1. Introduction

2. This workshop will: Goal o Create Research OSCE at your institution Objectives o Identify collaborative opportunities o Brainstorm necessary institutional resources

3. How does this process work?

4. Educational Goals To ask a primary question about the case To acquire information via exploration of the literature To apply information in order to establish treatment plan To appraise information for level of evidence and relevance to the case To assess a patient’s condition via examination and differential diagnosis

5. Distinguish between the various point–of–care tools, the types of data retrieved from each tool, and incorporate their use into daily practice Search PubMed effectively Create a focused, well-articulated question using the PICO (patient, intervention, comparison, and outcome) model Objectives

6. During the OSCE (objective structured clinical exam), the participant will select various point–of–care tools and assess the data retrieved to determine the best answer to the test question *Integrate the EBM (evidence–based medicine) process with clinical expertise and the patient's values *Glasziou, Paul. Centre for Evidence-Based Medicine, Downloads. Hp. July, 2003. Powerpoint: Introduction to EBM. University of Oxford and Queensland. Available: http://www.cebm.net/learning_ebm.asp. 10 Apr. 2005

7. ASK a PICO patient clinical question o Receive instruction on EBM & PubMed databases o Practice PICO question with new knowledge Acquire the information from each point–of–care database and compare Appraise and compare information retrieved from point–of–care databases Apply new skills and knowledge The student will:

8. PICO What is it? How do you apply it?

9. Define PICO PICO is an acronym that describes the elements of a well-formed clinical question.

10. PICO: 1 st determine the type of question o Therapy o Diagnosis o Harm o Prognosis Clinical Question:

11. PICO o What are the characteristics of the patient or population? o What is the condition or disease? P= Patient Patient, population or problem being addressed

12. PICO o Exposure o Diagnostic test o Prognostic factor o Therapy o Patient perception P= Patient I= Intervention Intervention being considered which could include:

13. PICO Medication option? Surgical option? No treatment? Intervention: o What do you want to do with/for the patient? P= Patient I= Intervention

14. PICO o Medication option? o Surgical option? o No treatment? P= Patient I= Intervention C = Comparison of interventions or exposures What is the alternative to the intervention?

15. PICO o Full/partial recovery? Remission o Complications? Morbidity? Death? P= Patient I= Intervention C= Comparison of interventions or exposures O = Outcome of interest What are the relevant clinical outcomes of interest to your patient and you?

16. Focused, well–built question Then you can formulate an answerable question Once you fill out PICO form

17. ASK Student will identify a search question based on a patient case

18. PICO 35 yr. old man with 2 pack/week smoking habit. Promised fiancé that he would quit smoking before their wedding next year. P= I= C= O= 35 yr old smoker medication lifestyle change quit smoking Should medication and/or lifestyle changes be suggested?

19. ACQUIRE Using point–of–care databases, student will locate information to answer PICO question

20. DATABASES ACP PIER © DynaMed © Essential Evidence Plus © First Consult © National Guideline Clearinghouse © PubMed Clinical Queries © MedlinePlus © (Patient education database) Point–of–Care

21. ACP PIER Covers Diseases, Procedures, Screening and Prevention, Complementary/ Alternative Medicine, Ethical and Legal issues Includes level of evidence indicators Over 400 disease based modules

22. DynaMed Monitors the content of over 500 medical journals and systematic evidence review databases by using many journal review services Includes level of evidence indicators and updated daily Clinically-organized summaries for more than 3,000 topics

23. Essential Evidence Plus (EE+) Decision support calculators and clinical tools Includes level of evidence indicators Online repository of content from 2,500 journals, books, reference works, databases, laboratory manuals and The Cochrane Library

24. First Consult Information is based on multiple sources, reviewed and edited by opinion leaders in clinical practice Includes medical topics, procedures and differential diagnoses Evidence–based portion of MD Consult

25. National Guideline Clearinghouse Evidence–based clinical practice guidelines www.guideline.gov Public resource provided by the federal government

26. PubMed Clinical Queries Provides access to specialized PubMed searches designed to quickly connect clinicians with evidence-based clinical literature www.ncbi.nlm.nih.gov/pubmed/ clinical Public resource provided by the federal government Has five study categories – Etiology, Diagnosis, Prognosis, Clinical Prediction Guidelines and Therapy

27. MedlinePlus National Institutes of Health's website for patient education www.medlineplus.gov Public resource provided by the federal government About diseases, conditions, and wellness issues in language that the general public can understand Joint project with National Library of Medicine

28. DATABASES PubMed Gold RushSpecialized

29. PubMed Comprises approximately 20 million citations for biomedical literature from MEDLINE, life science journals, and online books www.pubmed.gov Public resource provided by the federal government Includes medicine, nursing, dentistry, veterinary medicine, health care systems, preclinical sciences, NCBI molecular biology and genetic resources

30. Gold Rush Most complete listing of our TTUHSC print and online journals View TTUHSC purchased articles with password and ID Includes almost 20,000 print and online journals

31. Foundations of searching PubMed (Hands-on) MeSH Boolean Logic (AND OR) Subheadings Explode feature MeSH vs. Major topic Limits and Advanced Search Publication Types, MeSH Terms, Substances, Grant Support Checklist info

32. Foundations of searching PubMed (Hands-on) Abstract format Clipboard E-mail Full-text icons Type of Article; Subsets: Systematic Reviews My NCBI (set up Search Filters) Export (Brief Intro to RefWorks) Checklist info continued

33. Medication (MeSH) = Pharmaceutical Preparations Lifestyle changes (MeSH) = life change events Stop smoking (MeSH) = Smoking cessation ACP PIER, DynaMed, EE+, First Consult, NGC, Medlineplus, PubMed Clinical Queries, PubMed In smokers what medication and/or life style changes are effective to stop smoking?

34. ACP PIER

35. DynaMed

36. Essential Evidence Plus (EE+)

37. First Consult

38. National Guideline Clearinghouse (NGC)

39. MedlinePlus (Patient Education)

40. PubMed Clinical Queries

41. PubMed "Pharmaceutical Preparations” [Mesh] OR "Life Change Events"[Mesh] AND "Smoking Cessation”[Majr] AND "humans"[MeSH Terms] AND English[lang]

42. APPRAISE Student will review data and explain relevance to librarian – during one–on–one session and OSCE

43. APPLY Student will present how the information is applicable to case

44. DEBRIEFING Student will review with physician

45. http://www.ttuhsc.edu/libraries

47. Small group discussions Where are you at the moment:

48. Small group discussions Goal/Idea:

49. Small group discussions Persons to contact:

50. Small group discussions Persons/Departments to contact:

51. Small group discussions Resources needed:

52. Small group discussions Facilities/Locations:

53. Small group discussions Time:

54. Small group discussions How to evaluate performance:

55. Small group discussions How to assess class:

56. ???

57. Contact Information Andrew Neal Dentino, M.D. Texas Tech University Health Sciences Center School of Medicine – Lubbock Department of Internal Medicine 3601 4th St Stop 9410 Lubbock, TX 79430-9410 andrew.dentino@ttuhsc.edu 806-743-3155 x221 Stephanie Shippey, MLS, AHIP Dawn Kruse, MSIS Margaret Vugrin, MSLS, AHIP Texas Tech University Health Sciences Center Preston Smith Library of the Health Sciences – Lubbock 806–743-2208 mylibrary@ttuhsc.edu

58. Thank you!