Pubmed

• Systematic reviews and meta-analyses synthesize multiple studies — start here for established topics
• Randomized controlled trials (RCTs) are gold standard for interventions — but not all questions are answerable by RCT
• Cohort studies for long-term outcomes and rare exposures
• Case-control for rare diseases
• Case reports are lowest evidence — interesting but not generalizable
• Guidelines synthesize evidence into recommendations — check who wrote them and when

Critical Appraisal

• Sample size matters — small studies may show effects that don't replicate
• Check confidence intervals, not just p-values — narrow CI with meaningful effect size beats p<0.05
• Funding source and conflicts of interest affect interpretation — industry-funded studies favor sponsors
• Primary vs secondary outcomes — cherry-picking significant secondary outcomes is common
• Intention-to-treat vs per-protocol analysis — ITT is more conservative and realistic

Common Traps

• Abstract conclusions may oversell results — read methods and results sections
• Single studies rarely settle questions — look for replication and systematic reviews
• Statistical significance isn't clinical significance — 1% improvement may not matter to patients
• Retracted papers still appear in searches — check Retraction Watch for controversial papers
• Predatory journals publish low-quality research — verify journal reputation
• Preprints haven't been peer-reviewed — useful for speed but not vetted

Search Strategy

• PICO framework: Patient/Population, Intervention, Comparison, Outcome — structures clinical questions
• Start broad, then narrow with filters — missing relevant papers worse than sorting through extras
• Save searches for ongoing monitoring — PubMed can email when new papers match
• Related Articles feature finds similar papers — useful after finding one good paper
• Citation tracking: who cited this paper? — follow research forward in time

Evaluating Sources

• Impact factor indicates journal prestige, not individual paper quality
• First and last authors typically did the work and led the project
• Corresponding author handles questions — contact for clarifications
• Check author affiliations — institutional reputation matters
• Methods section determines if results are trustworthy — results are only as good as methods

For Specific Questions

• Treatment efficacy: RCTs and systematic reviews first
• Diagnosis accuracy: sensitivity/specificity studies
• Prognosis: cohort studies with long follow-up
• Etiology/harm: cohort or case-control studies
• Prevention: RCTs when available, cohort otherwise

Practical Tips

• PubMed is free but full text often isn't — check institutional access, Unpaywall, or request from authors
• PMID is the unique identifier — use it for precise citations
• Export to reference manager (EndNote, Zotero) — manual citation is error-prone
• Clinical Queries filter pre-filters for clinical relevance — therapy, diagnosis, prognosis, etiology
• Similar Articles and Cited By expand discovery — algorithm finds related work

Red Flags in Papers

• No control group for intervention studies
• Conclusions not supported by data presented
• Missing or inadequate statistical analysis
• Selective reporting of outcomes
• Conflicts of interest not disclosed
• Extraordinary claims without extraordinary evidence