Find the Evidence! Sean Elliott, MD Annabel Nunez, MLIS
Medical Student! You incompetent moron! What do you mean you have no idea which incision is most appropriate to begin the Louffle-Whalley procedure?!
Learning Issues as QuestionsHow are you doing so far? • Did you focus your searching instead of browsing? • Have you framed questions to get at your knowledge gap? • Have you learned to use technology better? • Are to trying to apply the BEST evidence available to answer questions?
5 Steps to Evidence Based Clinical Practice • Construct a relevant, answerable question from a clinical case. • Plan and carry out a search of the literature for the best external evidence. • Critically appraise the literature for validity and applicability. • Apply the evidence to your patient. 5. Evaluate your performance.
Translating Clinical Case details into a Search • Step 1: Create a focused, answerable question: • “When is it appropriate to commence Highly Active Antiretroviral Therapy (HAART) in the HIV infected patient?” • PICO format can help…Patient, Intervention, Comparison, Outcome
Creating a PICO helps you isolate concepts, & choose search keywords • Patient: • HIV • Intervention: • HAART (Highly Active Antiretroviral Therapy) • Comparison: • Placebo? Other drugs/ combinations? • Outcome: • Clinical improvement
Step 2: Research your focused, answerable question • EBM Search tool • Searches the BEST e-resources available from the library • Includes Hierarchy of Evidence learning tool/ ranking system • EBM tool, but can also be used for researching learning issues
Learning Issue: When does “acute retroviral syndrome” typically occur?
Let’s go back to the search results and try another source…. UpToDate
Let’s look higher in the evidence pyramid…. PubMed – Prognosis Studies
Let’s look even higher in the evidence pyramid…. PubMed Systematic Reviews
Modern Medical Library • Electronic…. • Books • Journals (thousands of full-text titles) • Reserve readings • Videos • Software • Multimedia • Library Catalog / print format materials
Medical Education andClinical Research Tools • Examples of Databases • Stat!Ref • mainly full-text books • PubMed • Journal article database - 5000 journals back to 1950’s • MD Consult • Books, Journals, Monographs, Patient Education, Guidelines • UpToDate • Clinical decision support
Why not just use Google? • Plus’s • It includes PubMed citations • Its HUGE - you always find SOMETHING • Easy to remember web address • FAST!
Why not just use Google? • Downside • Is simply finding SOMETHING, enough? • No filtering – you get information from biased, commercial sites • No ranking of evidence strength • Despite fast search speeds, it takes TIME to sift through results • If its good, you have to often have to pay
Searches full-text of entire web pages Search results by keyword location(s) in web page Searches select databases plus Google Results ranked by quality Google EBM Search Breast cancer PubMed Article Citation SEARCHES: Title, Abstract, subject headings Breast cancer Buystuff.com Book: Harrison’s Principles of Internal Medicine Blah blah blah blah breast Blah Blah blah cancer blah blah blah Blah blah blah blah blah blah blah ALL full-text
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