Transcript PubMed (MEDLINE)

Course: Research in Biomedicine and Health III
Lab 3: Looking for evidence

EBM steps
◦ Step 1: Formulating questions that can be
answered
◦ Step 2: Finding best evidence
◦ Step 3: Quick critical assessment of the
evidence
◦ Step 4: Applying evidence
◦ Step 5: Assessing effectiveness and
efficiency of the process
Be precise!
P
Patient,
problem
I
C
O
intervention Comparison Outcome
(not always)
Kew words for
database search
T
Type of
study
Metaanalysis
Systematic review
ACP Journal Club / Cochrane Database of Systematic
Reviews
Pubmed (MEDLINE) “AND” meta-analysis
ACP Journal Club / Cochrane Database of Systematic
Reviews
Pubmed (MEDLINE) Clinical Queries (Systematic Reviews)
RCT
ACP Journal Club / Cochrane Central Register of
Controlled Trials
Pubmed (MEDLINE) Clinical Queries (Therapy)
Cohort study
PubMed (MEDLINE)
“AND” cohort study
Case-control study
PubMed (MEDLINE)
“AND” case control study
Case series/case reports
PubMed (MEDLINE)
“AND” case report


65 year-old patient is recovering from a stroke. He
has narrowing of the left carotid artery confirmed by
US.
Would therapy with acetyl-salicilic acid decrease the
risk of another stroke?
Example – What needs to be
determined

Type of question:
◦ Therapy/prevention

Study design:
◦ RCT/systematic review

Concepts:
◦ stroke
◦ Acetyl-salicilic acid (aspirin)
◦ Systematic reviews or randomized controlled studies



First search Cochrane Database of Systematic
Reviews.
CDSR can be accessed via OvidSP – link on the website of the School’s library.
Choose the database on the front page.
•
•
•
•
•
•
•
Choose “Advanced Search” and check that the search is
by “Keywords”
Enter only one term and start “Search”
Enter the second key word and “Search”
Click Search History
If you are using more keywords, link them with OR and
then link their sets with AND
Limit the search to “Full Systematic Reviews”
Check the results
•
•
•
•
•
•
If you want to look for a RCT, choose PubMed or
Ovid MEDLINE
PubMed has special interface for clinical
questions
At the start page of PubMeda click on Clinical
Queries (below PubMed Tools)
Enter keywords, e.g.:
probiotics irritable bowel syndrome
Choose the category for your search (e.g.
Therapy) i search precision (Broad/Narrow)
Start the search



In the column Clinical Study Categories click on “See
all” below search results
When the search results are displayed, click Limits
Choose Randomized Controlled Trial under Type of
Article

Define a search strategy according to your PICO(T)
questions from day 2.

Your patient has 45 years and complains of frequent
migraine headaches. She tried different medications
but is afraid of side-effects. She is healthy, except for
the history of asthma during childhood. She read in a
magazine about bio-feedback and using relaxation as
a treatment for migraine. She is asking you for
advice.

Your patient has 56 years. He was released from a
hospital 6 weeks before, after he was admitted
because of slight heart failure. He comes to you for a
check up. He feels well but sometime fells that his
heart “misses a beat”. ECG confirms atrial fibrillation.
The patient wanders if this arrythmia is dangerous
and needs a treatment. Preventive anticoagulant
warfarine therapy is one possibility but carries a
small risk of stroke because of bleeding. You want to
check if the risks of such therapy outweigh its
benefits.

Parents of your patient want to sue you as her family
physician because of malpractice. Their 22 year-old
daughter suddenly fainted at home. They took her to
ER, where she was pronounced dead on arrival. The
ER doctor mentioned a blood clot in her lungs. Local
organization “Parents against contraceptives
industry” is talking the parents into suing the
producer and you because you prescribed the
contraceptive about a year ago. You want to check
the association between oral contraceptives and
thromboembolism.

Your patient takes nicotine replacement therapy as
smoking cessation treatment. His friends suggested
acupuncture as a quicker therapy. You want to check
if this is true.

Your friend asks you if there is evidence for the use
of feverfew in the therapy of migraine.

Your patient is middle-aged and is a frequent
airplane traveler. He is worried because of the risk of
deep vein thrombosis during flight. You want to
check whether compression socks would be useful in
preventing the problem.