Faculty development workshop given at the University of Western Ontario on October 19, 2010

1. Clinical Tools: DynaMed, MICROMEDEX, e-CPS,
ACP PIER, UpToDate, Natural Standard, TRIP
Faculty & Staff Development
Oct 19, 2010
Robin Featherstone, MLIS
Clinical Medicine Librarian
rfeathe@uwo.ca
Presentation available at:
http://www.slideshare.net/featherr

2. Objectives
1. Recognize where Point-of-Care tools fit
within the evidence-based hierarchy of
information resources
2. Gain familiarity using a variety of Point-of-
Care tools to answer clinical questions

3. Agenda
• Sources of medical evidence
• Case studies and searching exercises

4. Evidence to answer clinical questions1,2
Type of Question Type of Evidence
Aetiology •Randomized controlled trials
•Case-control or cohort studies
•Case series
Diagnosis •Diagnostic validation studies
•Prospective studies / blind comparison to a gold standard
Prognosis •Inception cohort studies
•Case control studies
•Case series
Therapy •Randomized controlled trials
•Systematic reviews / meta-analyses
Prevention •Randomizes controlled trials
•Cohort studies, case control studies
•Systematic reviews / meta-analyses
Cost-effectiveness •Economic analyses
Quality of life •Qualitative studies
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/

5. Level of Evidence Pyramid
Trip searches both
Qualitative Studies

6. Systems, Synopses & Summaries
Systems Synopses Summaries
Few exist Number in the thousands Fewer than 50,000
Textbook-like; integrate Summaries of studies and Systematic reviews of
clinical evidence with other systematic reviews; articles and guidelines; you
types of info; directed at includes guides or advice assess and make decisions
clinical practice decisions from expert clinicians
Very easy to use Easy to use May require searching

7. Criteria for Selecting a Resource
1. Soundness of evidence-based approach
2. Comprehensiveness and specificity
3. Ease of use
4. Availability

8. Studies
• Number in the millions
• No processing of evidence – must individually
assess
• Require searching large databases
Qualitative Studies

9. Available from Western Libraries (or for free)
Systems Synopses Syntheses Studies
• ACP PIER • ACP Journal Club • Cochrane • MEDLINE
Database of  PubMed
• DynaMed • InfoPOEMS Systematic Reviews  Ovid Medline
(Essential Evidence  Cochrane  Pubget
• Natural Standard Plus) Library • EMBASE
• SCOPUS
• UpToDate • DARE (Database of • US National • Cochrane
Reviews of Effects) Guidelines Controlled Trials
• Micromedex Centre for Clearinghouse Registry (CCTR)
Reviews and  Cochrane
• E-CPS Dissemination Library
• CINAHL
• PsycINFO
• Web of Science
•TRIP Database
Find at: www.lib.uwo.ca/programs/clinicaloutreach/

10. Accessing Point-of-Care Tools (AKA Systems):
www.lib.uwo.ca/programs/clinicaloutreach

11. SEARCHING EXERCISES
DIAGNOSIS QUESTION
PROGNOSIS QUESTION
TREATMENT QUESTION
SCREENING QUESTION
DRUG INFORMATION – DOSING
DRUG INFORMATION – INTERACTION

12. Diagnosis Question
Search the following to answer the question:
What tests should be ordered to diagnose Lyme
Disease?
1. ACP Pier
2. UpToDate
3. DynaMed

13. Diagnosis Question - Results
Source Contains
ACP Pier - Diagnosis Summary
- Evidence grading
- Differential diagnosis
- Test information
- References
UpToDate - Diagnosis topic page
- Test information
- References
DynaMed - Diagnosis (Dx) summary
- Differential diagnosis
- Test information
- References

14. Prognosis Question
Search the following to answer the question:
What is the prognosis for a patient with Bell’s
Palsy?
1. ACP Pier
2. UpToDate
3. DynaMed

15. Prognosis Question - Results
Source Contains
ACP Pier - Follow-up summary
- Case studies
- References
UpToDate - Prognosis and Treatment information together
- Information tables
- Rick factors for recurrence
- References
DynaMed - Prognosis (Pr) summary
- Evidence grading
- Risk factors for recurrence
- References

16. Treatment Question
• Search the following sources to answer the
question: What is an appropriate second-line
topical treatment for atopic dermatitis?
1. ACP Pier
2. UpToDate
3. DynaMed
4. Natural Standard

17. Treatment Question - Results
Source Contains
ACP Pier •Evidence rating •Link to drug monograph from AHFS DI
•Evidence summary Essentials (US)
•Recommendations
UpToDate •Some evidence ratings •Link to detailed drug monograph from Lexi-
•Evidence summary Comp (US)
•Recommendations
DynaMed •Evidence rating •Link to detailed drug monograph from AHFS DI
•Evidence summary Essentials (US)
•Links to guidelines
Natural • Evidence ratings • No links to drug information
Standard • Includes integrative
therapies

18. Screening Question
• 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?
1. ACP Pier
2. UpToDate
3. DynaMed
4. TRIP Database

19. Screening Question - Results
Source Contains
ACP Pier •Evidence rating
•Evidence summary
•Links to assessment tools
UpToDate •Detailed screening topic
•Screening recommendations
•List of risk factors
DynaMed •Prevention and Screening Information together
•Evidence rating
•Evidence summary
TRIP Database •Filter by Evidence level
•Links to guidelines (including Canada)
•Links to websites that include assessment tools

20. SEARCHING EXERCISE – DRUG
INFORMATION

21. Drug Information - Dosing
Search the following information tools to answer
the question: What is the proper dosage of
Digoxin for a 2 year old?
1. UpToDate (Lexi-Comp)
2. DynaMed (AHFS)
3. MICROMEDEX
4. E-CPS

22. Drug Dosing - Results
Source Results
UpToDate (Lexi-Comp) •Pediatric drug information
•Detailed dosing chart
DynaMed •Pediatric dosing guide (under “Special Populations”)
MICROMEDEX •Pediatric Dosing Summary
•Canadian
E-CPS •Dosing information for Infants and Children
•Canadian

23. Drug Information - Interactions
You consider prescribing Tacrolimus to a patient
who is taking Fluconazole, Gabapentin and
Aspirin. Search the following tools to identify
any potential interactions:
1. Lexi-Interact (UpToDate)
2. MICROMEDEX
3. E-CPS

24. Drug Interactions - Results
Source Results
Lexi-Interact •Interaction analysis tool
•Risk ratings
•Patient Management recommendations
MICROMEDEX •Interaction analysis tool
•Risk ratings
•Includes other interactions (ex. Drug-Food)
•Canadian
E-CPS •Detailed drug monographs
•Drug Interactions

25. Summary
• Point-of-Care tools can be found...
• Point-of-Care tools are also known as...
• An example of a free Point-of-Care tool is...
• For alternative medicine information, try...
• For Canadian drug information, try...
• UpToDate’s drug information comes from...
• It makes Robin really happy when you fill out
your...

26. QUESTIONS
Robin Featherstone, MLIS
Clinical Medicine Librarian
rfeathe@uwo.ca
Presentation available at:
http://www.slideshare.net/featherr