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Finding Health Information on the Web to Improve Patient Care.

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  • Advantage to short clips: 40 seconds to 3 ½ minutes long easy to rerecord, update – example, MeSH Browser not MeSH Database change, easy to rerecord. Worth the time, since reaches more people, on and off site Usage stats:
  • Biomed Central: Not free sections: Images.md and Faculty of 1000 UW faculty can publish for free because institutional member -------------- July 14, 2004: U.S.House Appropriations Committee recommends that NIH provide free public access to research articles resulting from NIH-funded research. The Report calls on NIH to offer access to authors' final manuscripts (as accepted for journal publication) and supplemental materials via PubMed Central six months after publication. If the grantee used NIH funds to pay any publication charges (e.g., page or color charges, or fees for digital distribution), PMC access would be immediate. The Report instructs NIH to inform the Committee by December 1, 2004 how it intends to implement the policy. Needs to pass in Senate… -------------- BRITISH PARLIAMENTARY PANEL ENDORSES OPEN ACCESS TO SCIENTIFIC LITERATURE By Lila Guterman of the Chronicle of Higher Education In a much-anticipated report scheduled to be released today, the Science and Technology Committee of Britain's House of Commons endorsed open access to research results and criticized the scientific-publishing industry for the escalating prices of its journals. The report comes just days after a U.S. Congressional committee recommended requiring free access to papers based on research financed by the National Institutes of Health (The Chronicle, July 19). http://chronicle.com/prm/daily/2004/07/2004072002n.htm
  • Evidence-based practice uses the results of scientific studies whenever possible and expert opinion and extensive experience when data are lacking.
  • Why use email alerts? Keep abreast of new literature in your field Receive automatic updates View tables of contents from your home or office Some free, some via UW
  • RxList Top 300:
  • Prescription & OTC Drug information for consumers & professionals. Welcome to Drugs.com, the most popular, comprehensive and up-to-date drug information resource available online. Fast, easy searching on over 24,000 prescription and over the counter medicines.
  • RxList: Top 300 by prescriptions written: hydrocodone; lipitor
  • USP Advice for the Patient. New feature: Natural Standard herbal supplement database released – late Fall 2005 This is the 105 monographs in English and Spanish - written for the layperson. It is the same as on Harvard's site and Mayo clinic ( http://www.mayoclinic.com/findinformation/druginformation/index.cfm )   it’s the only appropriate one that is evidence based. 
  • English and Spanish with pictures Includes evidence-based information on effectiveness, side effects, interactions, dosing, and pregnancy, breastfeeding.
  • There are so many places to go on the Internet for quality information. We are going to describe the very best websites here. These websites are all consumer-oriented, up to date and contain accurate information. MedlinePlus is one of the best places of many to go for basic, quality consumer health information on the Web. In most cases you can start here. Why is it one of the best? The National Library of Medicine produces it The information is reviewed and reliable. It links to governmental and non-profit organizations’ Web sites. Continually updated No advertising or links to commercial sites Minimum redundancy American Customer Satisfaction Index Scores, Q1 2004 Government Web Sites: Health #1: MedlinePlus #2: MedlinePlus en español MedlinePlus is available in Spanish by clicking on the “espa ñol” link This is not a “mirror” site, all the materials here are responsive to the language, dietary, and cultural needs of the Hispanic population
  • Slide provided by Angela B. Ruffin, Head NN/LM National Network Office National Library of Medicine National Institutes of Health, HHS October 18, 2005 Senior Health: can enlarge text and view in high contrast Clinical Trials: provides easy information on clinical trials for a wide range of conditions Pre-recorded webcasts of surgical procedures Actual operations performed at medical centers in U.S. One-hour programs with printable transcripts
  • 2004 1 hour videos Need Real Player
  • Encyclopedia includes: 4,000+ entries on diseases, tests, symptoms, injuries and surgeries an extensive library of photographs and illustrations.
