Searching with Point of Care Tools Clerkship - Meds 2012 Sept 21, 2010 Robin Featherstone, MLIS Clinical Medicine Libraria...
 
Objectives <ul><li>Recognize where Point-of-Care tools fit within the evidence-based hierarchy of information resources </...
Agenda <ul><li>Sources of medical evidence </li></ul><ul><li>Case studies and searching exercises </li></ul>
Lots of questions... <ul><li>Study conducted of 64 residents in 2 hospitals </li></ul><ul><li>401 consultations </li></ul>...
Lots of barriers... <ul><li>Focus groups with 34 residents </li></ul><ul><li>Barriers to answering clinical questions were...
Evidence to answer clinical questions 1,2 1   Heneghan, Carl, and Douglas Badenoch.  Evidence-Based Medicine Toolkit.  2nd...
Level of Evidence Pyramid Qualitative Studies Trip searches both
Systems, Synopses & Summaries Systems Synopses Summaries Few exist Number in the thousands Fewer than 50,000 Textbook-like...
Criteria for Selecting a Resource <ul><li>Soundness of evidence-based approach </li></ul><ul><li>Comprehensiveness and spe...
Studies <ul><li>Number in the millions </li></ul><ul><li>No processing  of evidence – must individually assess </li></ul><...
Available from Western Libraries (or for free) Find at:  www.lib.uwo.ca/programs/undergraduatemedicaleducation/ Systems Sy...
Accessing Point-of-Care Tools (AKA Systems):  www.lib.uwo.ca/programs/undergraduatemedicaleducation
SEARCHING EXERCISES DIAGNOSIS QUESTION PROGNOSIS QUESTION TREATMENT QUESTION SCREENING QUESTION DRUG INFORMATION – DOSING ...
Diagnosis Question <ul><li>Search the following to answer the question:  What tests should be ordered to diagnose Lyme Dis...
Diagnosis Question - Results Source Contains ACP Pier <ul><li>Diagnosis Summary </li></ul><ul><li>Evidence grading </li></...
Prognosis Question <ul><li>Search the following to answer the question:  What is the prognosis for a patient with Bell’s P...
Prognosis Question - Results Source Contains ACP Pier <ul><li>Follow-up summary </li></ul><ul><li>Case studies </li></ul><...
Treatment Question <ul><li>Search the following sources to answer the question:  What is an appropriate second-line topica...
Treatment Question - Results Source Contains ACP Pier <ul><li>Evidence rating  </li></ul><ul><li>Evidence summary </li></u...
<ul><li>Search the following tools to answer the question:  Should a 53 year old, postmenopausal woman who smokes one pack...
Screening Question - Results Source Contains ACP Pier <ul><li>Evidence rating  </li></ul><ul><li>Evidence summary </li></u...
SEARCHING EXERCISE – DRUG INFORMATION
Drug Information - Dosing <ul><li>Search the following information tools to answer the question:  What is the proper dosag...
Drug Dosing - Results Source Results UpToDate (Lexi-Comp) <ul><li>Pediatric drug information </li></ul><ul><li>Detailed do...
Drug Information - Interactions <ul><li>You consider prescribing Tacrolimus to a patient who is taking Fluconazole, Gabape...
Drug Interactions - Results Source Results Lexi-Interact <ul><li>Interaction analysis tool </li></ul><ul><li>Risk ratings ...
Summary <ul><li>Point-of-Care tools can be found... </li></ul><ul><li>Point-of-Care tools are also known as... </li></ul><...
QUESTIONS Robin Featherstone, MLIS Clinical Medicine Librarian [email_address] Presentation available at:  http://www.slid...
