolier is produced monthly in Oxford for the NHS R&D Directorate. It contains bullet points (hence its title) of evidence-based medicine. No information is provided on how topics are selected for discussion. A search engine for the site is provided. Other useful information provided includes information on pain research and an easy-to-use NNT calculator. The site also provides links to other good websites such as the Oxford Pain Relief website which has a database of NNTs for various analgesics.

Best BETS http://www.bestbets.org/

Best Evidence Topics (BETs) were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is.

Center for Clinical Effectiveness www.med.monash.edu.au/healthservices/cce/

This site is operated through the Monash Medical Center in Australia. The site offers users full evidence reports on a number of topics. As well, it provides good links to similar websites, which are separated by category, making the site easy to use. Finally, the Center has a section of its website where you can actually submit clinical questions regarding patients and they will research the topic of interest and respond directly to your question.

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EBM Links :
Centre for Evidence-Based Medicine cebm.net

The NHS R&D CEBM was established in Oxford as the first of several centres around the UK whose goal is to promote evidence-based health care and to provide support and resources to others trying to practice and teach EBM. The website includes an EBM Toolbox with various tools for practising and teaching EBM, the CATMaker (a software programme allowing the user to create 1-page summaries of the evidence), a calendar of EBM events, and links to other EBM sites.

Centre for Evidence-Based Mental Health http://www.cebmh.com/

The aim of the CEBMH is to promote and support the teaching and practice of evidence-based mental health care. This site provides materials to help develop skills in practising EBMH and is aimed at users trying to provide training courses and at people wanting to improve their EBMH skills by working through some online tutorials for practising EBMH. Links to other useful resources including the full text online journal Evidence-Based Mental Health are also available from this site. The site is regularly updated (every Friday at 6pm GMT), and the most recent additions are highlighted on the homepage. The EBMH journal is updated quarterly and runs alongside the paper version of the journal.

Centres for Health Evidence http://www.cche.net/

The principal task of Centres of Health Evidence (CHE) is to package, disseminate, and present health knowledge in ways that facilitate its optimum use. Within the CHE, staff will monitor knowledge-based software and literature from a variety of public and private sources. Significant resources are identified and structured abstracts are developed to alert the user to the quality of evidence and how the needs of specific patients, practitioners and settings are addressed in these resources. This web site hosts the Users Guides to the Medical Literature produced by JAMA.
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EBM Links :
Clinical Assessment of the Reliability of the Examination http://www.carestudy.com/

This site provides all the protocols that the study group is involved with and instructions on how to join the group. Protocol development, investigator recruitment, patient enrollment and date entry are all done via the Internet.

Clinical Decision Rules, The Samuel Bronfman Department of Medicine http://www.mssm.edu/medicine/general-medicine/ebm/

This is a great site providing clinicians with valid clinical decision rules. Clinicians just need to fill in the information for their patients and then it will derive the post-test probabilities.

Clinical Evidence http://www.clinicalevidence.org/

Clinical evidence is a six monthly, updated compendium of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. It summarises the best available evidence and focuses on the effects of preventative and therapeutic interventions as demonstrated by randomised trials and systematic reviews of such trials.

Clinical Examination Research Interest Group http://www.sgim.org/clinexam.cfm

This site outlines the activities of the Clinical Examination Research Interest Group which includes the Rational Clinical Examination Series published in JAMA. This is a series of more than 30 systematic reviews which address the precision and accuracy of various elements of the clinical examination. The site provides a complete listing of all of these articles and links to

Clinical Resources, Clindx Update Listserv & Bibliography clinical.uthscsa.edu/clindx/update.htm

This webpage lists evidence-based articles on clinical diagnosis and the clinical examination. They have created a service that will help keep you up-to-date on the latest and best evidence on the medical history or physical examination. This information should be useful to both clinicians and clinical educators. To get the information, you simply need to subscribe to the ClinDX listserv. Once you enroll, listserv will e-mail you the current links (from above) to recent articles, every month, on the medical history and clinical examination. EBM Searching

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EBM Links :
Critique et Pratique www.crsfa.ulaval.ca/umf

This site is in French only. It uses EBM guides for critically appraising articles from recent issues of well known medical journals and provides a clinical bottom line for each. A brief glossary of EBM terms is available on this site and a search engine is also available.

