1. PubMed and Beyond: Clinical Resources from the National Library of Medicine Kate Flewelling, MLIS National Network of Libraries of Medicine, Middle Atlantic Region Updated: 7/24/14

2. Objectives Find patient education information using MedlinePlus, NIHSeniorHealth and Genetics Home Reference. List 2 ways clinicians can promote MedlinePlus to patients. Access drug information using Drug Information Portal. Find clinical trials by condition and limit to those with results in ClinicalTrials.gov. Find Systematic Reviews in PubMed Health and PubMed/MEDLINE.

3. Resources for Clinicians Patient Education Drug Information Clinical Effectiveness and Clinical Guidelines Research

4. PATIENT EDUCATION

5. E-Patients Over half of US adults have looked online for health information in the past year. 35% of US adults have used the Internet to self-diagnosis, but only half of them talked to a clinician about what they found online. 54% of those 65+ are online—and over half of them have looked up health information online in the past year. Source: Pew Internet and American Life Project (2013) http://www.pewinternet.org/

6. MedlinePlus http://medlineplus.gov/ http://medlineplus.gov/

7. MedlinePlus In a Nutshell Over 900 health topics in English and Spanish Drug and herbal supplement information Videos and animations Surgery videos Health Check tools Easy-to-read Materials Multiple Languages Medical Dictionary & Encyclopedia Health News

8. 900 Topics! Caregivers Prescription Drug Abuse Elder Abuse Tick Bites Gay, Lesbian, Bisexual and Transgender Health Self-Harm Coping with Chronic Illness Osteoporosis Food Allergy Cardiac Rehabilitation Ostomy

9. Post-traumatic stress disorder

10. Health Topic: PTSD

11. MedlinePlus en español

12. NIH MedlinePlus magazine http://www.nlm.nih.gov/medlineplus/magazine/ Bulk orders: http://www.vitalitycommunications.com/medlineplus/libraries.php http://www.vitalitycommunications.com/medlineplus/libraries.php

13. Link MedlinePlus to EHRs! http://www.nlm.nih.gov/medlineplus/connect/overview.html

14. MedlinePlus Connect

15. MedlinePlus Connect  returns targeted MedlinePlus.gov information Delivers tailored information for a patient’s specific diagnosis, medication or lab test Responds to code-based requests used by health IT systems Problem codes (diagnoses): ICD-9-CM and SNOMED CT® Medications: RXCUI and NDC Lab tests: LOINC® Genetics information: Some requests provide responses from GHR Supports HL7 Infobutton standard Context-sensitive standard for the exchange of information between EHRs and other clinical information systems

16. How It Works EHR/Health IT System Problem, medication, or lab code-based request MedlinePlus Connect Consumer health information targeted response Patient portalClinical system

17. Web Service AND Web Application Web Service returns information and links in XML Health IT system has flexibility in controlling the display of information to the user Web application returns formatted Web page with tailored MedlinePlus content This is an interim page in between the health IT system and full pages on MedlinePlus.gov Explore demos of MedlinePlus Connect: http://apps.nlm.nih.gov/medlineplus/services/servicedemo.cfm http://apps.nlm.nih.gov/medlineplus/services/demo.html

18. Why MedlinePlus Connect? MedlinePlus Connect outreach identified as an NN/LM national initiative HHSinnovates Award in March 2011 It is free and easy to implement It can be used alone or in conjunction with other patient education services Helps meet the patient-specific education criteria objective for meaningful use

19. Health Care Organizations & EHRs Health care: Cleveland Clinic Institute for Family Health Ohio State University Wexner Medical Center University of Utah (Geisinger Health System) EHR and Health IT systems: Epic, Procentive, ComChart, Dexter-Solutions, Aetna Easy to implement. It’s a one-time change on the back end of the system

20. Find Details from Link on Home Page http://www.nlm.nih.gov/medlineplus/connect/overview.html

21. Genetics Home Reference http://ghr.nlm.nih.gov/ http://ghr.nlm.nih.gov/

22. Resource for genetic conditions, including rare diseases

23. Information Rx http://informationrx.org/ http://informationrx.org/ Refer people to MedlinePlus and Genetics Home Reference Order special prescription pads and other materials Help people: better understand health information enhance conversations between healthcare providers and patients encourage the use of evidence- based health information on the Internet

24. NIHSeniorHealth http://nihseniorhealth.gov http://nihseniorhealth.gov Joint project of NLM and National Institute on Aging senior-friendly format 64 health topics 150 health videos

25. Information specific for older adults

26. DRUG INFORMATION

27. Drug Information Portal http://druginfo.nlm.nih.gov/ http://druginfo.nlm.nih.gov/

28. Drug Information Portal: Haldol

29. Resources by audience

30. DailyMed http://dailymed.nlm.nih.gov http://dailymed.nlm.nih.gov Manufacturer’s Label Indications and Usage Contraindications Warnings Dosage and Administration Patient Counseling Information

31. Pillbox http://pillbox.nlm.nih.gov/ http://pillbox.nlm.nih.gov/ Pillbox enables rapid identification of unknown solid-dosage medications (tablets/capsules) based on physical characteristics and high-resolution images. Once a medication is identified, Pillbox provides links to drug information and drug labels.

