1. Evidence Based Medicine at the Point of Care: Maurer’s Mobile POEMS Douglas Maurer, DO, MPH, FAAFP Program Director Madigan Faculty Development Fellowship Sterling Brodniak, DO Fellow

2. Disclosures The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

3. Objectives Distinguished between DOEs / POEMs Learned the best sources of POEMS Solved problems using EBM and Smart Devices Improved the utility of your Smart Device

4. Information Anxiety Too much information “Ping-pong” between sources “My last case…In my experience…” How do we find the “truth”?

5. DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions

6. DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions

7. DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions

8. Identifying POEMS Is it something that your patients care about? Is it a common problem in your practice? If true, will it require you to change your current practice behavior?

9. The Usefulness Equation Usefulness = Relevance X Validity Work

10. Case 1 An 80 y/o male with Type II diabetes, hypertension, and hyperlipidemia has an A1c of 8, and a blood pressure of 145/90. -What is his goal A1C and blood pressure? -He is on a statin. Should he be? -He is not on aspirin. Should he be? 5 minutes

11. Where Would I Go? UpToDate OR Dynamed

12. UpToDate Super EBM textbook Covers multiple specialties Quick and concise Consensus / expert opinion

13. Dynamed Point of care reference tool Monitors over 500 journals Systematic Literature Surveillance More “up to date” than UpToDate

14. Case 2 A 65 y/o male presents with CAP, PMHx of CHF, a temp of 101.5, RR 35, HR 130, and BUN 35. -Should the patient be hospitalized? -When could he be discharged? -How effective is Pneumovax 23? 5 minutes

15. Where Would I Go? Essential Evidence Plus OR Pneumonia OR Any Medical Calculator

16. Essential Evidence Plus POEMS at the point of care Searches 7 databases at once Over 2000 medical calculators Goal to improve outcomes

17. Case 3 A 35 y/o G2P101 at 12 wks gestation with prior C-section presents for her new OB appt. Urinalysis shows bacteriuria. -% chance of a successful VBAC? -Risks of VBAC? -Treat asymptomatic bacteriuria? -If so, what would you use? 5 minutes

18. Where Would I Go? PubMed

19. Huge database Typically searches are painful Use Clinical Queries or PICO

20. No REALLY?! UpToDate OR Dynamed OR Essential Evidence Plus

21. Case 4 A 75 y/o male diabetic, with chronic afib on warfarin, hospital day 5 s/p inferior MI, now has a fever and pneumonia on CXR. -What antibiotic(s) should you rx? -Worried about drug interactions? 5 minutes

22. Where Would I Go? Johns Hopkins Abx Guide AND/OR Sanford Abx Guide AND/OR Epocrates/Lexicomp

23. Case 5 A 30 y/o G2P101 at 38 wks gestation presents in active labor. NO GBS testing was performed. Membranes just ruptured at home approx 8 hours ago. -Does this patient require GBS prophylaxis? -Does your answer change if pt’s temp is 100.6? -What antibiotic would you use if PCN allergic? 5 minute

24. Where Would I Go? UpToDate OR Dynamed OR Prevent GBS

25. Case 6 12 mo male for WBE and immunizations. Previously received PCV #1 at 8 months and PCV #2 at 11 months. -When can he receive PCV #3 and #4? -What social development milestones should he be meeting? -Should he receive fluoride? How much? i 5 minute

26. Where Would I Go? SHOTS AND Kidometer AND Smiles for Life

27. Case 7 A 24 y/o G0P0 presents for f/u of her well woman exam. Her pap revealed LSIL. -What is the next step of her treatment? -What if that intervention revealed LSIL? -When could the patient return to routine screening? 5 minute

28. Where Would I Go? UpToDate OR Dynamed OR ASCCP App

29. Dr Maurer’s POEM Finder UpToDate Dynamed Essential Evidence Plus AFP by Topic eMedicine/Medscape PICO PubMed Epocrates/Lexicomp Hopkins Abx Guide/ Sanford Guide Prescriber’s Letter

30. Dr Maurer’s POEM Finder UpToDate Dynamed Essential Evidence Plus AFP by Topic eMedicine/Medscape PICO PubMed Epocrates/Lexicomp Hopkins Abx Guide/ Sanford Guide Prescriber’s Letter

31. Take Home Points We suffer from TMI Use POEMS at the POC UpToDate, Dynamed, and EE Plus rock! Yes, there IS an app for that!

32. Objectives Distinguished between DOEs / POEMs Learned the best sources of POEMS Solved problems using EBM and Smart Devices Improved the utility of your Smart Device

33. Questions?

34. Case 4 A 25 y/o G1P0 at 9 weeks gestation presents for vaginitis. Your exam confirms the patient has a vaginal yeast infection. -What antifungal(s) should you rx? -Worried about birth defects? Which ones? 5 minute