1. DynaMed for the Rest of Us Michelle Henley, MLS Instruction & Consultation Services 1

2. Class outline Describe Dynamed Locate evidence-based condition summaries Get evidence-based treatment guidelines Access information for patients Review clinical case scenarios Access Dynamed via desktop or mobile 2

3. What is Dynamed? A point of care evidence-based tool with clinically-organized summaries for over 3,200 topics; information is updated daily. Dynamed editors systematically identify, select and evaluate the content of 500+ medical journals on a daily basis, then provide summaries of the best evidence. Also provides treatment guidelines and patient information, as well as direct links to the SFGH formulary. 3

4. What is evidence-based? Conclusions are based on best available evidence In clinical setting, best available evidence is typically: –Systematic Reviews –Meta-Analysis –Randomized Controlled Trial Image source: SUNY Downstate Medical Center. Medical Research Library of Brooklyn. The Evidence pyramid. Accessed January 3, 2013 from http://library.downstate.edu/EBM2/2100.htm

5. Dynameds Levels of Evidence Recommendations are graded by the level of evidence found; other grading systems noted (e.g., ACCP) when appropriate

6. How to access resource 6 sfghlibrary.ucsf.edu

7. Browse topics in DynaMed 7 Enter key words in search box to see results ranked by relevancy OR Select a letter to browse alphabetically OR Select here to view topics by category, e.g., allergic disorders

8. Condition summary Treatment options, rated by level of evidence Includes symptoms Links to guidelines

9. History & Physical See symptoms under History

10. Treatment Levels of Evidence label

11. Guidelines & Resources 11 Links to full-text of guidelines

12. Patient Information 12 Links to patient handouts from reliable sources

13. Case scenario example Mr. B is in Med-Surg recovering after hip surgery. He is over 65 and obese, but has no other risk factors for deep vein thrombosis (DVT). Still, the physician suggests he be monitored for symptoms, ambulated early if he presents with DVT, and provided appropriate education for prevention. You dont have time to do all this research, so decide to use DynaMed. You hope to find a summary noting symptoms and evidence for early ambulation, prevention guidelines for post-surgical patients, as well as a handout on prevention for Mr B.

14. Exercise 1 14 Mrs. T visits the clinic, complaining she cant sleep due to nervous legs. The physician suspects Restless Leg Syndrome (RLS) and prescribes pramipexole. Mrs. T seems concerned about taking the medication so you wonder whether non-pharmacological approaches, such as exercise, may be effective in relieving symptoms. 1.Search for a report on RLS 2.Is there good evidence that exercise relieves RLS symptoms? 3.What do AASM guidelines say about non-pharmacological therapies? 4.Is there at least one patient handout that discusses both therapies?

15. Exercise 2 15 A 65 yo man presents to the ED complaining of chest pain, fatigue and weakness. He is diagnosed with heart failure and prescribed a diuretic. You wonder if diuretics can effectively reduce his risk of death from heart failure and if there are any guidelines highlighting non-pharmacological ways to prevent recurrence. 1.Search for a report on heart failure 2.Is there good evidence that diuretics improve mortality rates? 3.Are there any guidelines for non-pharmacologic management? 4.Is there at least one patient handout noting ways to reduce his risk for heart failure?

16. How to access via mobile device 16 Use the DynaMed Mobile app from your mobile phone or other device Compatible with iPhone, iPad, iPod touch, Android, BlackBerry, Windows Phone & Palm Contact the Library to get instructions and a serial number to use library@sfgh.ucsf.edulibrary@sfgh.ucsf.edu OR 206-3114

17. Need more help? 17 DynaMed guide http://sfghdean.ucsf.libguides.com/dynamed Contact me Michelle Henley Barnett-Briggs Medical Library 206-6638 or michelle.henley@ucsf.edumichelle.henley@ucsf.edu