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Finding Reliable Clinical Information Online. An Introduction. Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine. http://www.med.fsu.edu/informatics/MedicalReferences.asp. Major Competency. Students will

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finding reliable clinical information online

Finding Reliable Clinical Information Online

An Introduction

Nancy Clark, M.Ed.

Director of Medical Informatics Education

FSU College of Medicine

http://www.med.fsu.edu/informatics/MedicalReferences.asp

major competency
Major Competency
  • Students will
    • Demonstrate the ability to acquire new data and information and to critically appraise its validity and applicability.
objectives of session
Objectives of Session
  • Students will
    • Demonstrate ability to locate quality clinical information on the web utilizing a variety of strategies
    • Assess the reliability and validity of clinical information found using search engines on the web
    • Begin to utilize the FSU COM virtual library resources to locate medical information for clinical decision support [Old and new]
resources
Resources
  • http://www.med.fsu.edu/informatics/
  • Medical References
    • PowerPoint
    • Assessing the Validity of Online Medical Information
    • Decision Support
    • Using Drug Resources
review
Review
  • What is the most efficient, unbiased way to keep up to date?
    • Go to conferences
    • Read 20-30 journal articles a week
    • Look up answers to clinical questions when they occur in a reliable, current resource
in the beginning
In the Beginning…

Journals

Pocket Manuals

Drug Info

Text Books

Note Cards

Peer Reviewed

david sackett md pioneer of evidence based medicine ebm

“Textbooks don’t smell as their contents rot, so readers will need to develop alternative crap detectors to avoid poisoning their minds and robbing their patients of current best care.”

David Sackett, MDPioneer of Evidence Based Medicine (EBM)

The half life of medical information is estimated at 5 years.

21 st century medical information
21st Century Medical Information

Journals

Pocket Manuals

Drug Info

Text Books

Note Cards

here is the problem
Here is the Problem…

Which of these sites are accurate?

Which of these sites are reliable?

Which of these sites are up to date?

Which of these sites are not biased?

assessing the validity of information on the web1
Assessing the Validity of Information on the Web
  • Site ownership/domain
  • Gov
    • CDC
    • AHRQ
    • NLM.NIH
    • DHHS
    • FDA
    • States fl.us
  • Edu
    • Medical Centers
  • Org
    • Associations
      • AAFP
      • ACP
      • ACOG
    • Disease orgs
      • ADA
      • ALA
  • Com
    • Commercial
assessing the validity of information on the web2
Assessing the Validity of Information on the Web
  • Site ownership/domain
  • Contributors listed, credentials, contact info
  • Highly referenced, linked to primary literature
    • MEDLINE Abstracts/Journal Articles
    • Proceedings from scientific meetings
  • Timeliness: date posted, revised
  • Viewer access, payment and privacy
  • Funding and sponsorship
wikipedia
Wikipedia
  • List 5 ways Wikipedia does not fit the criteria as a reliable site.
exercise
Exercise
  • Search Google for treatment of back pain
  • Rate the first 20 hits
    • Sponsor? Advertisements?
    • Audience?
    • Authors?
    • Links?
    • Date Revised?
  • Do advanced search limit to .gov domain and compare results
  • Search for prostate cancer screening
types of information found free on the web
Types of Information Found Free on the Web
  • Information for/by students
  • Information for/by patients
  • Information for/by clinicians
  • Information for/by researchers
  • Sales pitches, ads
  • Quacks who want to sell something
  • Unproven, unsubstantiated nonsense
assessing the validity of information on the web3
Assessing the Validity of Information on the Web
  • Library subscription resource = reliable
be skeptical