EPIQ (Effective Practice, Informatics & Quality Improvement) http://www.health.auckland.ac.nz/population-health/epidemiology-biostats/epiq/

EPIQ (Effective Practice, Informatics & Quality Improvement) was established in 2002 to support effective evidence-based practice, health informatics and quality improvement initiatives in the health and disability support sectors. EPIQ is a collaboration of academics, clinicians and other health sector professionals and replaces EPI (the Effective Practice Institute).

Evidence-Based Medicine ebm.bmjjournals.com

Evidence-Based Medicine is a journal released every other month which alerts clinicians of important advances in general and family practice, internal medicine, surgery, psychiatry, pediatrics and obstetrics and gynecology. This is accomplished by selecting from the biomedical literature those original and review articles whose results are most likely to be true and useful.

Evidence-Based Mental Health http://ebmh.bmjjournals.com/

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Evidence-Based Mental Health is a journal released four times a year which alerts clinicians working in the field of mental health of important and clinically relevant advances in treatment, diagnosis, aetiology, prognosis/outcome research, quality improvement, continuing education, economic evaluation and qualitative research. This is accomplished by selecting original and review articles whose results are most likely to be accurate and clinically useful. EBM Searching

EBM Links :
Evidence-Based Nursing http://ebn.bmjjournals.com/

Evidence-Based Nursing is a journal released four times a year which alerts practising nurses of important and clinically relevant advances in treatment, diagnosis, aetiology, prognosis/outcome research, quality improvement, continuing education, economic evaluation and qualitative research.

Evidence-Based Pediatrics www.med.umich.edu/pediatrics

This site is a resource for evidence-based pediatrics provided through the University of Michigan. The site includes a list of CATs, a CAT template (step by step guide on how to create a CAT), guidelines for starting a journal club and links to other websites.

Evidence-Based Practice Centers http://www.ahrq.gov/

The Agency for Health Care Policy and Research (AHCPR) has 12 centers in the United States for developing evidence reports and technology assessments of diagnostic and therapeutic interventions used in a variety of clinical conditions. The partners of AHCPR use the products of Evidence-Based Practice Centers to develop and implement practice guidelines and other clinical quality improvement tools. The site contains evidence reports as well as links to each of the 12 centers across the US.

McMaster Health Information Research Unit hiru.mcmaster.ca/

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The goal of HIRU is to improve the effectiveness and efficiency of health care by providing innovative evidence-based information products and systems to health professionals, patients, policy makers, and the public. It is involved in a number of initiatives including being the location for: a national centre for the Cochrane Collaboration; HEALNet; an Evidence-based Practice Centre; Cancer Care Ontario and a variety of evidence-based publications. EBM Searching

EBM Links :
National Library of Medicines Health Services/Technology Assessment Text (HSTAT) gateway.nlm.nih.gov/gw/Cmd

This site is basically a very detailed search engine. It contains holdings from the AHCPR support guidelines, the AHCPR technology assessments and reviews, ATIS (HIV/AIDS technical information), NIH Warren G. Magnuson Clinical Research Studies, NIH Consensus Development Program, PHS Guide to Clinical Preventative Services (1989) and SAMHSA/CSAT Treatment Improvement Protocol (TIP).

Netting the Evidence www.shef.ac.uk/~scharr/ir/netting/

The goal of this website is to provide a complete list of evidence-based practice resources that are available on the Internet. There are more than 140 listings (arranged alphabetically), each of which includes a short description of the resource with a link to it. This list is preceded by a link to "the latest articles on Evidence Based Medicine from the MEDLINE database". No information is provided on the website about criteria used for selecting resources for inclusion. The website is easy to use and a search engine is provided.