  • Cancer.gov Centers for Disease Control and Prevention (CDC) A-Z Topics familydoctor.org healthfinder® HIV InSite Kidshealth® Mayo Clinic MEDEM: an information partnership of medical societies MedlinePlus (English | Spanish) NOAH: New York Online Access to Health
  • Familydoctor.org: American Academy of Family Practitioners www.familydoctor.org Conditions A-Z Healthy Living Other links Parents & kids Health tools
  • Medem: Professional Associations Provides patient information through a web site called Medem www.medem.com
  • Lab Tests Online ( www.labtestsonline.org ) This is a very good web site for information about lab tests for the consumer; it uses easy to understand language. Produced by a collaboration of professional societies in the lab community Peer-reviewed, non-commercial, patient-centered Can be searched by disease or the name of a test Example: “The doctor prescribed a lipid profile for my wife. What is he looking for?” Scroll down to lipid profile on the right. The results of the search describe the test, normal values and ends with common questions about the test. Many will ask if their test results are “normal” or what the “normal” value of a test is. For many tests, there is no single reference range that applies to everyone because the tests performed may be affected by the age and sex of the patient, as well as many other considerations.
  • Somali Asthma Cultural Profile Foods commonly consumed Dietary beliefs Religious dietary beliefs Diet related health problems
  • Combined coverage of eleven major search engines is 42% of the Web. No individual search engine covers more than 16% of the Web. Overlap between individual search engines is low .
  • View cached page to resurrect dead pages Includes similar pages feature Search for images Includes pdf and other file types Search within results
  • Authority: Is the author an authority on the subject? Can you even identify an author? If it is unsigned, is it posted in a usually authoritative place (NIH, for example) Does the author bring any biases in posting the information? Is there contact information? Is there an “about us” link? Does the site state the evidence upon which the material is based? Accuracy: Are the facts accurate? Are the sources of information clearly given? Refs to verify info? Is the information consistent with other sources? Is the information well written, well organized, and logically presented? Is it free from spelling and grammatical errors? Objectivity/bias: Web pages often function as “soapboxes” Goals of the person presenting the material aren’t clearly stated Watch out for the emotional “kick” – photographs, exclamation points, huge fonts Can you judge the author’s purpose in posting the information – Persuade? Selling a product? Who paid for the web page? EX of bias: Toilet Training: Signs of Readiness www.pampers.com What about the statement: “While children begin to master most of the necessary skills between the ages of 18 and 30 months, your toddler may not be ready to master toilet training until as late as the end of her fourth year.” Currency: Is the information timely and current? Dates are not always included on web pages If dates are included, it may not be clear if the date is the date created, the date revised, or the date the page was placed on the web. Is the information likely to change? Is it recent enough to be useful? Ex for currency: Even if information is accurate, is it comprehensive? What’s missing? How does this information compare with other sources (including print sources) on the same topic? Is a better source available? Does the site have a disclaimer that describes any limitations, purpose, scope, currency, etc.? Hormone Replacement www.pslgroup.com/dg950925.htm What dates can you find on the page? Has much changed on this topic since then? Who is the author? Is s/he an authority? What type of site is this? What is its purpose? Coverage: Even if information is accurate, is it comprehensive? What’s missing? How does this information compare with other sources (including print sources) on the same topic? Is a better source available? Does the site have a disclaimer that describes any limitations, purpose, scope, currency, etc.? Ex of coverage: “ Runny Nose” www.medical-library.net What conditions are associated with a runny nose, according to this site? What other conditions could be associated with a runny nose that aren’t included here?