Be Skeptical

You will be taught the principles of critical review of the literature in your second year along with Evidence Based Medicine (EBM)

what kind of question do i have
What Kind of Question Do I Have?
  • Basic science or background question?
    • What is an olecranon?
  • Clinical question?
    • What are the risk factors for hypertension?
    • Which is better for diagnosing pneumonia: x-ray, CT or MRI?
    • How should I treat otitis media?
    • How much does amoxicillin cost?
answering a background question
Answering a Background Question
  • Searching most efficient
  • Google/Wikipedia (assess the validity)
  • Use Medical Dictionary
  • Basic Science Textbooks
    • Access Medicine
    • Thieme
searching with google
Searching with Google

$ubscription

Web Based Medical Information

Free

Google Search

medical dictionaries
Medical Dictionaries
  • Stedman’s is at eMedicine, in PEPID
  • Dorland’s at Merck
exercises for practice
Exercises for Practice
  • Using Stedman’s Medical Dictionary
    • eMedicine online
    • PEPID online and PDA
  • Look up:

dyspnea nephrolithiasis

teratogenic iatrogenic

epistaxis

cyanosis

when to use ebooks versus quick references
When to Use eBooks versus Quick References
  • Background information on topic
    • Basic science question instead of disease specific question
  • Detailed information/explanations versus bottom line
  • Lots of time versus short on time
  • Zebras versus common problems
webfeat search
WebFeat Search
  • Searches Library Resources
  • Pick the type of resources to search
  • Groups by resource
  • Uses resource search engine
new website searches
New Website Searches
  • Multi-Search = Webfeat
  • Changing to SerialSolutions 360, August 2010
  • Only eBooks and Patient Education
access medicine
Access Medicine
  • Best selection of all basic science books
  • Combined with good clinical medicine books
  • Search productive
answering clinical questions

Answering Clinical Questions

At the Point of Care

answering clinical questions1
Answering Clinical Questions
  • Quickest method: Browse to specific resource
  • Requires: knowing the content of sites/resources
  • Starting point: Library web page or your handheld (iPod or cell phone)
  • Learn to use subscription resources
access issues
Access Issues
  • IP address verification
  • Limited simultaneous users
  • Special URL issues
  • Bottom Line
    • Use links on Library Homepage
off campus access
Off Campus Access
  • IP authentication
  • Proxy server – EZProxy
  • FSU COM ID and password
  • Use links on library page
differential diagnosis tools1
Differential Diagnosis Tools
  • Enter symptoms or chief complaint
    • Get a differential
    • Get more info on disease
  • DxPlain *****
    • Harvard
    • Allows for multiple symptoms and lab results
    • Drawback: Slow
  • PEPID***
    • Multiple symptoms
    • Lab Results
    • Age, gender, duration
  • eMedicine **
  • Access Medicine’s
    • Diagnosaurus* (DDX tab)
exercises for practice1
Using DxPlain or PEPID

Patient 35 yr old female

Chief complaint – fatigue, duration 2 months

Other symptoms: throat pain, cold intolerance, weight gain, bradycardia, and constipation,

Differential?

Add lab: elevated TSH

Exercises for Practice
drug information

Drug Information

Rx

Epocrates Online

PEPID

Harrison’s Practice

epocrates online
Epocrates Online
  • Rx, OTC and Alternative medicines by brand name, generic, and by class
  • Formularies
  • Drug Interaction tool
  • Disease reference, pill identifier, medical calculators, tables
  • Constantly updated
epocrates drug interaction multicheck tool
Epocrates Drug Interaction MultiCheck Tool
  • Add all the drugs on the patients medications list (Rx, OTC, Alt) plus drug considering
  • Look to see if any interactions
  • What is the severity of interaction
pepid crc suite
PEPID CRC Suite
  • Rx, OTC and Alternative medicines by brand name, generic, and by class
  • Drug Interaction tool
  • DDx, Disease reference, Lab manual, medical calculators, clerkships, images
  • Constantly updated
pepid drug interaction tool
PEPID Drug Interaction Tool
  • Select all drugs on list
  • Say Done
  • Click Interactions
  • Click specific interaction to read details
exercises for practice2
Exercises for Practice
  • Using Epocrates Online
  • How should you prescribe acyclovir for chicken pox in an immunocompromised patient? (dose)
  • How much do 9 (50 mg) tablets of Imitrex cost? (common migraine drug)
  • Are there any drug interactions between Lexapro, Lortab, Xanax and Zocor?
disease quick references

