Ovid MEDLINE for KSOM Y1 Pamela M. Corley, MLS, AHIP Adrian Follette, MLIS Evans Whitaker, MD, MLIS Janis Brown, MLS, AHIP Norris Medical Library University of Southern California Los Angeles, CA 90089-9130 Melissa Just, MLIS, EdD Director, Graff Library City of Hope Hospital 1500 East Duarte Road Duarte, California 91010 Handouts: Ovid SP flow sheet Trifold Searches to try

Administrative Notes Introduction to personnel Synchronize clickers “Go”, “4”, “1”, “Go”, “1/A” to test ASK QUESTIONS! Personal Librarian program – new this year. Contact your “personal librarian” with information questions. You can work with any of us, but this program gives you a designated contact. Door code

Personal Librarian Program Student last name Personal Librarian Email Phone AhnFecht Pamela Corley pcorley@usc.edu (323) 442-1125 Fernandez Lee Eileen Eandi eeandi@usc.edu (323) 442-1133 LeongPenman Adrian Follette follette@usc.edu (323) 442-1972 PerrinYasmeh Evans Whitaker ewhitake@usc.edu (323) 442-1128

Additional Business This PowerPoint and the other documents that go with the two sessions today will be posted to the Medical Student portal on the Norris Medical library website. Fill out evaluation form; with your feedback we can continue to improve this presentation. At the end of the session you will be asked to fill in emergency contact information on MyMedWeb site.

Introduction OvidSP – new product introduced February, 2008 Used for Literature Search Project -- Phases 1, 2, and 3 Enhanced features Basic Search added Advanced Search similar to “old Ovid” Personal Account (free) allows user to save searches and annotate articles This class and Literature Search Project 1, 2, and 3 will focus on MEDLINE searching. Other Ovid databases searched similarly You have heard or will hear about Norris Medical Library resources in another presentation today. This presentation concerns searching MEDLINE for information.

Level of experience? 4 Questions follow Vote with your clickers

Are you comfortable searching for medical information with Ovid MEDLINE or PubMed? Very comfortable! Yes I can do it, but… Not really I am more comfortable at the dentist’s office!

Do you know how to use MeSH? Always use MeSH when searching! I know what it is but don’t use it I may have heard the term… Not familiar with it Yes, surgeons put it in a hernia repair!

Are you familiar with the use of subheadings in MEDLINE searching? Yes, and I use them! Yes. Not really. No.

Do you use the MeSH tree when searching? Yes No, but I know what it is I don’t know what that is

Ovid vs. PubMed Ovid PubMed Commercial product, usually in academic libraries Multiple databases including MEDLINE Libraries subscribe to an information “package” -- the search engine plus full text of books and journals PubMed U.S. governmental bibliographic database Collaboration of National Library of Medicine (NLM), National Center for Biotechnology Information (NCBI), and the National Institutes of Health (NIH) Free to use, not easy to use well It is the only database of its size and scope in the world Estimated 40,000 biomedical journals world-wide, ~5,000 indexed in MEDLINE ~18 x 106 citations in PubMed, 16.5 x 106 in MEDLINE OK this is the dry part, hang in there and you will get to do some hands on work later in the hour…

PubMed and MEDLINE OvidSP -- different interface and search engine, same contents as MEDLINE MEDLINE is a subset of PubMed. The 1-2 million article difference is made up of both articles that are being processed and will move into MEDLINE, and articles which will never be included in MEDLINE (e.g., outside the scope of the database). (18.2/16.8 as of 08/07/08)

Pros and Cons of Ovid MEDLINE Easier than PubMed, Advanced is good PubMed training Automatic “mapping” of search terms is more effective than equivalent function in PubMed Basic search can be used at the speed of clinical medicine Basic and Advanced search modes work well together Cons Expensive After your training, it is unlikely you will have access PubMed is more current; Ovid gets its material from PM Other Ovid has a pay-per-use option