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Searching with point of care tools sept 2010

  1. 1. Searching with Point of Care Tools Clerkship - Meds 2012 Sept 21, 2010 Robin Featherstone, MLIS Clinical Medicine Librarian [email_address] Presentation available at: http://www.slideshare.net/featherr
  2. 3. Objectives <ul><li>Recognize where Point-of-Care tools fit within the evidence-based hierarchy of information resources </li></ul><ul><li>Gain familiarity using a variety of Point-of-Care tools to answer clinical questions </li></ul>
  3. 4. Agenda <ul><li>Sources of medical evidence </li></ul><ul><li>Case studies and searching exercises </li></ul>
  4. 5. Lots of questions... <ul><li>Study conducted of 64 residents in 2 hospitals </li></ul><ul><li>401 consultations </li></ul><ul><li>280 questions (2 questions for every 3 patients seen) </li></ul><ul><li>Answers were sought for 80 (29%) of the questions </li></ul>References: Green ML, Ciampi MA and Ellis PJ (2000). Residents’ medical information needs in clinical: are they being met? American Journal of Medicine 109:218-233.
  5. 6. Lots of barriers... <ul><li>Focus groups with 34 residents </li></ul><ul><li>Barriers to answering clinical questions were reported as: </li></ul><ul><ul><ul><ul><li>Access to electronic information resources </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Skills in searching information resources </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Clinical question tracking </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Time </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Clinical question priority </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Personal initiative </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Team dynamics </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Institutional culture </li></ul></ul></ul></ul>Reference: Green ML, and Ruff TR (2005). Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Academic Medicine, 80(2): 176-182.
  6. 7. Evidence to answer clinical questions 1,2 1 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006. 2 Glover, Jan, and Lei Wang. Find it Fast: The Clinical Question : www.med.yale.edu/library/education/guides/screencasts/finditfast/finditfast_2/ Type of Question Type of Evidence Aetiology <ul><li>Randomized controlled trials </li></ul><ul><li>Case-control or cohort studies </li></ul><ul><li>Case series </li></ul>Diagnosis <ul><li>Diagnostic validation studies </li></ul><ul><li>Prospective studies / blind comparison to a gold standard </li></ul>Prognosis <ul><li>Inception cohort studies </li></ul><ul><li>Case control studies </li></ul><ul><li>Case series </li></ul>Therapy <ul><li>Randomized controlled trials </li></ul><ul><li>Systematic reviews / meta-analyses </li></ul>Prevention <ul><li>Randomizes controlled trials </li></ul><ul><li>Cohort studies, case control studies </li></ul><ul><li>Systematic reviews / meta-analyses </li></ul>Cost-effectiveness <ul><li>Economic analyses </li></ul>Quality of life <ul><li>Qualitative studies </li></ul>
  7. 8. Level of Evidence Pyramid Qualitative Studies Trip searches both
  8. 9. Systems, Synopses & Summaries Systems Synopses Summaries Few exist Number in the thousands Fewer than 50,000 Textbook-like; integrate clinical evidence with other types of info; directed at clinical practice decisions Summaries of studies and systematic reviews; includes guides or advice from expert clinicians Systematic reviews of articles and guidelines; you assess and make decisions Very easy to use Easy to use May require searching
  9. 10. Criteria for Selecting a Resource <ul><li>Soundness of evidence-based approach </li></ul><ul><li>Comprehensiveness and specificity </li></ul><ul><li>Ease of use </li></ul><ul><li>Availability </li></ul>