Disease Quick References

DynaMed (Web and PDA)

eMedicine (Web and PDA)

Harrison’s Practice (Web and PDA)

Epocrates Dx

PEPID

types of questions best answered by disease quick references
Types of Questions Best Answered by Disease Quick References
  • Description/background
  • Epidemiology
  • Diagnosis
  • Treatment
  • Ongoing management
  • Prognosis/outcomes
  • Prevention

Bottom

Line

dynamed
DynaMed
  • Most comprehensive disease reference
  • Summarizes all the latest research on topic
  • Very detailed
  • Well organized
  • Links out to full text articles if more details needed
  • Includes both diseases and symptoms like chest pain

PDA and Online

dynamed1
DynaMed
  • Organization:
  • Includes History and Physical sections (why am I asking these questions)
  • Expand or collapse sections
  • Use CTRL-F to search page
dynamed exercise
Using Dynamed -- Question: What is the typical history of present illness for someone with SARS?

Type in SARS or use alphabetical listing

Explode History

Exercises for Practice

Dynamed Exercise
emedicine

Use FireFox

eMedicine
  • Moderate amount of detail and information
  • Several monographs on one topic by different specialties
  • Google searches it
  • Now owned by WebMD/Medscape. Suggest registering.
  • One of Student’s favorite
  • iPhone version in Medscape
emedicine monographs
eMedicine Monographs
  • Subscription eliminates ads found on free Medscape site
  • One long page of information
  • Navigation clunky, inconsistent

CTRL-F

exercises for practice3
Using eMedicine - Question: What is the functional anatomy when you have a Rotator Cuff Injury?

Search or browse to Rotator Cuff Injury. Use Sports Medicine article.

Select Introduction

Exercises for Practice
harrison s practice
Harrison’s Practice
  • Internal Medicine focus
  • Linked to Access Medicine content
  • Has drug information from GoldStandard
  • Nice navigation on left side

PDA and Online

exercises for practice4
Exercises for Practice
  • Using DynaMed, eMedicine, Epocrates and/or Harrison’s Practice:
    • Develop a scenario for CSSC practice
    • Complete form provided
    • (optional) Pick from diseases top 10 DDx in primary care or top 20 diagnoses seen by students
    • Complete electronically (form on Blackboard)
    • Change file name to your name (John_Doe.doc)
    • Upload to Blackboard Assignments Tab on D101 BB by Friday the 7/23/09, by midnight
top 10 chief concerns
Top 10 Chief Concerns
  • Cough
  • Fatigue
  • Low Back Pain
  • Fever
  • Dyspnea
  • Generalized Abdominal Pain
  • Headache
  • Vertigo
  • Chest Pain
  • Edema

Ponka, D., et al. Top Ten Differential Diagnoses in Primary Care. [Web Resource] U of Ottowa. 2006. Accessed at www.familymedicine.uottawa.ca/

top 20 diseases
Top 20 Diseases

Recorded by FSU CoM Students in 3rd year Clerkships

ipod iphone ipad versions
iPod/iPhone/iPad Versions
  • Clinical Evidence
  • DynaMed
  • Epocrates Essentials
  • Essential Evidence+
  • Harrison’s Practice
    • PEPID
    • Geriatrics at Your Fingertips
  • Free resources
    • ePSS USPSTF Tool
    • Mobile Merck Medicus
    • Medscape

PDAs to be distributed in August 25-27

review1
Review
  • Name three things you should look for in a web site with medical information that would make you feel more confident about the content of that website.
  • What resources are going to be the most accurate, reliable, and up to date?
  • Name a library drug reference, a differential diagnosis resource, and a disease quick reference
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