Clinical Information ResourcesOPT 5191 Intro to Clinic II

Sandra A. Martin, M.L.I.S.Health Sciences Resource Coordinator

Instructor of Library ServicesJohn Vaughan Library Room 305B

marti004@nsuok.edu – 918-444-3263

Existing knowledge can prevent…

•Waste•Errors•Poor quality clinical care•Poor patient experience•Adoption of interventions of low value•Failure to adopt interventions of high value

Source: Sir Muir Gray, Chief Knowledge Officer of Britain’s National Health Service. Quoted on http://www.nks.nhs.uk/.

Learning Objectives

To familiarize students with the information retrieval process for evidence-based patient care

To enable students to access and use synthesized, evidence-based resources to answer clinical questions

To enable students to conduct efficient online searches of databases, e-Journals, and e-Books to answer clinical questions

Sandra Provides….

Instruction Research Assistance Consulting for individuals and small groups Database Searches Help in Locating Full Text Articles

Online – Mobile - Print RUSH delivery of Interlibrary loan requests Assistance with any health-related information need

Helpful Tools Optometry Web Page

Optometry Databases, e-journals, e-books, and other tools available 24/7

Supports specific research, teaching, and patient care needs of NSUOCO faculty, students, and residents

Start Here to find resources for all vision science and medical topics http://library.nsuok.edu/collegeop/index.html

Guide to Library Resources and Services Lists current online databases, e-Journals, and e-Books

Database Guides and Tutorials Clinical Key, OVID,

Remote Access

Enter NT-NSU user id and password to access the library’s electronic resources

Contact Tom Tinnell if you have problems with your user id or password

Contact Sandra to report other technical problems or for search assistance

Information Retrieval for Evidence Based Patient Care Using research findings versus conducting research Retrieving and evaluating information that has direct

application to specific patient care problems Selecting resources that are current, valid and available

at point-of-care Developing search strategies that are feasible within

time constraints of clinical practice

Integration of Clinical Research into Patient Care Process

www.cebm.net

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”

Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.

Patient Concerns

Clinical Expertise

Best research evidence

EBM

What is EBM?

Information Retrieval to Answer Clinical Questions Requires New Skills

Clinical question formulation Search and retrieval of best evidence Critical appraisal of study methods

Clinical Questions

Most common types: Therapy/prevention Diagnosis

Answerable Questions: Are most important to the patient’s well being Fill gaps in your clinical knowledge Are feasible to answer in the time available

Is All Evidence Created Equal?

Small portion of medical literature is immediately useful to answer clinical questions

Understanding “wedge or pyramid of evidence” is helpful in finding highest level of evidence

High levels of evidence may not exist for all questions due to nature of medical problems and research limitations

As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting.

Source:  Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

Best Study Design for Type of Question

Type of Question Study Design

Therapy/prevention Randomized controlled trials

Diagnosis Prospective cohort, blind comparison to a gold standard

Prognosis Cohort, Case Control, Case Series

Etiology/Harm Cohort, Case Control, Case Series

Therapy/Prevention Question

1. In patients with open angle glaucoma [patient], does lowering intraocular pressure [intervention] versus no treatment[comparison] delay visual field loss [outcome]? PICO Model

2. Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner

4S Hierarchy

Critically Appraised Content

Evidence Based Summaries Dynamed, Clinical Key, First Consult, UptoDate

ACP Journal Club

Cochrane Database of Systematic Reviews

Clinical Key & Ovid MEDLINE

SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36

New Resource – Clinical Key Full text access to 1,000 books and 500 journals in every

medical and surgical specialty Ophthalmology – Over 60 full text books Includes 12 Content Types Access to information at all levels from topic overview to

evidence-based data in one search Smart search engine matches first few letters of search

word/words to relevant clinical content No complicated search strategies or Boolean connectors Easier than Google – but with reliable, evidence-based

results

Clinical Key includes all 4S levels plus MEDLINE, books and overviews

Systems/Summaries• FirstConsult

– Available through NSU subscription to Clinical Key for iPhone or iPad only

– Create a personal account in Clinical Key– Download the app from the Apple app store– Login with your Clinical Key username and

password– Summaries are detailed and include sections

on Differential Diagnosis– Eyes and Vision topics well covered

Systems/Summaries

• DynaMed– Summaries for more than 3,000 topics– Monitors >500 medical journals and

systematic review databases– Updated daily– Each article evaluated for clinical relevance

and scientific validity– Includes “graded evidence”

Glaucoma Summary

Evidence-based answer found in 1 minute, 39 seconds

Systems/Summaries• UptoDate

– Evidence based summaries of over 9,500 topics in over 20 specialties

– Ophthalmology not one of the specialties– Good for information on systemic conditions– Available through individual subscription.

Online access plus Mobile app for iPhone and iPad. Cost: $199 per year in training; $499 per year in practice

Available in the Optometry Clinic at Hastings Hospital. Use Resource tab and scroll down to the UptoDate linkSample summary at http://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

If you need Help, contact Sandra

Click on the Optometry Librarian’s Page link from the Optometry web page http://library.nsuok.edu/collegeop/index.html

Email: marti004@nsuok.edu Phone: ext. 3263 or 918.444.3263 Location: Library Room 305B Available for individual or small group consultation Send email with “OPT Clinical” in the subject line -

Receive a response within 24 hours