  • You can often tell something about a web site by its address Examples: www.jcpenney.com www.hmassoc.org www.washington.edu www.cdc.gov
  • PubMed, including Clinical Queries and My NCBI

Finding Health Information on the Web to Improve Patient Care. Finding Health Information on the Web to Improve Patient Care. Presentation Transcript

  • Janet G Schnall, MS, AHIP Information Management Librarian Health Sciences Libraries University of Washington, Seattle, WA [email_address] Finding Health Information on the Web to Improve Patient Care
  • Objectives
    • Identify 10 ways to improve patient care using library and internet resources
    • Describe different tools to navigate the web to find clinical resources
    • Describe web resources for evidence-based practice
    • Identify ways to find and obtain full-text articles
  • #1 Search a Database to find Journal Articles
  • Databases
    • PubMed
    • pubmed.gov
    • NLM Gateway gateway.nlm.nih.gov/gw/Cmd
  • PubMed pubmed.gov
    • Includes MEDLINE (1950’s to present)
    • Indexes 5,000 biomedical journals
    • Covers all aspects of biosciences and healthcare
    • 75% of citations have abstracts
    • Updated 5x/week
    • Can easily limit your search to:
      • Age groups
      • Human or Animal studies
      • Language
      • Research or Review articles
      • Subsets, such as Core Clinical Journals or CAM
  •  
  • Related Articles
  •  
  • Advantages of PubMed
    • Free
    • Links to publisher’s sites for full-text journals
    • Or, can order full-text journal articles
    • Can easily find related articles
    • Clinical Queries and Systematic Reviews sections limit retrieval using research filters
  • Try healthlinks.washington.edu/howto/pubmed
  • NLM Gateway gateway.nlm.nih.gov
    • Provides "one-stop shopping" for many of NLM's databases
    • Offers citations, full text, video, audio, and images
    • Accesses:
      • PubMed
      • NLM Catalog - catalog information for books, serial titles, audiovisuals
      • TOXLINE® Special - toxicology citations
      • DART® - Developmental and Reproductive Toxicology
      • MedlinePlus® - consumer health information
      • ClinicalTrials.gov - information for the public about clinical trials
      • DIRLINE® - Directory of Health Organizations
      • Genetics Home Reference™ - consumer info for genetic conditions
      • Household Products Database
      • HSRProj - health services research projects
      • OMIM - Online Mendelian Inheritance in Man
      • HSDB® - Hazardous Substances Data Bank AND MORE…
  • NLM Gateway gateway.nlm.nih.gov
  • E-Journals
    • Check with your library for access to
    • full-text e-journals
    • For UW Affiliates: use the Proxy service to access full-text e-journals from off-campus healthlinks.washington.edu/howto/connect
  • Open Access Journal Sites
    • BioMed Central
    • www.biomedcentral.com
    • Independent publishing house providing immediate free access to peer-reviewed biomedical research
    • PubMed Central
    • pubmedcentral.gov
    • National Library of Medicine's free digital archive of biomedical and life sciences journal literature
  • Order Articles Online for a Fee
    • Document Services/University of Washington https://healthlinks.washington.edu/hsl/docservices/services.html
    • Loansome Doc
    • healthlinks.washington.edu/hsl/docservices/lds-na.html
      • Allows you to order full-text articles while searching PubMed
  • https://healthlinks.washington.edu/hsl/docservices/services.html
  • Loansome Doc
  • #2 Search for Evidence
  • What is evidence-based practice?
    • Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
    • The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
    • Sackett DL et al. Evidence based medicine: what it is and what it isn't. BMJ 1996 Jan 13; 312 (7023): 71-2.
  • EBP and Guidelines Resources
    • PubMed Clinical Queries/Systematic Reviews
    • www.ncbi.nlm.nih.gov/entrez/query/static/
    • clinical.shtml
    • Cochrane Library (fee): gold standard
    • www.cochrane.org
    • National Guideline Clearinghouse
    • guideline.gov
    • TRIP (Turning Research into Practice)
    • www.tripdatabase.com
  • PubMed Strategies for Evidence-Based Citations
    • PubMed Limits
      • Randomized Controlled Trial
      • Meta-Analysis
      • Practice Guideline
      • Clinical Trial
    • PubMed Clinical Queries and Systematic Reviews
  • PubMed Limits
  • obesity American Indians obesity american indians PubMed Clinical Queries
  •  
  • www.cochrane.org Pressure ulcers beds
  • guideline.gov
  •  
  •  
  • TRIP Database www.tripdatabase.com
    • Metasearch engine
    • Performs a simple search of more than 75 databases
    • Finds evidence based resources
    • Searches Cochrane, National Guideline Clearinghouse, Bandolier, etc.
