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?!

A great relationship…

Learning Issues as Questions How 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 1.Construct a relevant, answerable question from a clinical case. 2.Plan and carry out a search of the literature for the best external evidence. 3.Critically appraise the literature for validity and applicability. 4.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

URL:

EBM Search Strategies

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

Finished here

Modern Medical Library Electronic…. –Books –Journals (thousands of full-text titles) –Reserve readings –Videos –Software –Multimedia Library Catalog / print format materials

Medical Education and Clinical Research Tools Examples of Databases –Stat!Ref mainly full-text books –PubMed Journal article database journals back to 1950’s –MD Consult Books, Journals, Monographs, Patient Education, Guidelines –UpToDate Clinical decision support

Ugh…which one should I use?…

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

Google EBM Search 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 PubMed Article Citation SEARCHES: Title, Abstract, subject headings Book: Harrison’s Principles of Internal Medicine ALL full-text Breast cancer Buystuff.com Blah blah blah blah breast Blah Blah blah cancer blah blah blah Blah blah blah blah blah blah blah

Arizona Health Sciences Library: Services Overview NetID/ password –Off campus access Hours  Group study rooms  Wireless access  IS Lab - Computers “Ask a Health Librarian” service Print vs. E-Reserves DocOrder Coffee bar  Comfy furniture as well as tables

Thanks!