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Strategies for Answering Clinical Queries Introduction to Health Informatics April 6, 2010 Robin Featherstone, BA, MLIS Cl...
Objectives <ul><li>Develop an understanding of search tools within an EBM framework </li></ul><ul><li>Introduce a variety ...
Agenda <ul><li>Sources of Medical Evidence (EBM) & PICO </li></ul><ul><li>Searching Exercises </li></ul><ul><ul><li>Medica...
SOURCES OF MEDICAL EVIDENCE & PICO
Level of Evidence Pyramid Qualitative Studies Trip searches both
Refine Questions using PICO <ul><li>P  = Patient, Problem or Population </li></ul><ul><li>I  = Intervention or Exposure </...
PICO Example <ul><li>A patient travels frequently and report suffering from the effects of jet lag. They ask about prevent...
Use PICO to develop your query <ul><li>P:  Jet lag </li></ul><ul><li>I:  Melatonin </li></ul><ul><li>C:  Exercise </li></u...
Determine your Question Type 1,2 <ul><ul><li>Aetiology:  What is the cause of the disease and its mode of operation? </li>...
Studies to Answer Each Type 1,2 1   Heneghan, Carl, and Douglas Badenoch.  Evidence-Based Medicine Toolkit.  2nd ed. Malde...
Level of Evidence Pyramid Qualitative Studies Trip searches both
SEARCHING EXERCISE – MEDICAL LITERATURE
Searching the Medical Literature <ul><li>Please search the following sources to answer the question:  Are probiotics effec...
Treatment Question - Results Source Results Cochrane Library 2 Cochrane Reviews 3 Other Reviews 47 Clinical Trials PubMed ...
SEARCHING EXERCISE – POINT OF CARE TOOLS
Searching Point-of-Care Tools <ul><li>Search the following sources to answer the question:  What is an appropriate second-...
2 nd  Line Treatment Question - Results Source Contains ACP Pier <ul><li>Evidence rating  </li></ul><ul><li>Evidence summa...
<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
Searching for Drug Information <ul><li>You consider prescribing Tacrolimus to a patient who is taking Fluconazole, Gabapen...
Drug Interactions - Results Source Results Lexi-Interact <ul><li>Interaction analysis tool </li></ul><ul><li>Risk ratings ...
Summary <ul><li>Use PICO to develop clinical queries </li></ul><ul><li>Select the level of evidence to best answer your qu...
QUESTIONS
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Strategies For Answering Clinical Queries

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Presentation given to 4th year MD students taking "Introduction to Health Informatics" at the University of Western Ontario on April 6th, 2010

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Strategies For Answering Clinical Queries

  1. 1. Strategies for Answering Clinical Queries Introduction to Health Informatics April 6, 2010 Robin Featherstone, BA, MLIS Clinical Medicine Librarian Allyn & Betty Taylor Library [email_address] Presentation available at: http://www.slideshare.net/featherr
  2. 2. Objectives <ul><li>Develop an understanding of search tools within an EBM framework </li></ul><ul><li>Introduce a variety of products to support clinical decision making </li></ul>
  3. 3. Agenda <ul><li>Sources of Medical Evidence (EBM) & PICO </li></ul><ul><li>Searching Exercises </li></ul><ul><ul><li>Medical Literature </li></ul></ul><ul><ul><ul><ul><li>Cochrane Library </li></ul></ul></ul></ul><ul><ul><ul><ul><li>PubMed (Clinical Queries) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>TRIP Database </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Natural Standard </li></ul></ul></ul></ul><ul><ul><li>Point-of-Care Tools </li></ul></ul><ul><ul><ul><ul><li>ACP Pier </li></ul></ul></ul></ul><ul><ul><ul><ul><li>UpToDate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DynaMed </li></ul></ul></ul></ul><ul><ul><li>Drug Information Resources </li></ul></ul><ul><ul><ul><ul><li>E-CPS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>MICROMEDEX </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lexi-Interact </li></ul></ul></ul></ul>
  4. 4. SOURCES OF MEDICAL EVIDENCE & PICO
  5. 5. Level of Evidence Pyramid Qualitative Studies Trip searches both
  6. 6. Refine Questions using PICO <ul><li>P = Patient, Problem or Population </li></ul><ul><li>I = Intervention or Exposure </li></ul><ul><li>C = Comparison </li></ul><ul><li>O = Outcomes </li></ul>
  7. 7. PICO Example <ul><li>A patient travels frequently and report suffering from the effects of jet lag. They ask about prevention methods. Have you heard of using melatonin? They’ve also read that exercise can be used to prevent symptoms. What do you recommend? </li></ul>
  8. 8. Use PICO to develop your query <ul><li>P: Jet lag </li></ul><ul><li>I: Melatonin </li></ul><ul><li>C: Exercise </li></ul><ul><li>O: Prevention of symptoms </li></ul><ul><li>Which is more effective in preventing jet lag: melatonin or exercise? </li></ul>
  9. 9. Determine your Question Type 1,2 <ul><ul><li>Aetiology: What is the cause of the disease and its mode of operation? </li></ul></ul><ul><ul><li>Diagnosis: How accurate is this diagnostic test? </li></ul></ul><ul><ul><li>Prognosis: What is the probable course of the disease? </li></ul></ul><ul><ul><li>Therapy: Is one intervention more effective than another? </li></ul></ul><ul><ul><li>Prevention: How to reduce the risk of this disease? </li></ul></ul><ul><ul><li>Cost-effectiveness: Is one intervention more cost-effective than another? </li></ul></ul><ul><ul><li>Quality of life: What will be the patient’s quality of life? </li></ul></ul>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/
  10. 10. Studies to Answer Each Type 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>
  11. 11. Level of Evidence Pyramid Qualitative Studies Trip searches both
  12. 12. SEARCHING EXERCISE – MEDICAL LITERATURE
  13. 13. Searching the Medical Literature <ul><li>Please search the following sources to answer the question: Are probiotics effective in reducing symptoms of eczema/atopic dermatitis? </li></ul><ul><ul><ul><li>Cochrane Library </li></ul></ul></ul><ul><ul><ul><li>PubMed (clinical queries) </li></ul></ul></ul><ul><ul><ul><li>TRIP Database </li></ul></ul></ul><ul><ul><ul><li>Natural Standard </li></ul></ul></ul>
  14. 14. Treatment Question - Results Source Results Cochrane Library 2 Cochrane Reviews 3 Other Reviews 47 Clinical Trials PubMed 199 Citations total 88 Review articles 48 citations if searching Clinical Queries – looks for randomized controlled trials TRIP Database 81 Citations Natural Standard 1 disease summary 1 drug summary
  15. 15. SEARCHING EXERCISE – POINT OF CARE TOOLS
  16. 16. Searching Point-of-Care Tools <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><ul><li>Locate temporary link from: http://taylormedinfo.blogspot.com/ </li></ul></ul></ul></ul>
  17. 17. 2 nd Line 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>
  18. 18. <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><ul><li>Locate temporary link from: http://taylormedinfo.blogspot.com/ </li></ul></ul></ul></ul>Searching Point-of-Care Tools: 2. Screening question
  19. 19. 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>
  20. 20. SEARCHING EXERCISE – DRUG INFORMATION
  21. 21. Searching for Drug Information <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>
  22. 22. 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>
  23. 23. Summary <ul><li>Use PICO to develop clinical queries </li></ul><ul><li>Select the level of evidence to best answer your query type </li></ul><ul><li>Consider using a variety of filtered information tools based on the information needed </li></ul>
  24. 24. QUESTIONS

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