Drug Information: MEDLINE

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Drug Information MEDLINE EBM Databases

• Kathy Davies
• Summer 2005

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MEDLINE Searching Tools

• PICO Method
• MeSH (Medical Subject Headings)
• EBM search Filters
• Search Options to focus citations
• Limits Subheadings
• Boolean Operators

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Medical Subject Headings

• Official Term for Disease or Topic
• MeSH includes narrower terms with broader ones
• Click Directly on Term to View Tree
• Click the I Button to view Definition
• Similar Terms can have different meanings

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Search Options Subheadings

• Subheadings are attached to MeSH term
• Subheadings narrow focus of term
• Example asthma/classification
• Finds articles on different types/levels of
  asthma
• severe asthma, chronic asthma
• NOT specific treatments or genetic info
• Slash (/) equivalent to of

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Search Options Boolean Operators

• AND
• Include multiple terms in search
• Bronchitis AND steroids
• OR
• Any term listed (conditions/treatments may occur
  together)
• Penicillin OR Cycloserine
• NOT
• Eliminate certain terms from search
• Otitis Media NOT Mastoiditis

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Search Options Limits

• Apply limits to set with all desired terms
• Usually the last step in searching
• Restrict results to specific
• Population, Gender, Language
• Age Group, Publication Type
• Journal Subsets, Range of Years
• Use CTRL key to select multiple limits
• Example Newborn Infant Infant

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Big Four Clinical Questions

• Therapy
• Efficacy safety of treatment
• Is the treatment effective and not harmful?
• Diagnosis/Screening
• Precision and accuracy of diagnostic tests
• Preventing false positives not missing existing
  conditions

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Big Four Clinical Questions

• Therapy
• Efficacy safety of treatment
• Is the treatment effective and not harmful?
• Diagnosis/Screening
• Precision and accuracy of diagnostic tests
• Preventing false positives not missing existing
  conditions

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Big Four Clinical Questions

• Prognosis
• Power of predictive markers
• Determine who has increased risk for condition
• Long Term Outcome for patient
• Etiology (Harm/Benefits)
• Assess treatment benefit to patient
• Risks of treatment

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Clinical Question Therapy

• Does using botulism toxins improve spastic
  muscle symptoms commonly experienced by patients
  after a stroke?

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PICO Elements

• P stroke
• I botulism toxins
• C No treatment
• O reduce spastic muscle symptoms

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Building A Search

• 1 exp Botulinum Toxins/ 3794
• 2 exp Muscle Spasticity/ 1384
• 3 exp Cerebrovascular Accident/ 22606
• 4 1 and 2 and 3 43
• 5 limit 4 to (humans and english language and
  "therapy (optimized)") 18

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Clinical Question Etiology

• Are lifestyle changes effective in reducing
  the development of diabetes mellitus for patients
  with impaired glucose tolerance?

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Building A Search

• 1 exp DIABETES MELLITUS/ 72656
• 2 exp Glucose Intolerance/ 2073
• 3 exp Life Style/ 16604
• 4 1 and 2 and 3 92
• 5 limit 4 to (humans and english language and
  "etiology (optimized)") 38

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Clinical QuestionPrognosis

•  Does using corticosteroids in patients with
  asthma reduce the need for hospitalizations over
  time?

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Building A Search

• 1 exp Adrenal Cortex Hormones/ 30751 2 exp
  ASTHMA/ 27476
• 3 exp HOSPITALIZATION/ 41479
• 4 1 and 2 and 3 67
• 5 limit 4 to (humans and english language and
  "prognosis (optimized)") 20

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Clinical QuestionDiagnosis

• Should the possibility of celiac disease be
  routinely investigated in the diabetic patient
  population?

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Building A Search

• 1 exp Celiac Disease/ 3372
• 2 exp Diabetes Mellitus/ 72656
• 3 1 and 2 184
• 4 limit 3 to (humans and english language and
  "diagnosis (optimized)") 20

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Cochrane Databases

• ACP Journal Club
• methodologically sound clinically relevant
  studies selected for publication
• an enhanced abstract of the chosen articles
• value of the article for clinical practice.
• DARE (Reviews of Effectiveness)
• critical assessments of systematic reviews
• variety of medical journals included

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Cochrane Databases

• Controlled Trials
• 300,000 controlled health care trials referenced
• Found by handsearching database searching
• Includes indexed controlled trials in MEDLINE
• Systematic Reviews
• Systematic reviews prepared by Cochrane
• Includes completed reviews protocol for reviews
  in progress

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Cochrane Databases

• Much smaller than MEDLINE
• Some are expert opinions/commentary
• Focus on common conditions
• May miss articles on your topic

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OVID EBM Databases

• ACP Journal Club
• Database of Reviews of Effectiveness
• Cochrane Database of Systematic Reviews
• Cochrane Controlled Trials Register