NHS Centre for Reviews and Dissemination http://www.york.ac.uk/inst/crd/

The NHS Centre for Reviews and Dissemination (CRD) is the sibling of the UK Cochrane Centre and has the goal of producing reviews concerning the effectiveness and cost-effectiveness of healthcare interventions. It provides access to several databases including a database of structured abstracts of good quality systematic reviews (DARE) which comment on the methodological features of published reviews and summarise the authors conclusions and any implications for health practice. It also provides the full text Effective Health Care Bulletin which is a bi-monthly bulletin for decision-makers that examines the effectiveness of a variety of health care interventions.

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EBM Searching

EBM Links :
Ovid EBM http://www.ovid.com/

Ovids goal is "to support and improve information access for researchers, clinicians, and students in scientific, medical, and academic communities worldwide by providing innovative and interlinked text retrieval software and database solutions."mount sinai hospital intranet accessConnect now to the Ovid via the Sidney Liswood Library at Mount Sinai Hospital access limited to MSH intranet users. Ovid provides access to a variety of resources including bibliographic databases (such as MEDLINE, EMBASE and CINAHL); more than 300 full text journals; and other clinical information products such as Evidence Based Medicine Reviews (EBMR) and some textbooks. EBMR contains material from Best Evidence (which includes the contents of ACP Journal Club and Evidence Based Medicine) and the Cochrane Database of Systematic Reviews. It combines Best Evidence and the Cochrane Database into a single, fully searchable database with links to both MEDLINE and Ovid full-text journals. Because the databases are interlinked, users can begin a search in MEDLINE and link from MEDLINE citations to the abstract and commentary for the relevant article in Best Evidence, to the full text article, and to relevant Cochrane Reviews. Alternatively, MEDLINE searches can be limited to articles retrieved from Best Evidence.

Physiotherapy Evidence Database (PEDro) http://www.pedro.fhs.usyd.edu.au/

PEDro is an initiative of the Centre for Evidence-Based Physiotherapy (CEBP) and has been developed to give physiotherapists and others rapid access to bibliographic details and abstracts of randomised controlled trials, and systematic reviews of randomised controlled trials, in physiotherapy. Most English-language randomised controlled trials and systematic reviews in physiotherapy are on the database. Trials and reviews in other languages are represented, but probably less comprehensively. Information is also provided on how to critically appraise the trials that have been identified. Links to other useful websites are also provided. There is no information on how often the database is updated.
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EBM Links :
PubMed http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed/

PubMed is an Internet interface for MEDLINE. It is a project developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM), located at the National Institutes of Health (NIH). If the publisher has a WWW site that offers full text of its journals, PubMed provides links to that site. In addition, PubMed provides a WWW Citation Matcher service, which allows publishers (or other outside users) to match up their own citations to PubMed entries, using bibliographic information such as journal, volume, issue, page number, and year.

Resources for Practicing Evidence-Based Medicine pedsccm.wustl.edu/EBJournal_Club.html

This site specializes in pediatric critical care (intensive care) medicine. It teaches the user how to use evidence-based medicine (e.g. how to critically appraise medical literature, how to use and calculate relevant statistics and how to use systematic reviews). The site also contains links to websites providing CATs, evidence-based medicine groups, databases/directories, journal clubs as well as teaching resources.

SumSearch (formerly SmartSearch) http://sumsearch.uthscsa.edu/

SumSearch is a meta-searching service that searches the following resources:

Textbook. The default textbook to search is the Merck Manual. MEDLINE for review articles and editorials from high quality, general journals that have full texts available. National Guideline Clearinghouse from the Agency for Health Care Policy and Research (AHCPR) Database of Abstract of Reviews of Effectiveness (DARE) MEDLINE for original research.

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SUMSearch will also do focused searches depending on the type of information requested. For example, if the question being searched is one about the physical examination, SUMSearch will search the database Bedside Diagnosis.

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Can medical practice be evidence-based?

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