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Core modules

Core modules

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Core modules

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  1. What to expect? Core modules • Introduction • Finding out relevant literature • General guidelines for literature appraisal • Abstract and Introduction appraisal • Methods and Results appraisal 1 - Patients and procedures • Methods and Results appraisal 2 - Data collection/management and descriptive analysis • Methods and Results appraisal 3 - Inferential analysis • Discussion and Conclusions appraisal

  2. Resources for finding the literature • Seniors, juniors, and colleagues • Textbooks • Medical journals • World wide web

  3. What to choose? or … fast but tough? Simple and easy-going

  4. Seniors, juniors, and colleagues

  5. Textbooks

  6. Medical journals

  7. World wide web

  8. 1st step: framing the question • Population:who are the relevant patients? • Intervention or exposure:what are the management strategies we want to appraise or the relevant harmful exposure we want to study? • Outcome:what are the patient-relevant consequences of the exposure in which we are interested?

  9. 2nd step: determining question type • Therapy:determining the effect of different treatments on improving patient function and avoiding adverse events • Harm:ascertaining the effects of potentially harmful agents on patient function, morbidity, and mortality • Diagnosis:establishing the power of an intervention to differentiate between those with and those without a target condition or disease • Prognosis:estimating the future course of a patient’s disease

  10. 1st step: example • All-purpose question:are coronary drug-eluting stents beneficial? • Improved (searchable) question: • Population: patients with acute or chronic coronary artery disease undergoing percutaneous revascularization • Intervention: coronary stents eluting anti-proliferative drugs • Outcome: cardiac death, non-fatal myocardial infarction, or ischemia-driven target vessel revascularization

  11. 2nd step: example • Therapy:which coronary device is more effective and safe? • Harm:what is the risk of stent thrombosis with drug-eluting stents? • Diagnosis:can I recognize which angiographically-intermediate lesions are functionally (ie, clinically) significant? • Prognosis:can I predict which patients are more likely to develop restenosis if treated with a bare-metal stent?

  12. WWW resources • BioMedCentral: www.biomedcentral.com • Clinical Trial Results: www.clinicaltrialresults.org/ • DARE: www.york.ac.uk/inst/crd/crddatabases.htm • EMBASE: www.embase.com • Google scholar: scholar.google.com • Medscape: www.medscape.com • meta Register of Controlled Trials (mRCT):www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The Cochrane Library: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science: isiknowledge.com

  13. WWW resources • BioMedCentral: www.biomedcentral.com • Clinical Trial Results: www.clinicaltrialresults.org/ • DARE: www.york.ac.uk/inst/crd/crddatabases.htm • EMBASE: www.embase.com • Google scholar: scholar.google.com • Medscape: www.medscape.com • meta Register of Controlled Trials (mRCT):www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The Cochrane Library: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science: isiknowledge.com

  14. BioMedCentral

  15. BioMedCentral

  16. BioMedCentral • BioMedCentral is provided by a private UK company (the same that provides mRCT) • It mostly contains open access journals or conference proceedings • It may be a useful and cheap (it’s free!) starting point, but to date its content is limited • In the future however it should vastly expand

  17. Clinical Trial Results

  18. Clinical Trial Results • CTR is provided for free by C.M. Gibson (the inventor of the TIMI frame count and TIMI myocardial perfusion grade) • It contains pre-publication data from recent clinical trials • However, it is not comprehensive and its scope largely reflects the interests of its developer (ie acute coronary syndromes)

  19. DARE

  20. DARE • The Database of Abstracts of Reviews of Effectiveness is provided for free by the University of York • It contains titles and abstracts of systematic reviews of effectiveness • Each item contained (ie systematic reviews) is a very good starting point to get info on a topic • However, some hits are obsolete and no papers on prognosis, diagnosis, or pathophysiology are included to date

  21. EMBASE

  22. EMBASE • EMBASE is a comprehensive archiving site, provided for a fee by Elsevier • Its scope is similar but greater and largely non-overlapping with MEDLINE/PubMed • It may be useful for sophisticated researchers and systematic reviewers • However, it’s expensive and rarely needed, as most important papers will be already in MEDLINE/ PubMed

  23. MEDSCAPE

  24. MEDSCAPE • A freely surfable website providing disparate content, owned by the WebMD company • The Cardiology section is often updated and may provide recent data on trials or other news • It is not developed or maintained systematically, and thus lacks comprehensiveness

  25. mRCT

  26. mRCT • The meta Register of Controlled Trials is a freely searchable website containing data on registered trials • It is provided by the owner of BioMedCentral • It’s a good source on recent or ongoing (thus unpublished) trials • While interesting for the clinical researcher or meta-analyst, it’s scope is limited to RCT

  27. PubMed

  28. PubMed • PubMed is the web (and free) version of MEDLINE (provided by the US National Library of Medicine) • It contains data on articles printed every day in several thousands medical journals around the world, even if there is some bias toward US and English publications • It is reasonably comprehensive and sophisticated, especially for the expert user • Nonetheless, many papers can still be missed by the MEDLINE indexers, and using PubMed requires some expertise

  29. PubMed: tips and tricks • There are 4 basic ways to search PubMed: • Free text searches • Searches with descriptors(Medical Subject Headings, MeSH) • Clinical queries(specific filters for studies or topics) • Limits(enable the searcher to select several characteristics, such as language, article type, study type, and so forth) • The ideal search combines one or more of such instruments to obtain precise and concise answers to the clinical question

  30. Free text searches

  31. MeSH

  32. Limits

  33. Clinical queries

  34. History

  35. Tutorials

  36. Scholar Google

  37. Scholar Google • Scholar Google is provided for free by the Google company • It contains citations and direct links to abstracts or full text articles • In addition, it enables citation analysis, thus forward and backward snowballing • It’s not yet very structered, and highly relevant citations might not be included or missed because buried among thousands of non-relevant ones

  38. The Cochrane Collaboration

  39. The Cochrane Collaboration • The Cochrane Collaboration provides abstracts of systematic reviews for free and full texts and additional services for a fee • It contains the most rigorous systematic reviews available to date on treatment • No comprehensive systematic reviews are yet available for other topics • Many reviews, while highly valid and pertinent, might be outdated because of infrequent updates

  40. UpToDate

  41. UpToDate • UpToDate is provided for a fee by an American company • It provides qualitative reviews of most topics, with the specific features that reviews are updated very frequently • No strict methodology for review production or update is enforced • In addition, it might seem superficial and not detailed enough for experts of a topic

  42. WebMD

  43. WebMD • WebMD is a comprehensive website for healthcare professional, that can be accessed upon fee subscription • It is relatively comprehensive but unstructured • Resembles (albeit with less cardiology focus) www.medscape.com, www.theheart.org, and www.tctmd.com

  44. Web of Science

  45. Web of Science • Provided for an expensive fee by Thompson-Institute for Scientific Indexing, is the basis for the computation of impact factors and citation indexes • Contains titles and abstracts from several thousands journals • In addition, it enables forward and backward snowballing • However, it lacks the comprehensiveness of EMBASE or PubMed

  46. Take home messages The most important tips to remember when looking for scientific literature are:

  47. Take home messages The most important tips to remember when looking for scientific literature are: 1 – begin with a broad search: it you find too much, you can always refine the search later on

  48. Take home messages The most important tips to remember when looking for scientific literature are: 1 – begin with a broad search: it you find too much, you can always refine the search later on 2 – use as starting points authoritative investigators, seminal papers and/or clear-cut key-words