1. Clinical Information Resources OPT 5191 Intro to Clinic II Sandra A. Martin, M.L.I.S. Health Sciences Resource Coordinator Instructor of Library Services John Vaughan Library Room 305B marti004@nsuok.edu – 918-444-3263

3. Existing knowledge can prevent… Waste Errors Poor quality clinical care Poor patient experience Adoption of interventions of low value Failure to adopt interventions of high value Source: Sir Muir Gray, Chief Knowledge Officer of Britain’s National Health Service. Quoted on http://www.nks.nhs.uk/.

4. Learning Objectives To familiarize students with the information retrieval process for evidence-based patient care To enable students to access and use synthesized, evidence-based resources to answer clinical questions To enable students to conduct efficient online searches of databases, e-Journals, and e-Books to answer clinical questions

5. Sandra Provides…. Instruction Research Assistance Consulting for individuals and small groups Database Searches Help in Locating Full Text Articles  Online – Mobile - Print RUSH delivery of Interlibrary loan requests Assistance with any health-related information need

6. Helpful Tools Optometry Web Page  Optometry Databases, e-journals, e-books, and other tools available 24/7  Supports specific research, teaching, and patient care needs of NSUOCO faculty, students, and residents  Start Here to find resources for all vision science and medical topics http://library.nsuok.edu/collegeop/index.html Guide to Library Resources and Services  Lists current online databases, e-Journals, and e-Books Database Guides and Tutorials  Clinical Key, OVID,

8. Remote Access Enter NT-NSU user id and password to access the library’s electronic resources Contact Tom Tinnell if you have problems with your user id or password Contact Sandra to report other technical problems or for search assistance

9. Information Retrieval for Evidence Based Patient Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid and available at point-of-care Developing search strategies that are feasible within time constraints of clinical practice

10. Integration of Clinical Research into Patient Care Process

11. www.cebm.net “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. Patient Concerns Clinical Expertise Best research evidence EBM What is EBM?

12. Information Retrieval to Answer Clinical Questions Requires New Skills Clinical question formulation Search and retrieval of best evidence Critical appraisal of study methods

13. Clinical Questions Most common types:  Therapy/prevention  Diagnosis Answerable Questions:  Are most important to the patient’s well being  Fill gaps in your clinical knowledge  Are feasible to answer in the time available

14. Is All Evidence Created Equal? Small portion of medical literature is immediately useful to answer clinical questions Understanding “wedge or pyramid of evidence” is helpful in finding highest level of evidence High levels of evidence may not exist for all questions due to nature of medical problems and research limitations

15. As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting. Source: Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

16. Best Study Design for Type of Question Type of QuestionStudy Design Therapy/preventionRandomized controlled trials DiagnosisProspective cohort, blind comparison to a gold standard PrognosisCohort, Case Control, Case Series Etiology/HarmCohort, Case Control, Case Series

17. Therapy/Prevention Question 1. In patients with open angle glaucoma [patient], does lowering intraocular pressure [intervention] versus no treatment[comparison] delay visual field loss [outcome]? PICO Model 2. Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner

18. 4S Hierarchy

19. Critically Appraised Content Evidence Based Summaries Dynamed, Clinical Key, First Consult, UptoDate ACP Journal Club Cochrane Database of Systematic Reviews Clinical Key & Ovid MEDLINE SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36 http://ebm.bmj.com/cgi/reprint/6/2/36

20. New Resource – Clinical Key Full text access to 1,000 books and 500 journals in every medical and surgical specialty Ophthalmology – Over 60 full text books Includes 12 Content Types Access to information at all levels from topic overview to evidence-based data in one search Smart search engine matches first few letters of search word/words to relevant clinical content No complicated search strategies or Boolean connectors Easier than Google – but with reliable, evidence-based results

21. Clinical Key includes all 4S levels plus MEDLINE, books and overviews

22. Systems/Summaries FirstConsult –Available through NSU subscription to Clinical Key for iPhone or iPad only –Create a personal account in Clinical Key –Download the app from the Apple app store –Login with your Clinical Key username and password –Summaries are detailed and include sections on Differential Diagnosis –Eyes and Vision topics well covered

23. Systems/Summaries DynaMed –Summaries for more than 3,000 topics –Monitors >500 medical journals and systematic review databases –Updated daily –Each article evaluated for clinical relevance and scientific validity –Includes “graded evidence”

24. Glaucoma Summary Evidence-based answer found in 1 minute, 39 seconds

25. Systems/Summaries UptoDate –Evidence based summaries of over 9,500 topics in over 20 specialties –Ophthalmology not one of the specialties –Good for information on systemic conditions –Available through individual subscription. Online access plus Mobile app for iPhone and iPad. Cost: $199 per year in training; $499 per year in practice

26.  Available in the Optometry Clinic at Hastings Hospital. Use Resource tab and scroll down to the UptoDate link  Sample summary at http://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2- diabetes-mellitus http://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2- diabetes-mellitus

28. Click on the Optometry Librarian’s Page link from the Optometry web page http://library.nsuok.edu/collegeop/index.html http://library.nsuok.edu/collegeop/index.html Email: marti004@nsuok.edumarti004@nsuok.edu Phone: ext. 3263 or 918.444.3263 Location: Library Room 305B Available for individual or small group consultation Send email with “OPT Clinical” in the subject line - Receive a response within 24 hours