Evidence Based

Medicine using PubMed

Friday SET B - Group 1
Objectives

Why Evidence Based Medicine?

To understand EBM in the practice of medicine
To understand how EBM affects outcomes of practice
Promises and Pitfalls of EBM in practice
To understand how to use PubMed as a tool for EBM
To integrate PubMed usage in EBM.
Why evidence Based Medicine?

We believe that the practice of Evidence Based Medicine is fundamental to

ensuring that good quality healthcare is delivered to patients incorporating the
values of the patient, knowledge of the doctor with best research evidence.
EBM in the practice of Medicine

Our mission is to improve the practice, teaching and dissemination of

high quality evidence based medicine to clinicians and the public to
improve healthcare. - Prof Carl Heneghan, Director CEBM
How do EBM affect outcomes of
practice?

Evidence-based medical practice has 5 components: defining a clinically

relevant question, searching for the best evidence, appraising the quality of the
evidence, applying the evidence to clinical practice, and evaluating the process.
Evidence-based medicine integrates the research evidence, clinician's expertise,
and patient's preferences to guide clinical decision making
Promises and Pitfalls of EBM in practice

Evidence-based medicine (EBM) aims to address the persistent problem of

clinical practice variation with the help of various tools, including standardized
practice guidelines. While advocates welcome the stronger scientific foundation
of such guidelines, critics fear that they will lead to cookbook medicine.
How to use PubMed as a tool for EBM?

Searching for Evidence-Based Medicine

Literature in PubMed

http://www.ncbi.nlm.nih.gov/pubmed

One of the easiest to use websites for consideration in the EBM selection process is
freely available at the US National Library of Medicine's PubMed/MEDLINE
database.
About PubMed

PubMed comprises over 25 million citations for biomedical literature from

MEDLINE, life science journals, and online books.
PubMed citations and abstracts include the fields of biomedicine and health,
covering portions of the life sciences, behavioral sciences, chemical sciences,
and bioengineering.
PubMed also provides access to additional relevant web sites and links to the
other NCBI molecular biology resources.
PubMed is a free resource that is developed and maintained by the National
Center for Biotechnology Information (NCBI), at the U.S. National Library of
Medicine (NLM), located at the National Institutes of Health (NIH).
http://www.ncbi.nlm.nih.gov/pubme
d

PubMeds User Interface

How do I search PubMed?

1. Identify the key concepts for your search.

2. Enter the terms (or key concepts) in the search box.
3. Suggestions will display as you type your search terms. Click Turn off to
temporarily disable the autocomplete feature. The autocomplete feature is
based on PubMed query log analysis described in
Finding Query Suggestions for PubMed.
4. Click Search.
Within the Clinical Queries feature are three methods (filters) for extracting EBM
materials from the PubMed database:

1. Clinical Queries using Research Methodology Filters

2. Systematic Reviews
3. Medical Genetics
Clinical study category

The clinical study categories use built-in search filters that will limit retrieval
to citations to articles reporting research conducted with specific
methodologies, including those that report applied clinical research.
To find citations for a specific clinical study category:
1. Click Clinical Queries from the PubMed homepage or from the advanced
search more resources menu.
2. Enter your search terms in the search box, and then click search.
3. You may then change the category or scope, if desired.
Systematic Reviews

Displays citations for systematic reviews, meta-analyses, reviews of clinical

trials, evidence-based medicine, consensus development conferences, and
guidelines.

Systematic Reviews is available on result sets as a filter under article types,

as well as a selection on the Clinical Queries page.
Medical Genetics

Displays citations pertaining to topics in medical genetics.

Cover a broad set of articles that build consensus on biomedical topics and
medical genetics find citations related to topics in medical genetics.
Activity: Etiology of Renal Cell
Carcinoma
Parameters/Limitations:

Subject(s) Gender : MALE

Subject(s) Age : 60 y/o

Question Formulated:
What are the possible etiology/cause of
renal cell carcinoma of 45+y/o male.
Key Articles:
Critical Appraisal:
What are the Study Results?
The study results above suggest that though the etiology of Renal Cell
Carcinoma is still partially understood, RCC in general is linked to cigarette
smoking, obesity, and hypertension are the most well-established risk factors
for sporadic RCC. Acquired cystic kidney disease (ACKD) is also a significant
risk factor.
Critical Appraisal:
Are the study results valid?
After consolidating several published research, the study results are
considered valid because of 2 main reasons:
1. Most research emphasize the risk of acquiring RCC based on unhealthy
practices such as smoking and increased fat consumption.
2. Several researches have the same age range and race parameter.
EBM - PubMed and Practice
Will the results help in caring for my patient?

Were clinical outcomes reported?

Clinical outcomes and recommendations were thoroughly discussed on individual research as well
as the pros and cons of the research.

Are likely treatment benefits greater than potential harm?

Generally, cancer specific treatment is still under research and treatment modality is based on
Chemotheraphy, Radiation Theraphy, Nuclear Medicine, Surgery. Though, one research is based on
treatment @ genetic level, we may not conclude the beneficence or non-maleficence of the
treatment modality.

Can the result help my patient?

Yes, the results of the above researches will narrow down to prevention. Since RCC is generally
linked to modifiable factors, doctors as well as patients will be able to understand the etiology of
the disease.
Pros and Cons of PubMed

Even the comparison of different medical databases were put into research!
Cont.

Based on group discussion, Weve decided to provide top 2 Pros and Cons on
Pubmed compared to Elvesier and Google Scholar.
Pros:
Like google scholar, PubMed is a collection of medical database of research.
Compared to other medical database, Pubmed has comprehensive filtering that can
easily narrow down your search.

Cons:
COST! COST! COST! Some researches need subscription fee for one to be able to
read the full text of the research.
Filtering should also include researches based on country/continent.
Thank you!