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

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.

Resources for Clinicians

• Patient Education

• Drug Information

• Clinical Effectiveness and Clinical Guidelines

• Research

PATIENT EDUCATION

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/

MedlinePlus http://medlineplus.gov/

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

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

Post-traumatic stress disorder

Health Topic: PTSD

MedlinePlus en español

NIH MedlinePlus magazine

• http://www.nlm.nih.gov/medlineplus/magazine/• Bulk orders: http://

www.vitalitycommunications.com/medlineplus/libraries.php

Link MedlinePlus to EHRs!

http://www.nlm.nih.gov/medlineplus/connect/overview.html

MedlinePlus Connect

MedlinePlus Connect

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

How It Works

EHR/Health IT System

Problem, medication, or lab code-based request

MedlinePlus ConnectConsumer health information

targeted response

Patient portal Clinical system

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

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

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

Find Details from Link on Home Page

http://www.nlm.nih.gov/medlineplus/connect/overview.html

Genetics Home Referencehttp://ghr.nlm.nih.gov/

Resource for genetic conditions, including rare diseases

Information Rxhttp://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

NIHSeniorHealthhttp://nihseniorhealth.gov

• Joint project of NLM and National Institute on Aging

• senior-friendly format• 64 health topics• 150 health videos

Information specific for older adults

DRUG INFORMATION

Drug Information Portalhttp://druginfo.nlm.nih.gov/

Drug Information Portal: Haldol

Resources by audience

DailyMed http://dailymed.nlm.nih.gov

• Manufacturer’s Label• Indications and Usage• Contraindications• Warnings• Dosage and Administration• Patient Counseling Information

Pillbox 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.

Exercises Part 1

CLINICAL EFFECTIVENESS AND CLINICAL GUIDELINES

PubMed Healthhttp://www.ncbi.nlm.nih.gov/pubmedhealth

• Clinical effectiveness research

• Summaries for practitioners and consumers

• Systematic Reviews

Systematic Reviews

• 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

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

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

Search Results example 1

Search results example 2

Filters

Caution

• Searching functionality needs work• Expect enhancements over time• Be as specific as possible-use words such

as Prevention, Screening, Treatment, Management

National Guideline Clearinghousehttp://guidelines.gov/

• Search evidence-based guidelines from a variety of sources

• Compare Guidelines side by side• Save your favorite guidelines and organizations.

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

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

Advanced search

Compare guidelines

My NGC

RESEARCH

ClinicalTrials.gov

Sample Uses of ClinicalTrials.gov

• Access information about specific trialoFind trials for potential participantsoTrack progress and protocol changesoSee 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

PUBMED

Find Literature Fast

PubMed http://www.pubmed.gov/

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

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.

Clinical Queries

Evidence-based search filters

Systematic Reviews

Therapy

Etiology

Prognosis

Diagnosis

Clinical Prediction Guides

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

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

Example: Sickle Cell Disease

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

A PubMed Subject Search

• Be specific • Don’t use punctuation (quotation marks)• Don’t worry about capitalization

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!

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

Search Details Show Mapping

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)

Related citations

Show Additional Filters for more options

Filter to Free Full Text

Abstract View

Save time with preformulated PubMed searches and filters!

PubMed Special Querieshttp://www.nlm.nih.gov/bsd/special_queries.html

MedlinePlus: Searches on Health Topicshttp://www.nlm.nih.gov/medlineplus

Where to find other PubMed searches?

• Everywhere in the NLM-universe!• Genetics Home Reference Conditions• Drug Information Portal• ClinicalTrials.gov

Genetics Home Reference-PubMed Searches

http://ghr.nlm.nih.gov/

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

ClinicalTrials.govhttp://clinicaltrials.gov/

• Study Records Link to Publications(when available)

Exercises Part 2

Questions?

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, MLISNational Network of Libraries of Medicine,

Middle Atlantic Regionhttp://nnlm.gov/mar/flewkate@pitt.edu

http://guides.nnlm.gov/mar_clinical