  • TRIP search: prevention of pressure ulcers
  • #3 Keep Current with Email Alert Services
  • Information Overload!
    • 2 million articles published in biomedical journals each year
    • considering everything of potential biomedical importance would require perusing about 6,000 articles per day…
    • If a physician only read 2 articles a day, at the end of year you would be 60 centuries behind.
    Lundberg GD. Perspective from the editor of JAMA, The Journal of the American Medical Association. Bull Med Libr Assoc. 1992 Apr;80(2):110-4.
  • What are Email Alert Services?
    • Deliver current citations into your email
    • Based on a search strategy you create
    • In most cases, abstracts of the articles are provided
    • May provide links to PubMed and full-text articles
  • PubMed : My NCBI
    • Your personal space on the NLM computer system for storing search strategies to generate updates
    • Free registration required
    • Recent PubMed citations sent automatically to your email
    • PubMed: My NCBI help page: healthlinks.washington.edu/howto/myncbi.html
  • My NCBI My NCBI Go to: pubmed.gov And click on My NCBI
  • Health News
    • CNN Health www.cnn.com/HEALTH
    • New York Times Health
    • nytimes.com/pages/health
    • USA Today Health www.usatoday.com/news/health/front.htm
    • Yahoo! News news.yahoo.com
  •  
  • #4 Explore e-Textbooks
  • e-Textbooks
    • UpToDate (fee)
      • Concise comprehensive uptodate reviews of clinical topics in multiple specialties
      • uptodate.com
    • MD Consult (fee)
      • online medical information system that includes textbooks, journals, drug information, patient ed materials, practice guidelines
      • mdconsult.com
  • UpToDate
  • Textbook otitis media
  • Patient Handout
  • e-Textbooks
    • HealthLinks Textbooks page
      • 550+ e-texts
      • Most UW restricted, but some open to all
      • healthlinks.washington.edu/textbooks
      • healthlinks.washington.edu/textbooks
  • Free Text Resources
    • Merck Manual of Medical Information
    • www.merck.com/mmhe
    • Merck Manual of Geriatric Information
    • www.merck.com/mrkshared/mmg/home.jsp
    • emedicine emedicine.com
  • Merck Manual of Medical Information www.merckhomeedition.com
      • www.merck.com/mrkshared/mmg/home.jsp
  • emedicine.com
  • #5 Keep up with Drug Resources
  • Drug Information: Basic Compilations
    • Micromedex (fee) www.micromedex.com
      • Clinical information on toxicology, drugs, drug interactions, and reproductive risks
      • Provides evidence-based medical information
      • Available at most hospitals
    • CDER www.fda.gov/CDER
      • Center for Drug Evaluation and Research
      • Includes Drugs @ FDA , a catalog of FDA Approved Drug Products
  • Micromedex
  • CDER www.fda.gov/CDER
  • Additional Drug Resources
    • DrugInfoNet
    • www.druginfonet.com/index.php?pageID=drug.htm
      • Includes official package inserts and patient package insert information
    • Drugs.com drugs.com
      • Includes Pill Identifier
    • MedlinePlus: Drugs, Supplements and Herbal Information
    • http://www.nlm.nih.gov/medlineplus/druginformation.html
      • Information on thousands of prescription and over-the-counter medications, herbals and supplements
    • PillBot.com pillbot.com
      • Prescription comparison shopping guide
    • RxList rxlist.com
      • Includes the Top 200 list, the Top 300 list, and a Tablet/Capsule Imprint Code
  • DrugInfoNet druginfonet.com/index.php?pageID=drug.htm
  • Drugs.com-Pill Identifier drugs.com
  • Pillbot pillbot.com
  • RxList rxlist.com Accupril side effects
  • Drug Information: Herbals
    • MedlinePlus: Drugs, Supplements and Herbal Information www.nlm.nih.gov/medlineplus/druginformation.html
      • Information on thousands of prescription and over-the-counter medications, herbals and supplements provided by MedMaster and the Natural Standard
  • Drugs, Supplements & Herbal Information page
  • 105 Herbs and Supplements Monographs in English & Spanish Peppermint oil
  •  
  • Drug Information for PDAs
    • Epocrates Rx
      • epocrates.com
      • monographs for the most prescribed meds
      • free download after registration
    • PDA resources for UW
      • healthlinks.washington.edu/howto/pda
  • #6 Explore Patient Ed Sites
  • MedlinePlus medlineplus.gov
    • #1 SOURCE for basic quality consumer/patient information
    • Includes drug information
    • Medical Encyclopedia – full-text with illustrations
