Evidence Based Practice (with Librarians)

Robert Johnson, MLIS Financial relationships Employed by the University of Southern California’s Norris Medical Library Nonfinancial relationships I have no financial relationship with any product/service discussed I do not negotiate licenses for any product/service discussed Disclosures

Overview of librarian’s role in EBP Mobile apps in clinical practice Information resources for residents/students Goals

Evidence Based Practice EBP Straus, S. E. (2011). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Elsevier Churchill Livingstone.

Ely, et. al. describe 59 barriers to information. These are broken down into 6 types of barriers: Time required Original question was often vague and open to interpretation Optimal search strategy Finding appropriate resource Uncertainty about when the search can stop Synthesizing evidence into a clinically useful statement Information Barriers Ely, J. W., Osheroff, J. A., Ebell, M. H., Chambliss, M. L., Vinson, D. C., Stevermer, J. J., & Pifer, E. A. (2002). Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ: British Medical Journal 324(7339), 710.

Ely, et. al. describe 59 barriers to information. These are broken down into 6 types of barriers: Time required Original question was often vague and open to interpretation Optimal search strategy Finding appropriate resource Uncertainty about when the search can stop Synthesizing evidence into a clinically useful statement Information Barriers Ely, J. W., Osheroff, J. A., Ebell, M. H., Chambliss, M. L., Vinson, D. C., Stevermer, J. J., & Pifer, E. A. (2002). Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ: British Medical Journal 324(7339), 710.

Expertise in navigating information resources Librarians build/maintain sites you use to access information Life cycle of information We’re NOT specialists in your field! Explaining a search helps clarify the search Unbiased Why work with a librarian?

Just In Time (fast answers) PubMed, Cochrane, UpToDate, Stat!Ref, National Guidelines Clearinghouse, etc. Shortcuts and work-arounds Mobile resources Just In Case (further research) Island of Misfit Toys: Gideon, Visual Dx, Read by QXMD, EndNote, etc. Productivity: CamScanner, iAnnotate, Evernote, etc. Publishing: Impact factors, systematic reviews, etc. Librarians In The Clinic

What is the best evidence? Depends on your question Diagnosis Therapy Prognosis Harm/Etiology Asking the question

Most common type of questions:Type of study: Diagnosis How to select and interpret diagnostic tests Prospective, blind comparison to a gold standard or cross-sectional Therapy How to select treatments that do more good than harm and that are worth the efforts and costs of using them Randomized controlled trial > cohort study Prognosis How to estimate the patient’s likely clinical course over time (based on factors other than the intervention) and anticipate likely complications of disease Cohort study > case control > case series Harm/Etiology How to identify causes for disease (including iatrogenic forms) Cohort > case control > case series Asking the question From: Duke University Medical Center Library: Introduction to Evidence Based Practice

PICO Can children’s anxiety about upcoming cancer treatments be reduced by listening to music? Asking the question

P = Pediatric oncology patients I = Music therapy C = O = Reduced anxiety Therapy Question 12 Asking the question

PubMed Clinical Queries

PubMed4Hh Freely available product from National Library of Medicine Includes Clinical Queries function

PubMed4Hh Not intuitive If used properly, same initial results as browser interface No limit filters

But sometimes you will get a PDF!

Background vs. Foreground Info Straus, S. E. (2011). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Elsevier Churchill Livingstone.

ACP Smart Medicine

STAT!Ref Contains 115 ebooks such as: AAFP Conditions A to Z ACP Medicine ACP Smart Medicine ACS Surgery: Principles and Practice Current Diagnosis & Treatment Critical Care Delmar’s Guide to Laboratory and Diagnostic Tests Red Book Atlas of Pediatric Infectious Diseases Stedman’s Medical Dictionary

UpToDate

VisualDx

CDC Vaccine Schedules

Epocrates

QxCalculate

AHRQ ePSS Electronic Preventive Services Selector (ePSS) from Agency for Healthcare Research and Quality (AHRQ)

Figure 1

Read by QXMD

Browzine

Robert Johnson, MLIS Norris Medical Library Questions? 43