The document serves as a guide for Western Libraries' internal medicine residents on how to access and search for medical evidence and resources effectively. It outlines the resources available through the library, including databases, journals, and clinical tools, and provides instructions for accessing them and formulating clinical questions using the PICO model. Additionally, it emphasizes the importance of identifying valid evidence and applying it to patient care.

1. Need to Know: Western Libraries Internal Medicine Residents

2. Agenda How to access the evidence How to search the evidence

3. 1. Western Libraries: What we’ve got Journals and databases Books Clinical Tools Learning modules Calculators Drug Identification Tools Images

4. 2. Medicine Info: How to access - Go to: http://www.lib.uwo.ca/ - Log in to Off-Campus Access with your UWO username and password (same as email) - Select Browse by Program - Select Medicine and Dentistry - Select a specialty

5. http://www.lib.uwo.ca/programs/generalmedicine/ Use this page to find selected resources for general medicine Electronic Books Point of Care Tools Databases Image and video collections

6. 2. How to search our collections Select “Catalogue” Search the Catalogue to find anything Western Libraries owns or subscribes to ...including: Journals Books Databases Point of Care Tools

7. http://alpha.lib.uwo.ca You can even search for electronic full-text journals. Select “Journal Title” Then enter the name of the journal And select “Go”

8. Parts of a Catalogue Record Full title of the journal Links to electronic articles Coverage dates Call # & location of print volumes

9. Other ways to access electronic full text When searching for articles in databases, use the button to link to full-text Tip: To see the buttons in PubMed Use the PubMed links from the library website Change the display in PubMed to Abstract or AbstractPlus

10. Exercise How would you get a hold of this article? 1: Olsson SB, Orndahl G, Erneström S, Eskilsson J, Persson S, Grennert ML, Johansson BW. Spontaneous reversion from long-lasting atrial fibrillation to sinus rhythm . Acta Med Scand. 1980;207(1-2):5-20. PubMed PMID: 7368973.

11. Searching

12. Exercise 1 Answer the following background question using the library website: What conditions are in the differential diagnosis for atrial fibrillation? (hint: check AHA Clinical Cardiac Consult )

13. Clinical Questions

14. Using the Evidence to Answer Clinical Questions Identify your problem Define a structured question Find the best evidence How valid is the evidence? What are the results? How should I apply the results to patient care? 1 1 Guyatt, Gordon, Drummond Rennie, Evidence-Based Medicine Working Group, and American Medical Association. Users‘ Guides to the Medical Literature :A Manual for Evidence-Based Clinical Practice. Chicago, IL: AMA Press, 2002. We’ll be focusing on two steps

15. Case study Using the PICO model, formulate an answerable question A patient with atrial fibrillation wishes to discontinue taking warfarin. You consider aspirin as an alternative therapy for reducing the patient’s risk of stroke when a colleague suggests you prescribe both aspirin and clopidogrel

16. Create an answerable question In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke? Population Patients with atrial fibrillation Intervention Aspirin alone Comparison Aspirin combined with clopidogrel Outcomes Prevention of stroke

17. Clarify the question type In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke? What kind of question is this?

18. 6 Question Types Aetiology: the causes of the disease and their modes of operation Diagnosis: signs, symptoms or tests for diagnosing a disorder Prognosis: the probable course of the disease over time Therapy: selection of effective treatments which meet you patient’s values. Cost-effectiveness: is one intervention more cost-effective than another? Quality of life: what will be the quality of life of the patient? 3 3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

19. Find the Best Evidence Studies which best answer each question type 4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006. Type of Question Type of Evidence Aetiology Case-control or cohort study Diagnosis Diagnostic validation study Prognosis Inception cohort study Therapy Randomized controlled trial Cost-effectiveness Economic evaluation Quality of life Qualitative study 4

20. Evidence Pyramid Less time More time http://www.mh.org.au/royal_melbourne_hospital/www/353/files/pyramidopt.jpg

21. Formulating your search State the search question Isolate the main concepts (keywords) Search each concept separately Use controlled vocabulary if available (MeSH) Combine search sets to get final results Apply limits (language, age group)

22. Exercise In groups, search the following resources to answer the question: In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke? Cochrane Library Micromedex PubMed EMBASE e-CPS

23. Conclusions Number of results Source Hits PubMed 100 (11 if searching narrow/therapy study category) Cochrane Library 6 Embase 256 Micromedex 2 e-CPS 1 drug monograph

24. Evidence Pyramid Cochrane Library Micromedex e-CPS PubMed EMBASE

25. Summary & Key Points “ Off campus access” Browse by Program pages The Library Catalogue Clinical Questions Constructing a search Levels of Evidence

26. And, finally... Who to call for help: Research Help: General or access type questions Service Desk Phone: 519 661 3168 Email, Chat: http://www.lib.uwo.ca/taylor/researchhelp.shtml Subject Librarian (Robin): Specific searching questions Phone: 519 661 2111 ext: 86383 Email: [email_address] Chat: http://www.lib.uwo.ca/programs/generalmedicine/

27. Questions?