32. Exercises Part 1

33. CLINICAL EFFECTIVENESS AND CLINICAL GUIDELINES

34. PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth http://www.ncbi.nlm.nih.gov/pubmedhealth Clinical effectiveness research Summaries for practitioners and consumers Systematic Reviews

35. Critical assessment and evaluation of all research studies that address a particular clinical issue Studies are searched for and included in the review using a set of specific criteria May include a quantitative pooling of data, called a meta- analysis. Example: Scientists collected all the published studies that compared types of treatment for prostate cancer that had not spread beyond the prostate gland. They compiled the results of these studies in a comparative effectiveness review, which is a type of systematic review. Source: Agency for Health Care Research and Quality http://1.usa.gov/1gFJZnw

36. Contents Abstracts (short technical summaries) of systematic reviews in DARE, the Database of Abstracts of Reviews of Effects—many of them include a critical summary of the review Plain language summaries and abstracts of reviews from the Cochrane Collaboration Full texts of reviews from a growing group of public agencies Information developed by public agencies for consumers and clinicians that is based on systematic reviews More info: http://1.usa.gov/1iKAAA8

37. Sources Cochrane Collaboration-Plain Language Summaries National Institute for Health and Care Excellence (NICE) (UK) Agency for Healthcare Research and Quality (US) National Cancer Institute-PDQ (Physician Data Query) Dept. of Veterans Affairs- Evidence-based Synthesis Program Canadian Agency for Drugs and Technologies in Health. Over 30,000 systematic reviews from last 10 years

38. Search Results example 1

39. Search results example 2

40. Filters

41. Caution Searching functionality needs work Expect enhancements over time Be as specific as possible-use words such as Prevention, Screening, Treatment, Management

42. National Guideline Clearinghouse http://guidelines.gov/ http://guidelines.gov/ Search evidence-based guidelines from a variety of sources Compare Guidelines side by side Save your favorite guidelines and organizations.

43. Examples-Organizations American Academy of Child and Adolescent Psychiatry American Psychiatric Association American College of Physicians Department of Veterans Affairs Health Care for the Homeless (HCH) Clinician's Network National Collaborating Centre for Mental Health (UK) American Geriatrics Society

44. Inclusion criteria as of June 2104 Documentation will need to be provided showing that the guideline is based upon a systematic review of the evidence. Documentation must contain an assessment of the benefits and harms of the recommended care and alternative care options. Source: http://www.guideline.gov/faq.aspx#Inclusion

45. Advanced search

46. Compare guidelines

47. My NGC

48. RESEARCH

49. ClinicalTrials.gov

50. Sample Uses of ClinicalTrials.gov Access information about specific trial o Find trials for potential participants o Track progress and protocol changes o See results (if available) Assess available evidence relevant to a specific clinical topic Assess nature of current and past research Review methodologies used in clinical trials

51. PUBMED Find Literature Fast

52. PubMed http://www.pubmed.gov / http://www.pubmed.gov /

53. What is PubMed? The world’s premiere biomedical bibliographic database Online access to the MEDLINE database Contains more that 22 million citations to journal articles in these major content areas: Biomedical Sciences Nursing, Dentistry, Pharmacy and Allied Health Veterinary Medicine Preclinical sciences

54. 3 ways to speed up your search 1.Use clinical queries to limit to clinical research areas 2.Use filters to limit your search quickly 3.Once you have one good article, click Related Citations to see more like it.

55. Clinical Queries Evidence-based search filters Systematic Reviews Therapy Etiology Prognosis Diagnosis Clinical Prediction Guides

56. PubMed Clinical Queries Available from the PubMed Home page Therapy Diagnosis Etiology Prognosis Clinical Prediction Guides Search filters: http://1.usa.gov/1bj4De4 Systematic Review Search filter: http://1.usa.gov/184vDzf

57. Medical Genetics Available from PubMed Clinical Queries Developed in conjunction with the staff of GeneReviews: Genetic Disease Online Reviews at GeneTests, University of Washington, Seattle Topics: Diagnosis Differential Diagnosis Clinical Description Management Genetic Counseling Molecular Genetics Genetics Testing All

58. Example: Sickle Cell Disease

59. PubMed Search Tips and Tricks Designed to be easy to use A few tricks make it even more powerful Tutorials help you master the skills to become an efficient, expert searcher

60. A PubMed Subject Search Be specific Don’t use punctuation (quotation marks) Don’t worry about capitalization

61. Examples Use key words for main concepts Leave out words like the, of, for The word “and” is a Boolean operator; it is assumed and automatic Author and journal key words work too!

62. Automatic Term Mapping (ATM) PubMed uses Automatic Term Mapping which recognizes thousands of concepts and maps to an appropriate term. ATM checks these tables:  Subjects (MeSH – Medical Subject Headings )  Journal Titles  Authors

63. Search Details Show Mapping

64. Phrase Searching aids drugs breast feeding = 418 (processed using ATM, many relevant results) “aids drugs” AND “breast feeding” = 3 (very limiting; okay for specific items)

65. Related citations

66. Show Additional Filters for more options

67. Filter to Free Full Text

68. Abstract View

69. Save time with preformulated PubMed searches and filters!

70. PubMed Special Queries http://www.nlm.nih.gov/bsd/special_queries.html http://www.nlm.nih.gov/bsd/special_queries.html MedlinePlus: Searches on Health Topics http://www.nlm.nih.gov/medlineplus

71. Where to find other PubMed searches? Everywhere in the NLM-universe! Genetics Home Reference Conditions Drug Information Portal ClinicalTrials.gov

72. Genetics Home Reference-PubMed Searches http://ghr.nlm.nih.gov/ http://ghr.nlm.nih.gov/

73. Drug Information Portal http://druginfo.nlm.nih.gov/ http://druginfo.nlm.nih.gov/

74. ClinicalTrials.gov http://clinicaltrials.gov/ http://clinicaltrials.gov/ Study Records Link to Publications (when available)

75. Exercises Part 2

76. Questions?

77. Thank You! This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276- 2011-00003-C with the University of Pittsburgh, Health Sciences Library System. Kate Flewelling, MLIS National Network of Libraries of Medicine, Middle Atlantic Region http://nnlm.gov/mar/ flewkate@pitt.edu http://guides.nnlm.gov/mar_clinical