Searching with point of care tools sept 2010
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Transcript of Searching with point of care tools sept 2010
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Searching with Point of Care ToolsClerkship - Meds 2012Sept 21, 2010
Robin Featherstone, MLISClinical Medicine [email protected]
Presentation available at: http://www.slideshare.net/featherr
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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
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Agenda
• Sources of medical evidence • Case studies and searching exercises
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Lots of questions...
Study conducted of 64 residents in 2 hospitals• 401 consultations• 280 questions (2 questions for every 3 patients seen)• Answers were sought for 80 (29%) of the questions
References:
Green ML, Ciampi MA and Ellis PJ (2000). Residents’ medical information needs in clinical: are they being met? AmericanJournal of Medicine 109:218-233.
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Lots of barriers...Focus groups with 34 residents• Barriers to answering clinical questions were reported as:
– Access to electronic information resources– Skills in searching information resources– Clinical question tracking– Time– Clinical question priority– Personal initiative– Team dynamics– Institutional culture
Reference:
Green ML, and Ruff TR (2005). Why do residents fail to answer their clinical questions? A qualitative study of barriers topracticing evidence-based medicine. Academic Medicine, 80(2): 176-182.
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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 studies1 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/
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Level of Evidence Pyramid
Qualitative Studies
Trip searches both
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Systems, Synopses & Summaries
Systems Synopses SummariesFew exist Number in the thousands Fewer than 50,000
Textbook-like; integrate clinical evidence with other types of info; directed at clinical practice decisions
Summaries of studies and systematic reviews; includes guides or advice from expert clinicians
Systematic reviews of articles and guidelines; you assess and make decisions
Very easy to use Easy to use May require searching
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Criteria for Selecting a Resource
1. Soundness of evidence-based approach2. Comprehensiveness and specificity3. Ease of use4. Availability
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Studies
• Number in the millions• No processing of evidence – must individually
assess• Require searching large databases
Qualitative Studies
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Available from Western Libraries (or for free)Systems Synopses Syntheses Studies
• ACP PIER
• DynaMed
• Natural Standard
• UpToDate
• Micromedex
• E-CPS
• ACP Journal Club
• InfoPOEMS (Essential Evidence Plus)
• DARE (Database of Reviews of Effects)
Centre for Reviews and Dissemination
• Cochrane Database of Systematic Reviews
Cochrane Library
• US National Guidelines Clearinghouse
• MEDLINE PubMed Ovid Medline Pubget
• EMBASE• SCOPUS• Cochrane Controlled Trials Registry (CCTR)
Cochrane Library
• CINAHL• PsycINFO• Web of Science
•TRIP Database
Find at: www.lib.uwo.ca/programs/undergraduatemedicaleducation/
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Accessing Point-of-Care Tools (AKA Systems): www.lib.uwo.ca/programs/undergraduatemedicaleducation
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SEARCHING EXERCISESDIAGNOSIS QUESTIONPROGNOSIS QUESTIONTREATMENT QUESTIONSCREENING QUESTIONDRUG INFORMATION – DOSINGDRUG INFORMATION – INTERACTION
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Diagnosis Question
Search the following to answer the question: What tests should be ordered to diagnose Lyme Disease?
1. ACP Pier2. UpToDate3. DynaMed
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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
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Prognosis Question
Search the following to answer the question: What is the prognosis for a patient with Bell’s Palsy?
1. ACP Pier2. UpToDate3. DynaMed
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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
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Treatment Question
• Search the following sources to answer the question: What is an appropriate second-line topical treatment for atopic dermatitis?
1. ACP Pier2. UpToDate3. DynaMed4. Natural Standard
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Treatment Question - ResultsSource Contains
ACP Pier •Evidence rating •Evidence summary•Recommendations
•Link to drug monograph from AHFS DI Essentials (US)
UpToDate •Some evidence ratings•Evidence summary•Recommendations
•Link to detailed drug monograph from Lexi-Comp (US)
DynaMed •Evidence rating•Evidence summary•Links to guidelines
•Link to detailed drug monograph from AHFS DI Essentials (US)
Natural Standard
• Evidence ratings• Includes integrative therapies
• No links to drug information
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• 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 Pier2. UpToDate3. DynaMed4. TRIP Database
Screening Question
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Screening Question - ResultsSource 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
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SEARCHING EXERCISE – DRUG INFORMATION
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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. MICROMEDEX4. E-CPS
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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
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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. MICROMEDEX3. E-CPS
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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
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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...
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QUESTIONS
Robin Featherstone, MLISClinical Medicine [email protected]
Presentation available at: http://www.slideshare.net/featherr