Keeping Up Sources of Information Identifying Relevance and Validity Amy Lee, MD Allen Shaughnessy, PharmD

Where we’re going The importance of keeping up (foraging) tools: a first-alert system Assessing relevance and validity of keeping up sources Distinguish information from news Describe pitfalls in using information sources

How do you keep up?

Not all information is created equal Usefulness = Relevance x Validity of any sourceWork Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

Validity The hard part of Information Mastery Technique: EBM working group Guyatt G, Rennie D, ed. Users’ guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA, Self vs delegation- Take responsibility

Work “Work” = time Not all information sources are created equal Signal to noise ratio –News (noise): anything you didn’t know yesterday –Signal: Information that you can use in practice How much of your information is really noise?

Relevance POE: Patient-oriented evidence –mortality, morbidity, quality of life –Live longer and/or better DOE: Disease-oriented evidence –pathophysiology, pharmacology, etiology Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

POEM Patient-Oriented Evidence that Matters matters to you, the clinician, because if valid, will require you to change your practice Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

Highly Controlled Research  Randomized Controlled Trials  Systematic Reviews Physiologic Research Preliminary Clinical Research  Case reports  Observational studies Uncontrolled Observations & Conjecture Effect on Patient-Oriented Outcomes  Symptoms  Functioning  Quality of Life  Lifespan Effect on Disease Markers  A1c in diabetes  MICs in infection  BMD in osteoporosis Effect on Risk Factors for Disease  Improvement in markers (blood pressure, cholesterol) Valid Patient- Oriented Evidence Validity of Evidence Relevance of Outcome

Two Tools Needed to Master Information A method of being alerted to new information (a foraging tool) A tool for finding the information again when you need it (a hunting tool) Without both: –You don’t know that new info. is available –You can’t find it when you do Is your information system anemic?

Quality First-Alert Systems 1. How is the information filtered? –Patient- vs disease- oriented? –Specialty-specific? –Comprehensive? Which journals? –Does it matter (change my practice?) or is it simply news? 2. Is the information valid? –must have levels of evidence (LOE) labels –Beware of the “Trojan Horse”!

Quality First-Alert Systems 3. How well is information summarized? – words accurately in 200 words 4. Is the information placed into context? –Much more than abstracts –“Translational Validity” Transmitting the information from the study correctly and in an understandable format Putting the information into the context of the existing literature on the topic

First-Alert System Risks “Spyware” “Trojan Horse”: Who’s paying when it’s free? Abstracts only –No relevance/ validity filter

News  Information Everyone needs a system for keeping up We have to pay for information by: –Giving information (spyware) –Receiving Trojan horses –Paying a subscription –Investing our time The Final