    • Spanish version
    • Preformulated PubMed searches
    • Interactive tutorials
    • Current health news
  • MedlinePlus Content Health topics (today): 741 English 699 Spanish 2 drug and herbal databases: approx 1700 monographs ADAM.com encyclopedia: approx 4000 monographs Health news: Approx 15-20 new stories added per day Directories: Over 100 directories covering doctors, hospitals, clinics and libraries. Interactive tutorials: 175 total (soon) NIH-Seniorhealth 31 topics OR-Live surgery videos: 73 Announcement listservs: 11 daily & weekly ClinicalTrials links on display: 640 (today)
  • Medline Plus
  •  
  • New Interactive Tutorials
    • New titles:
      • Bronchoscopy
      • Amniocentesis
      • Low testosterone
      • Upper GI endoscopy
      • Pneumonia
  • Recently added OR-Live: Surgical Webcasts
    • Pre-recorded webcasts of surgical procedures
    • Actual operations performed at medical centers in U.S.
    • One-hour programs with printable transcripts
  • Medical Encyclopedia & Dictionary
    • Encyclopedia includes:
      • 4,000+ entries on diseases, tests, symptoms, injuries and surgeries
      • an extensive library of photographs and illustrations.
    • Medical Dictionary
  •  
  • Do you need…
    • Articles or research studies:
    • Go to PubMed
    • Information written for patients:
    • Start with MEDLINEplus
  • Additional Patient Ed Resources
    • MLA Top 10 Most Useful Health Web Sites
    • mlanet.org/resources/medspeak/topten.html
    • MyHealth Toolkit healthlinks.washington.edu/myhealth
    • Lab Tests Online labtestsonline.org
  • Medical Library Association’s Top Ten Most Useful Websites mlanet.org/resources/medspeak/topten.html
    • Cancer.gov
    • Centers for Disease Control and Prevention (CDC) A-Z Topics
    • familydoctor.org
    • healthfinder®
    • HIV InSite
  • MLA’s Top Ten, continued mlanet.org/resources/medspeak/topten.html
    • Kidshealth®
    • Mayo Clinic
    • MEDEM: an information partnership of medical societies
    • MedlinePlus (English | Spanish)
    • NOAH: New York Online Access to Health
  • healthlinks.washington.edu/myhealth
      • Lab Tests Online labtestsonline.org
    Search by disease or name of test
    • #7
    • Use Cross-Cultural
    • Healthcare Resources
  • Cross-Cultural Healthcare Resources
    • EthnoMed
    • ethnomed.org
      • A cross-cultural medicine database containing information about cultural beliefs and medical issues pertinent to healthcare of ethnic groups in Seattle area
    • Culture Clues
    • depts.washington.edu/pfes/cultureclues.html
      • Tip sheets designed to increase awareness about concepts and preferences of patients from diverse cultures
    • SPIRAL
    • spiral.tufts.edu
    • Patient ed resources in East Asian languages
  • ethnomed.org
  •  
  •  
  • Somali Health and Illness
  •  
  •  
  • depts.washington.edu/pfes/cultureclues.html
  •  
  • SPIRAL spiral.tufts.edu
    • #8
    • Navigate the Web
    • Beyond Basic Google
  • Navigation Difficulties
    • Size of the Web
    • Lack of control or review
    • Lack of quality standards
  • Google google.com
    • Largest: over 8 billion pages
    • Relevance ranking based on link analysis
    • Google Advanced Search
    • www.google.com/advanced_search?hl=en
    • Google Scholar scholar.google.com
  •  
  • Google Advanced Search Features www.google.com/advanced_search?hl=en
    • File Format , i.e. pdf
    • Date , i.e. pages updated in last 3 months
    • Occurrences , i.e. terms appear in title
    • Domain , i.e. .gov, .edu
    • Links , i.e. pages that link to the page
  •  
  •  
  • Google Scholar scholar.google.com
    • Searches for scholarly literature , including peer-reviewed papers, theses, books, abstracts and technical reports
    • Finds articles from academic publishers, professional societies, universities, etc. as well as scholarly articles on the web
    • " Cited by" link identifies # that have cited the original
    • Access to full text only available with subscription
    • NEW: Now links to full text articles the UW subscribes to
    • Caution: Not a reliable sole source for searching scholarly literature
  • Meta-Search Engines Allow you to send searches to more than one search engine at a time
  • Meta -Search Engines DogPile dogpile.com Clusty clusty.com
  • Clusty clusty.com
    • All the speed and functionality of Google , with clustering added
    • Clustered results in left margin
    • Why use clustering?
