1 WORK ON COMPUTERS Winter Semester : List of Topics 1. Medical literature as a resource for evidence based medicine. An overview. 2. Biomedical literature resources and hierarchy of evidence. 3. MEDLINE - the most important biomedical database. PubMed online training. 4. MEDLINE - sample searches. Search strategy tips, Boolean operators, working with search results. MeSH, links to fulltext articles.

2 FOREGROUND Question for Today Is early discharge of stroke patients followed by outpatient rehabilitation more efficient as compared to hospital care?

3 FQ 2 Background Questions  Definition of stroke  Physical therapy, rehabilitation (in general)

4 Background Questions Merck Manual of Diagnosis and Therapy  World widely used medical textbook  Publication is searchable Search  stroke +rehabilitation

5 Stroke - definition  Stroke occurs when an artery to the brain becomes blocked or ruptures death of an area of brain tissue (cerebral infarction) and causing  Sudden symptoms: muscle weakness, paralysis, abnormal or lost sensation on one side of the body, difficulty speaking, confusion, problems with vision, dizziness, and loss of balance and coordination.

6 Stroke - rehabilitation  Intensive rehabilitation can help many people overcome disabilities after a stroke  The exercises and training of rehabilitation encourage unaffected areas of the brain to learn to perform functions that were done by the damaged area.  Also, people are taught new ways to use muscles unaffected by the stroke to compensate for losses in function.  After discharge from the hospital, rehabilitation can be continued on an outpatient basis, in a nursing home, in a rehabilitation center, or at home.

7 Answering Foreground Questions  Foreground questions can be more difficult to answer than background questions;  They require sources that synthesize a wide range of knowledge.

8 Search Engines Google  All the words: stroke rehabilitation At least one of the words: discharge home outpatient Occurrence: in the title of the page

9 PUBMED SEARCH STRATEGY Step 1  stroke OR cerebrovascular disease OR cerebrovascular accident*  Limits: Title

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11 PUBMED SEARCH STRATEGY Step 2 rehabilitation OR physiotherap* OR physical therap* OR occupational therap*  Limits: Title  Note: therap* to get therapy, therapies, therapeutical, therapist…

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13 PUBMED SEARCH STRATEGY Step 3 discharge* OR outpatient* OR home*  Limits: Title

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15 PUBMED SEARCH STRATEGY Step 4 – History  Clear Limits  Combine Searches #1 AND #2 AND #3  Press Preview Button  Apply additional limits, if needed Limits: Type of article  Randomized Controlled Trials  Etc.

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18 Original Articles Randomized Controlled Trials

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20 PUBMED SEARCH RESULTS Display Format: Summary  All: 126 Reviews: 9 Randomized Controlled Trials: ??

21 Types of Reviews  Traditional („narrative“)  Systematic + Meta-analysis (selection of articles according to pre- determined criteria; statistical analysis)

22 Systematic Reviews & Meta-Analysis Statistical methods

23 Display Format : Summary Record Structure  Author(s) Björkdahl A et al.  Article title Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial.  Journal Clin Rehabil. 2006;20(12): Volume Issue Page(s)

24 Display Format : AbstractPlus Fulltext

25 Display Format : MEDLINE Record Structure Display format AbstractPlus + MeSH Terms Medical Subject Headings THESAURUS MeSH DATABASE

26 Display Format: MEDLINE

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