What Else is in Ovid? EBM (the three below and others) Cochrane Database of Systematic Reviews DARE (Database of Abstracts of Reviews of Effects) ACP Journal Club CINAHL -- allied health and nursing database Ovid Healthstar – “contains citations to the published literature on health services, technology, administration, and research.” Health and Psychosocial Instruments (HAPI) -- information on measurement tools for healthcare Books @ Ovid (almost 400 books included)

Basic Ovid MEDLINE

How to search OvidSP Basic “Natural language” search engine Can combine and limit searches Good for: locating a few good articles finding “the right words” for Advanced Ovid Search Basic tab is in green Simple interface Keep “include related terms” checked

Ovid Basic – things to know and tips Searches yield 500 or more hits “Good stuff” is in the first 20-30. If nothing relevant is found in that group, then reformulate search or move on to Advanced Based on our experience at NML, use keywords without AND, OR, or punctuation. Seems to retrieve the smallest, most focused set of results

Advanced Ovid MEDLINE

Advanced Ovid Search Default at Norris Medical Library Good for a thorough, focused search Resembles previous versions of Ovid Steps in a search (see flow sheet in handouts) Enter search concepts one at a time. Ovid translates the users terms into MeSH terms. User may choose MeSH terms, “explode”, “focus”, and apply sub-headings Combine concepts (AND or OR) Limit results, e.g. English, humans, publication types, publication years, etc.)

Definitions Broaden/Narrow MeSH Focus Explode Broaden and Narrow refer to how wide you throw your net when searching Broaden means more to sift through Narrow means less to search through

What is MeSH? Medical Subject Headings NLM indexers read papers, apply 5-10 agreed-upon terms (“controlled vocabulary”) to describe the content of the papers By looking up articles using MeSH terms you will find all the articles about a topic. Remember…MEDLINE is a human enterprise and therefore contains human errors

Heart attack Myocardial infarction Coronary, Coronary occlusion Q wave, non-Q wave, transmural, subendocardial All of the articles that use these variations are discovered when you search under the MeSH term “myocardial infarction” Myocardial infarction is separate from MeSH terms “angina” or “acute coronary syndrome”

Focus Intuitive Narrows your search Details: NLM personnel may label some MeSH terms as main topics of an article. These topics are a “focus” of the article

MeSH tree/Explode Hierarchical structure of MEDLINE is similar to a computer folder and file structure Pets Dogs Boxers Labradors Chihuahuas Cats Manx Siamese Persians Explode broadens your search Explode pets means you get the contents within the Pets folder. Choosing pets but not focusing means you get all the material in the pets folder that is not in the dogs and cats folder.

Scope Notes Where ever you see  get more information by clicking Scope Notes define terms

Advanced Ovid Search -Tips SUBHEADINGS narrow searches. Do not use subheadings unless they match your needs. Do not overuse subheadings – not all concepts need them, and few concepts need more than one or two. LIMITS narrow searches. Do not overuse limits Apply them once at the end of devising your search rather than using after each concept. Learn to use the “MeSH tree” and “scope notes”

The Search Process

Formulate your question This class is not about EBM or EBP, however many of the same concepts apply. First, identify the “information need”. Define the clinical question, remove extraneous details in order to make it “searchable”. Select concepts that will become search terms. Choose the most appropriate information source in which to begin your search – it might be a book! Enter your search terms. Review results and reformulate search if necessary. The hardest part of searching is analyzing what you need to know

Hands-On: Search 1 Your 63 y.o. patient brings in selenium 200 µg tablets. He had read that selenium helps to prevent prostate cancer. He wants your advice before he starts taking selenium. This is really two questions in one: Does selenium help prevent prostate cancer? Is selenium safe to take? Search each question. What is your advice?

How to: Search 1 Main concepts: Prostate cancer (prevention and control as subheading? Adverse effects as subheading?) Selenium (therapeutic use as subheading?) Limits: English, human. Middle aged Male?