  10. 11. Studies <ul><li>Number in the millions </li></ul><ul><li>No processing of evidence – must individually assess </li></ul><ul><li>Require searching large databases </li></ul>Qualitative Studies
  11. 12. Available from Western Libraries (or for free) Find at: www.lib.uwo.ca/programs/undergraduatemedicaleducation/ Systems Synopses Syntheses Studies <ul><li>ACP PIER </li></ul><ul><li>DynaMed </li></ul><ul><li>Natural Standard </li></ul><ul><li>UpToDate </li></ul><ul><li>Micromedex </li></ul><ul><li>E-CPS </li></ul><ul><li>ACP Journal Club </li></ul><ul><li>InfoPOEMS ( Essential Evidence Plus) </li></ul><ul><li>DARE (Database of Reviews of Effects) </li></ul><ul><ul><li>Centre for Reviews and Dissemination </li></ul></ul><ul><li>Cochrane Database of Systematic Reviews </li></ul><ul><ul><li>Cochrane Library </li></ul></ul><ul><li>US National Guidelines Clearinghouse </li></ul><ul><li>MEDLINE </li></ul><ul><ul><li>PubMed </li></ul></ul><ul><ul><li>Ovid Medline </li></ul></ul><ul><ul><li>Pubget </li></ul></ul><ul><li>EMBASE </li></ul><ul><li>SCOPUS </li></ul><ul><li>Cochrane Controlled Trials Registry (CCTR) </li></ul><ul><ul><ul><li>Cochrane Library </li></ul></ul></ul><ul><li>CINAHL </li></ul><ul><li>PsycINFO </li></ul><ul><li>Web of Science </li></ul><ul><li>TRIP Database </li></ul>
  12. 13. Accessing Point-of-Care Tools (AKA Systems): www.lib.uwo.ca/programs/undergraduatemedicaleducation
  13. 14. SEARCHING EXERCISES DIAGNOSIS QUESTION PROGNOSIS QUESTION TREATMENT QUESTION SCREENING QUESTION DRUG INFORMATION – DOSING DRUG INFORMATION – INTERACTION
  14. 15. Diagnosis Question <ul><li>Search the following to answer the question: What tests should be ordered to diagnose Lyme Disease? </li></ul><ul><ul><ul><li>ACP Pier </li></ul></ul></ul><ul><ul><ul><li>UpToDate </li></ul></ul></ul><ul><ul><ul><li>DynaMed </li></ul></ul></ul>
  15. 16. Diagnosis Question - Results Source Contains ACP Pier <ul><li>Diagnosis Summary </li></ul><ul><li>Evidence grading </li></ul><ul><li>Differential diagnosis </li></ul><ul><li>Test information </li></ul><ul><li>References </li></ul>UpToDate <ul><li>Diagnosis topic page </li></ul><ul><li>Test information </li></ul><ul><li>References </li></ul>DynaMed <ul><li>Diagnosis (Dx) summary </li></ul><ul><li>Differential diagnosis </li></ul><ul><li>Test information </li></ul><ul><li>- References </li></ul>
  16. 17. Prognosis Question <ul><li>Search the following to answer the question: What is the prognosis for a patient with Bell’s Palsy? </li></ul><ul><ul><ul><li>ACP Pier </li></ul></ul></ul><ul><ul><ul><li>UpToDate </li></ul></ul></ul><ul><ul><ul><li>DynaMed </li></ul></ul></ul>
  17. 18. Prognosis Question - Results Source Contains ACP Pier <ul><li>Follow-up summary </li></ul><ul><li>Case studies </li></ul><ul><li>References </li></ul>UpToDate <ul><li>Prognosis and Treatment information together </li></ul><ul><li>Information tables </li></ul><ul><li>Rick factors for recurrence </li></ul><ul><li>References </li></ul>DynaMed <ul><li>Prognosis (Pr) summary </li></ul><ul><li>Evidence grading </li></ul><ul><li>Risk factors for recurrence </li></ul><ul><li>References </li></ul>
  18. 19. Treatment Question <ul><li>Search the following sources to answer the question: What is an appropriate second-line topical treatment for atopic dermatitis? </li></ul><ul><ul><ul><li>ACP Pier </li></ul></ul></ul><ul><ul><ul><li>UpToDate </li></ul></ul></ul><ul><ul><ul><li>DynaMed </li></ul></ul></ul><ul><ul><ul><li>Natural Standard </li></ul></ul></ul>