        • Learn at a glance types of information available
        • Uncover results that are otherwise buried
  • Clusty clusty.com
  • Dogpile dogpile.com
    • Makes searching the web easier by returning the best results from these leading search engines:
    • Google · Yahoo · Ask.com About · LookSmart ·
    • Search for audio, images, and multimedia formats
  • MetaCrawler Hits Getting results for query: infant GERD AltaVista: 10 references returned Webcrawler: 10 references returned Thunderstone: 8 references returned Lycos: 1 references returned Excite: 10 references returned Infoseek: 10 references returned Looksmart: 0 references returned Finished sending hits ... Dogpile dogpile.com
  •  
  • Tips and Strategies
    • Select one or two tools and get to know
    • them well
      • Read the Help
      • Try Advanced Search options
    • Know when NOT to search: 10 minute rule
      • Is it worth your time?
      • Would a phone call to a colleague or librarian be more productive?
      • Is the information you seek likely to be on the web?
    • #9
    • Evaluate Web Resources
  • Evaluating Health Website Strategies
    • Evaluate using Criteria for Evaluating Web Resources
    • Determine the type of site by analyzing website Addresses
    • Use guides to evaluating health Information on the web
  • Criteria for Evaluating Web Sites healthlinks.washington.edu/howto/navigating/criteria.pdf
    • Authority
    • Accuracy
    • Objectivity
    • Currency
    • Coverage
  • Anatomy of a URL
    • edu
    • org
    • com
    • gov
    • The URL includes the name of the host computer which can indicate the purpose of the web site.
    http :// www.cdc.gov / nip / child.htm sub directory name of host computer how information is transmitted filename
  • Guides for Evaluating Health Information
    • Criteria for Evaluating Web Resources
      • healthlinks.washington.edu/howto/navigating/criteria.pdf
    • Thinking Critically about Discipline-Based World Wide Web Resources
    • www.library.ucla.edu/libraries/college/help/critical/discipline.htm
    • #10
    • Contact your ultimate search engine: a librarian!
  • Final Thoughts
    • Use Ten Steps for Finding Health Information on the Web to Improve Patient Care
    • Navigate the web efficiently with a search engine, Advanced Google or Google Scholar
    • Remember PubMed, MedlinePlus, EthnoMed, and drug resources
    • Ask a colleague or librarian, your ultimate search engine
  • For more information…
    • If you are affiliated with the UW, contact:
      • Janet G. Schnall, MS,AHIP
      • 206.543.7474
      • [email_address]
    • Or, contact the National Network of Libraries of Medicine (NN/LM) for exhibits, workshops, classes, and project collaborations
      • NN/LM 800.338.7657
      • Linda Milgrom 206.221.3400
      • [email_address]
  • Finding Health Information on the Web To Improve Patient Care PowerPoint presentation: healthlinks.washington.edu/hsl/liaisons/schnall/auburn.ppt Handout: healthlinks.washington.edu/hsl/liaisons/schnall/auburn.doc