Hands-On: Search 2 62 y.o. male with history of MCA in 20s in which he suffered a knee injury. Developed severe post-traumatic arthritis. He is now scheduled to have total knee replacement. No other significant medical problems. What kind of preventive therapy would you recommend to minimize his risk of blood clots in the leg veins post-operatively? (Hint: total knee replacement is called Arthroplasty, replacement, knee) Concepts:

How to: Search 2 Disease concept: Additional concepts: What is best term for blood clots in the leg? Subheading: Prevention and control? Additional concepts: Knee joint replacement surgery (other possible terms “orthopedic procedures” AND “knee”). Consider add “adverse effects” as subheading. “Post-operative complications” Limits: English, humans. Middle age? Male?

Hands-On: Search 3 45 y.o. woman with depression, she has not responded to several SSRIs. She continues with counseling, but is not making any substantial improvement. You want to place her on other antidepressant types…either Wellbutrin, Effexor, or Cymbalta. What can you find in the literature to predict your chances of pharmaceutical success? Treatment resistant depression Depressive disorder vs. depression Drug names are not in MeSH Treatment outcome Can search for “treatment resistant depression”

How to: Search 3 Disease concept: Treatment resistant depression Search as phrase or combine “depressive disorder, major” (with “drug therapy” subheading) AND “drug resistance” Additional concepts: treatment outcomes Limits: English, humans. Middle age? Female?

Hands-On: Search 4 On your third year surgery rotation you have a patient in the hospital with Kaposi’s sarcoma of the rectum. Your resident has not heard of this before. Do you have a reportable case? GoogleScholar did not reveal anything.

How to: Search 4 How do you do this search? A simple way to approach this is to enter “kaposis rectum” in basic search in Ovid. A few good articles appear in the first ten.

How to: Search 4 “Complete reference” shows the MeSH terms for these good articles. You choose “neoplasm, rectal” and “sarcoma, Kaposi” this combination used on the 1950-current database reveals several articles, most of which appear pertinent. You find to your dismay that your case is not unique enough to be reportable.

Final Exam (Time allowing) DIAGNOSIS 1. MRI for breast cancer screening, should this be our method of choice? 2. PSA variations – PSA velocity, PSA density, free PSA ratios – do these add value to prostate cancer screening? TREATMENT 3. Low back pain patients -- how effective (to decrease pain) are chiropractic and acupuncture therapies? Are there studies that compare these modalities? 4. Operative vs. non-operative treatment for acute Achilles tendon ruptures – which is better? exp Magnetic Resonance Imaging exp Breast Neoplasms/pc, di [Prevention & Control, Diagnosis] exp Mass Screening 1 and 2 and 3 Can use methods for first and third 2. exp Prostate-Specific Antigen exp Prostatic Neoplasms/pc, di [Prevention & Control, Diagnosis] exp "Sensitivity and Specificity“ density.mp. velocity.mp. free PSA.mp.704 5 or 6 4 and 8 3. Low back pain/therapy rehabilitation Chiropractic manipulation Acupuncture therapy AND all 3 only 3 articles one is relevant. Can try 1 and 2, or 1 and 3 with larger results 4. exp Achilles Tendon/in exp Rupture 1 and 2 exp Casts, Surgical Tendon Injuries 4 or 5 exp Treatment Outcome 3 and 6 and 7

Assignment Look at Literature Search Project handout. You will complete one of seven questions. Key points: Use Advanced Ovid. Use MeSH, focus, explode, subheadings, and limits to get full points on assignment Pick 5 relevant articles. Do not include comments, letters to the editor, foreign language articles Include abstracts (default setting) Display your work and print it, save a copy for backup

Summary Ovid provides an easy-to-learn MEDLINE search engine. Effective information finding and analysis are important skills in modern medicine. Today’s session presented Ovid MEDLINE, and provided search practice. Mastery of any skill requires practice and thought; searching is no exception

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