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SEARCHING AND

RETRIEVEING
INFORMATION
Why do we need EBM?
Save LIVES!
Encainide and flecainide for ventricular arrhythmia
Well proven to decrease the number of premature ventricular
beats became widely used 1980s
BUT
Further studies showed significant INCREASE in
MORTALITY died from other cardiac complications and
dysrhythmias ( a dangerous DOE)
Thrombolytics for acute MI
CLEAR evidence of benefit in the 1970s
Not widely recommended until 1988 almost 13 yrs later
How many thousands of people died unnecessarily in the
years in between?
SHIFTING PARADIGM

Scientific/medical
information

Clinical
problems

Evidence-based Medicine
Why do we need EBM?
We want to do the right thing what is
best for our patients
Practice variations that do not make
sense . . .
Not to doctors
Not to patients
Not to payors
Not to policy makers
Current vs future knowledge
validity

Current future knowledge


Innovation, development, & diffusion of
Medical technology

Established technology
Late adopters

Early adopters Obsolete


technology
Clinical trials
Abandoned
First medical use technology

InnovationDevelopment Diffusion Evaluation


Searching on the internet

Much database searching is based on


the principles of Boolean logic

Boolean logic refers to the logical


relationship among search terms

Is named for the British mathematician


George Boole
Boolean Searching
Boolean
logic

OR

OR

Query: I would like information about college.


Search terms Results

College 17,320,770
University 33,685,205
college OR university 33,702,660
The more terms or concepts we
combine in a search with OR logic, the
more records we will retrieve
Search terms Results

College 17,320,770
University 33,685,205
College OR university 3,702,660
College OR university OR campus 33,703,082
AND

poverty AND crime

Query: I'm interested in the relationship


between poverty and crime
Search terms Results

Poverty 783,447
Crime 2,962,165
poverty AND crime 1,677
The more terms or concepts we combine in a
search with AND logic, the fewer records we will
retrieve
Search terms Results

Poverty 783,447
Crime 2,962,165
poverty AND crime 1,677
poverty AND crime AND gender 76
NOT

cats NOT dogs

Query: I want to see information about cats, but I


want to avoid seeing anything about dogs.
Search terms Results

Cats 3,651,252
Dogs 4,556,515
cats NOT dogs 81,497
Full Boolean logic with the use of the
logical operators

Query : I need information about cats.


Boolean logic : OR
Search : cats OR felines

Query : I'm interested in dyslexia in adults.


Boolean logic : AND
Search : dyslexia AND adults
Implied Boolean logic with
keyword searching

Query : I need information about cats.


Boolean logic : OR
Search : cats felines

Query : I'm interested in dyslexia in


adults.
Boolean logic : AND
Search : +dyslexia +adults
How to find the article(s)

Life and death of a cell

will return all articles containing the terms life,


death, or cell in the title

"Life and death of a cell"

will return a specific article


Keywords can either be searched in the
Title/Abstract, or anywhere in the article

protein kinase c

will cause an error since every article in the


entire journal will have a C in it

"protein kinase c"

(forcing a phrase match) will yield better


results.
Article(s) from a particular
institution

Purdue

Author

will return articles by an author claiming


a Purdue affiliation (as well as any
articles written by someone named
"Purdue").
Using "Phrases"

signal transduction

will return articles which include either the term signal


or the term transduction (or both).

"signal transduction"

articles containing only signal, only transduction,


or even "transduction signal" are not returned.
Using "Wildcards"

child*

will return articles containing child, childcare,


and children

phospha*

will return articles containing


phosphatase and phosphate.
Capitalization and Punctuation

thrombin

will return all articles containing the term

Thrombin

will generally return articles where Thrombin


is the first word in a sentence.

In general, you should use lower-case in all of your


searches unless you have a specific reason to do
otherwise.
EBM sources
EBM sources Cochrane, USPSTF,
Clinical Evidence
+ Ideally best information source hard to
argue with, will explicitly state the level of
evidence (weak to strong)
- There may not be any good evidence
Cochrane Database of
Systematic Reviews
ACP Journal Club
Daily POEMS
Database of Abstracts of
Reviews of Effectiveness
Clinical Evidence
DynaMed
How does EBM REALLY
work?
Step 3: Critically appraise the evidence
Validity of the evidence
Internal study design, blinding, randomized, sample size,
appropriate statistics, etc.
Relevance of the evidence
Did they measure something pts care about?
Is population similar (enough) to mine?
Is the intervention feasible?
Importance of the evidence
Magnitude of effect or clinical significance?
P values, confidence intervals, relative risk or absolute risk
reduction
Step 3: Critically appraise the evidence
(cont.)
Requires some knowledge of basic
epidemiology and biostatistics
Sensitivity, specificity, prevalence, likelihood ratios
Absolute risk reduction, relative risk reduction, odds
ratios, number needed to treat
Requires knowledge of study types
ASSUMING THAT IT IS A WELL DESIGNED STUDY
Appropriate sample size, randomization, stats, treatment
allocation, etc., etc.
Meta-analysis of RCTs > RCT > Cohort > Case
Control > Case Series > Case Report
Hierarchy of studies
Please find current evidence on

1 Antibiotics prophylaxis for caesarean section

2 Antibiotics for common cold


How to search
Where to search
3 Use of NSAIDs for fever What to search
Which one could answer
4 Diagnosis for appendicitis the question
Why do you choose the
final one
5 Interferon for acute hepatitis C

6 Iron supplementation in pregnancy

7 Cisaprid for gastrooesophagal reflux in children


Discuss & Explain

How to search
Where to search
What to search
Which one could answer the
question
Why do you choose the final one