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Finding Medical Information
 

Finding Medical Information

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  • First of three lectures on medical information Unit 2 – General overview of medical information tools and PubMed searching labs Unit 8 – Pharmacology Resources & RefWorks training
  • Cochrane: first available on the web in 1996 Facebook: known then as “The Facebook” – launched in 2004 Google: Larry Page and Sergey Brin had only just met at Stanford. They begin collaborating on their search engine, then known as “ BackRub ” in 1996 Google Scholar: released in Beta in 2004 MedlinePlus: consumer website launched in 1998 PubMed: while the index called Medline has been around since the 1970s , PubMed (the searchable web interface) was first released in 1996 UpToDate: Bud Rose’s single-author nephrology textbook went online in the early 1990s. Arguably the first modern medical textbook: Principles and Practice of Medicine – 1892 Key point: There are at least 7 new revolutionary tools for finding medical information invented within the last 18 years. Many of the attending staff at the MUHC and clinical faculty at McGill have been practicing medicine for 20 years at least.
  • This is a highly simplified diagram of the medical literature. We’ll learn a lot more about the “levels of evidence” for medical information in January of 2014, right before you start clerkship. But, for an overview, it’s important to recognize the difference between filtered and unfiltered information. If a piece of information is “filtered,” that means an expert has collected many individual studies or opinions and created a summary. If a piece of information is unfiltered, it is either one single study or one person’s opinion. Information tools can be distinguished by the amount and the quality of unfiltered or filtered information they contain.
  • Another useful way we can distinguish information is by the kind of questions that it answers. Medical questions can be either background question or foreground questions Background questions tend to be broad and we ask them to learn more about the fundamental aspects of a disease or topic. Background questions are commonly asked on MCCQEs. The answers to background questions may not be widely known, but they are considered common knowledge. For example… What are the signs of an asthma attack? Foreground questions tend to be narrow or specific, and we ask them to learn more about a particular case. The kinds of questions which will arise during patient encounters will most likely be foreground. For example… What are the bronchodilatory effects of combined budesonide formoterol and budesonide salbutamol in acute asthma? During the first two years of medical school, you’ll be asking mostly background questions. As you move into the clinical environment, you’ll start asking more and more foreground questions.
  • Clinical scenarios, like this hematology case study will contain both kinds of questions. Sometimes you may have to answer a combination of background and foreground questions. Or you may have to answer a background question before you can address a foreground question.
  • So, in this case, there is the background question: What is the pathophysiology of Hodgkin’s lymphoma?
  • And then the foreground question related to treatment: Is combined modality therapy superior to chemotherapy alone? Or another foreground question could be: do the risks of developing breast cancer outweigh the benefits of combined modality therapy? There can be many questions in a single scenario
  • Before we talk about the information tools which best answer each type of question, can you please read this scenario. With your neighbour, discuss the case and write down one foreground and one background question.
  • Key point: Information sources for answering background questions tend to all be filtered. When answering foreground questions, you will find use a mix of unfiltered and filtered tools. Obviously, start with filtered tools and then look at individual studies. It all depends on how specific your question is.
  • Which resource will answer this question? Answer: 7 – 1 OR 3 OR 5 Why? These are all filtered sources for answering background questions
  • Remember: EMBASE is a database of individual articles, like PubMed. Answer 2 – it contains individual studies, which are unfiltered
  • After the poll: ask the class > Where would you look to answer this question? Answer: 2 – Foreground question – best answered with an individual study – these are answered in tools like PubMed
  • Key point: Information sources for answering background questions tend to all be filtered. When answering foreground questions, you will find use a mix of unfiltered and filtered tools. Obviously, start with filtered tools and then look at individual studies. It all depends on how specific your question is.
  • Mention the levels of evidence
  • Exam on the 26 th .

