1. (HINARI) PubMed
Conduct systematic reviews of the literature
Limit to specific populations & publication types
Utilize EBM built-in filters
Set up and distribute alerts relating to evidence-based medicine

2. We now search for evidence-based articles using PubMed
We now search for evidence-based articles using PubMed. From the main HINARI webpage, go to PubMed by clicking on Search inside HINARI full- text using PubMed.
Remember you must login to HINARI to have access to the full-text articles.

3. Open the Clinical Queries box
Open the Clinical Queries box. This search tool assigns filters to keyword searches - to locate articles on Clinical Studies, Systematic Reviews and Medical Genetics.
Note: for these PubMed applications, all individuals will have access to the free full text articles. The examples are from HINARI/PubMed searches and, for those properly logged in, will also include access to articles from HINARI participating publishers.

4. On the PubMed Clinical Queries page, we have entered the pregnancy pregnancy complications AND developing countries search.

5. The default search results for the Clinical Study Categories are Category: Therapy and Scope: Broad. Other options in the Category drop down menu are Etiology, Diagnosis, Prognosis and Clinical Prediction Guides. There are 1357 articles for Therapy: Broad and 165 articles for Systematic Reviews.
Note: you can go directly to PubMed Clinical Queries.
The direct link to PubMed Clinical Queries is

6. For the Scope option, we will enter Narrow and for the same pregnancy complications AND developing countries search.

7. The Therapy (Category) and Narrow (Scope) pregnancy complications AND developing countries search has resulted in 145 citations. We now will click on the See all option (bottom of the page).
Note that the results for Systematic Reviews and Medical Genetics also are displayed.

8. We have displayed all 145 articles for this search including 80 HINARI and 80 Free Full Text articles. Remember - you can access the full-text articles by clicking on these Filters or changing the display from Summary to Abstract.
Note that the specific search is listed in the Search box including the AND (Therapy/Narrow[filter]) for clinical studies categories and systematic reviews.

9. After returning to the search results on the Clinical Queries page, we have clicked on the See all option for the systematic reviews results. The pregnancy complications AND developing countries AND systematic [sb] search resulted in 165 articles.

10. If you have a MY NCBI account, you can add Practice Guideline, Meta- analysis, Randomized Control Trials and Systematic Reviews to your Filters. Go to Manage Filters, click on Properties option and put each term in the Search with terms box.
When you save a PubMed search, you will be sent an listing new articles on the specific topic with these filters. Remember that you will need to go to HINARI to get the full-text articles. In this example, Free Full Text, HINARI, Meta-analysis and Systematic Reviews are listed in Filters.

11. Another tool from PubMed is using the Filters option – see left-column
Another tool from PubMed is using the Filters option – see left-column. We have checked the Meta-Analysis box in the Article Types section and entered hypertension AND diet in the PubMed Search box. The search Results number is 86. Note the Filters activated: Meta-Analysis line below the Results number.
Filters can be activated from any search results page. Remember to clear them before beginning other searches.

12. Now displayed are the results of a hypertension AND diet search with the Systematic Reviews Article Type filter activated. The citations for this search include 109 Free Full text and 167 HINARI articles.

13. Now displayed are the results of a hypertension AND diet search with the Randomized Controlled Trial Article Type filter activated. The citations for this search include 371 Free Full text and 689 HINARI articles.

14. The final displayed search are the results of a hypertension AND diet search with the Meta-Analysis, Systematic Reviews and Randomized Controlled Trial Article Type filters activated. The citations for this search total 1598.

15. PubMed Health specializes in reviews of clinical effective research – which finds answers to ‘What Works’ in medicine and health care. It is based on systematic reviews of clinical trials.
PubMed Health is a service provided by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

16. From the Contents drop down menu, you can access PubMed Health’s information in the following categories: For consumers, Executive summaries, Clinical guides and Full text reviews. We will open the Executive summaries option. Note also that PubMed Health contains a Medical encyclopedia.

17. The Executive Summaries Results is organized via an A-Z alphabetical listing. This format also is used for the other options in the Contents drop down menu.
We have entered HIV AND pregnancy in the keyword search box.

18. For the HIV AND pregnancy search, there are 368 Results displayed in PubMed Health. The initial display is in the Summary format. By clicking on the title, the Abstract will be displayed.
The Refine your search option organizes the results by the categories in Contents drop down menu. Also note the Medical Encyclopedia links to key concepts in the search results.

19. When available, PubMed Health contains links to full-text documents
When available, PubMed Health contains links to full-text documents. Displayed in this slide are the titles from the H listing for the Full Text Reviews. We will open the HIV in Pregnant Women document.

20. The Full Text Review contains a Structured Abstract and then links to the various sections of the Review (next slide).

22. We have displayed the AIDS (Acquired immune deficiency syndrome) definition from the A.D.A.M. Medical Encyclopedia.

23. Other (Internet) Resources:
Trip Database
Evidence Updates - BMJ and McMaster University
Knowledge Translation Learning Modules – Canadian Institutes of Health Research
Essential Health Links gateway – annotated links

24. Additional CPG resources
National Guideline Clearinghouse (USA)
Open Clinical: Clinical Practice Guidelines
About Clinical Practice Guidelines

25. If you are interested in learning more about EBM, go to the online tutorial Introduction to Evidence-Based Medicine from the Health Sciences Library, University of North Carolina (USA):

26. Additional Evidence-based Health Resources
Bandolier Knowledge: Oxford University
The Campbell Library
DARE: Database of Abstracts of Reviews of Effects
Duke University Medical Center Library: EBM
Listed here are some freely available websites that are useful resources for finding clinical and public health evidence.

27. EBM Librarian
McMaster PLUS collection
National Guidelines Clearinghouse
Nesbit Guide Evidence-Based Resources

28. Review: 5 Steps to evidence-based health care
Step 1 Ask: Formulate your question
foreground clinical question
PICO format
population, intervention, comparison intervention, outcome
Step 2 Access: Search for the evidence – highest quality studies are included in a systematic review
types of studies
evidence hierarchies 
Here are some general comments to remember about evidence-based practice. We hope that this tutorial has led to a better understanding of what evidence-based practice is and how to efficiently find good evidence using HINARI resources.

29. Step 3: Appraise the evidence - use criteria to evaluate the studies for:
validity (internal & external)
impact
Step 4 Apply: Put the evidence into practice
patient
setting
Step 5: Assess progress and performance
yourself

30. This is the end of HINARI Advanced Course Module 6
There is a Work Book to accompany this part of the module. The workbook will take you through a live session covering the topics included in this demonstration with working examples.
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