  19. 20. Treatment Question - Results Source Contains ACP Pier <ul><li>Evidence rating </li></ul><ul><li>Evidence summary </li></ul><ul><li>Recommendations </li></ul><ul><li>Link to drug monograph from AHFS DI Essentials (US) </li></ul>UpToDate <ul><li>Some evidence ratings </li></ul><ul><li>Evidence summary </li></ul><ul><li>Recommendations </li></ul><ul><li>Link to detailed drug monograph from Lexi-Comp (US) </li></ul>DynaMed <ul><li>Evidence rating </li></ul><ul><li>Evidence summary </li></ul><ul><li>Links to guidelines </li></ul><ul><li>Link to detailed drug monograph from AHFS DI Essentials (US) </li></ul>Natural Standard <ul><li>Evidence ratings </li></ul><ul><li>Includes integrative therapies </li></ul><ul><li>No links to drug information </li></ul>
  20. 21. <ul><li>Search the following tools to answer the question: Should a 53 year old, postmenopausal woman who smokes one pack of cigarettes a day and reports low calcium intake be screened for osteoporosis ? </li></ul><ul><ul><ul><li>ACP Pier </li></ul></ul></ul><ul><ul><ul><li>UpToDate </li></ul></ul></ul><ul><ul><ul><li>DynaMed </li></ul></ul></ul><ul><ul><ul><li>TRIP Database </li></ul></ul></ul>Screening Question
  21. 22. Screening Question - Results Source Contains ACP Pier <ul><li>Evidence rating </li></ul><ul><li>Evidence summary </li></ul><ul><li>Links to assessment tools </li></ul>UpToDate <ul><li>Detailed screening topic </li></ul><ul><li>Screening recommendations </li></ul><ul><li>List of risk factors </li></ul>DynaMed <ul><li>Prevention and Screening Information together </li></ul><ul><li>Evidence rating </li></ul><ul><li>Evidence summary </li></ul>TRIP Database <ul><li>Filter by Evidence level </li></ul><ul><li>Links to guidelines (including Canada) </li></ul><ul><li>Links to websites that include assessment tools </li></ul>
  22. 23. SEARCHING EXERCISE – DRUG INFORMATION
  23. 24. Drug Information - Dosing <ul><li>Search the following information tools to answer the question: What is the proper dosage of Digoxin for a 2 year old? </li></ul><ul><ul><ul><li>UpToDate (Lexi-Comp) </li></ul></ul></ul><ul><ul><ul><li>DynaMed (AHFS) </li></ul></ul></ul><ul><ul><ul><li>MICROMEDEX </li></ul></ul></ul><ul><ul><ul><li>E-CPS </li></ul></ul></ul>
  24. 25. Drug Dosing - Results Source Results UpToDate (Lexi-Comp) <ul><li>Pediatric drug information </li></ul><ul><li>Detailed dosing chart </li></ul>DynaMed <ul><li>Pediatric dosing guide (under “Special Populations”) </li></ul>MICROMEDEX <ul><li>Pediatric Dosing Summary </li></ul><ul><li>Canadian </li></ul>E-CPS <ul><li>Dosing information for Infants and Children </li></ul><ul><li>Canadian </li></ul>
  25. 26. Drug Information - Interactions <ul><li>You consider prescribing Tacrolimus to a patient who is taking Fluconazole, Gabapentin and Aspirin. Search the following tools to identify any potential interactions: </li></ul><ul><ul><ul><li>Lexi-Interact (UpToDate) </li></ul></ul></ul><ul><ul><ul><li>MICROMEDEX </li></ul></ul></ul><ul><ul><ul><li>E-CPS </li></ul></ul></ul>
  26. 27. Drug Interactions - Results Source Results Lexi-Interact <ul><li>Interaction analysis tool </li></ul><ul><li>Risk ratings </li></ul><ul><li>Patient Management recommendations </li></ul>MICROMEDEX <ul><li>Interaction analysis tool </li></ul><ul><li>Risk ratings </li></ul><ul><li>Includes other interactions (ex. Drug-Food) </li></ul><ul><li>Canadian </li></ul>E-CPS <ul><li>Detailed drug monographs </li></ul><ul><li>Drug Interactions </li></ul>
  27. 28. Summary <ul><li>Point-of-Care tools can be found... </li></ul><ul><li>Point-of-Care tools are also known as... </li></ul><ul><li>An example of a free Point-of-Care tool is... </li></ul><ul><li>For alternative medicine information, try... </li></ul><ul><li>For Canadian drug information, try... </li></ul><ul><li>UpToDate’s drug information comes from... </li></ul>
  28. 29. QUESTIONS Robin Featherstone, MLIS Clinical Medicine Librarian [email_address] Presentation available at: http://www.slideshare.net/featherr

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