Finding Medical Information Finding Medical Information Presentation Transcript

  • Clicker Test – Do you think patients should be able to view doctors’ notes?1. Definitely, yes2. Absolutely no3. Maybe… it dependsDelbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, Feldman HJ, Mejilla R, Ngo L, Ralston JD, Ross SE, Trivedi N, Vodicka E, Leveille SG. Inviting Patients to Read Their Doctors Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med. 2012 Oct 2;157(7):461-70. doi: 10.7326/0003-4819-157-7-201210020- 00002. PubMed PMID: 23027317. http://www.ncbi.nlm.nih.gov/pubmed/23027317
  • Finding Medical InformationBasis of Medicine, Unit 2, October 2012 Robin Featherstone, MLIS Liaison Librarian (Medicine) robin.featherstone@mcgill.ca
  • Where would you go first to find information about asthma therapies?1. Cochrane Database of Systematic Reviews2. Expert opinion3. Facebook4. Google5. Google Scholar6. PubMed7. MedlinePlus8. Textbooks (i.e., Harrison’s)9. UpToDate10. Other
  • In 1995, where would you go first to find information about asthma therapies?1. Cochrane Database of Systematic Reviews2. Expert opinion3. Facebook4. Google5. Google Scholar6. PubMed7. MedlinePlus8. Textbooks (i.e., Harrison’s)9. UpToDate10. Other
  • ObjectivesBy the end of this lecture, you will beable to:1.Differentiate between filtered andunfiltered information2.Describe the difference betweenbackground and foreground questions3.Begin to identify the best sources toanswer medical questions
  • Less time Less work Less evidence Filtered Filtered Unfiltered Unfiltered Expert OpinionMore timeMore workMore evidence
  • What are the bronchodilatory effects of combined inhaled budesonide/formoterol and budesonide/salbutamol in acute asthma? Foreground questionsWhat are the signs of anasthma attack? Background questionsWhat is the pathology ofasthma? Novice Expert
  • A 25 year-old female has been recently diagnosed withclassical Hodgkin’s lymphoma (nodular sclerosing subtype).Staging reveals that she is a stage IIA with a 4.5 cm nodalmass in her neck and mediastinal nodes. Her hematologistrecommends combined modality therapy(chemotherapy/radiation therapy). The patient has donesome reading about therapy and is worried about the longterm effects of radiation especially the risk of breast cancer.Background Foreground
  • What is the pathophysiology ofHodgkin’s lymphoma?Background Foreground
  • For a 25 year old female with stage IIA Hodgkin’s lymphoma, is combined modality therapy superior to chemotherapy alone?Background Foreground
  • A 35 year-old patients presents to the ER with a right leg swellingx 3 days. The patient recently returned from a business trip inMalasia and therefore you suspect a deep vein thrombosis (DVT).It is the weekend and so the patient receives a CT angiogram thatdoes not reveal any pulmonary embolism and the venous portionof the study does not reveal any above or below knee clots. Thatsaid, you are still convinced that the patient may have a lowerlimb DVT and so you ask for a lower limb doppler which requiresthe radiologist to come into the hospital in the middle of thenight to perform the study. The radiologist is reluctant to come asthe venous phase of the CT angiogram was negative.Background Foreground
  • What diagnostic tests areperformed for a DVT?Background Foreground
  • Which of the following is more sensitive for detecting lower limb DVTs (both above and below knees): venous dopplers or CT angiograms?Background Foreground
  • Foreground questions Background questionsNovice Expert
  • Answers Background questions Audience EveryoneCompare to WebMD Contents Filtered information Cost Free URL http://www.nlm.nih.gov/ medlineplus/
  • HARRISON’S PRINCIPLES OF INTERNAL MEDICINE (AKA Harrison’s Online) Answers Background questions Audience Novice and expertCompare to Goldman’s Cecil Medicine Contents Filtered information Cost Institutional subscription URL http://bit.ly/harrisonsonline
  • Answers Background and foreground questions Audience Novice and expertCompare to Harrison’s or DynaMed Contents Filtered & unfiltered information Cost Institutional subscription URL http://bit.ly/uptodatemcgill
  • Answers Foreground questions Audience ExpertsCompare to MetaLib Contents Unfiltered information Cost Free URL http://scholar.google.ca/
  • Answers Foreground questions Audience ExpertsCompare to EMBASE Contents Unfiltered information Cost Free URL http://www.ncbi.nlm.nih.gov/pubm ed
  • Answers Foreground questions Audience ExpertsCompare to DARE Contents Filtered information Cost Institutional subscription URL http://bit.ly/cochranemcgill
  • Which tool contains the answer to the question: What is the treatment for Hodgkin’s disease?1. Google Scholar2. Harrison’s Online3. MedlinePlus4. PubMed5. UpToDate6. 1 OR 47. 2 OR 3 OR 5
  • What kind of information does EMBASE contain?1. Filtered2. Unfiltered3. Don’t know
  • What kind of question is this: Is written or videoeducational interventions more effective at increasing vaccination intention rates in young adults?1. Background2. Foreground3. Don’t know
  • Foreground questions Background questionsNovice Expert
  • Less time Less work Less evidence Filtered Filtered Unfiltered Unfiltered Expert OpinionMore timeMore workMore evidence
  • LabsGroups A, D & G Groups B, E & H Groups C, F & IMon Oct 22 Tues Oct 23 Weds Oct 2412:35 pm – 2:25 pm 12:35 pm – 2:25 pm 9:35 am – 11:25 amCybertheque, Redpath Redpath e-classroom, Rm 409, McIntyre (2ndLibrary Basement Rm 23 floor, Life Sciences Library) AssignmentTake home searching exercisesDue: 5 pm on Tues, Oct 30Submit to the Dean’s Office, 6th floor of McIntyre
  • Questions Robin Featherstone, MLIS Liaison Librarian (Medicine) robin.featherstone@mcgill.ca