Date post: | 11-May-2015 |
Category: |
Health & Medicine |
Upload: | robin-featherstone |
View: | 416 times |
Download: | 1 times |
Need to Know: Western Libraries
Internal Medicine Residents
Agenda
• How to access the evidence • How to search the evidence
1. Western Libraries: What we’ve got Journals
and databases
Books
Clinical Tools
Learning modules
Calculators
Drug Identification Tools
Images
2. Medicine Info: How to access- Go to: http://www.lib.uwo.ca/
- Log in to Off-Campus Access with your UWO username and password (same as email)
- Select Browse by Program
- Select Medicine and Dentistry
- Select a specialty
http://www.lib.uwo.ca/programs/generalmedicine/Use this page to find selected resources for general medicine
Electronic Books
Point of Care Tools
Databases
Image and video collections
2. How to search our collections
Select “Catalogue”
Search the Catalogue to find anything Western Libraries owns or subscribes to
...including:
• Journals• Books• Databases• Point of Care Tools
http://alpha.lib.uwo.ca
You can even search for electronic full-text journals.
Select “Journal Title”
Then enter the name of the journal
And select “Go”
Parts of a Catalogue Record
Full title of the journal
Links to electronic articles
Coverage dates
Call # & location of print volumes
Other ways to access electronic full text
• When searching for articles in databases, use the button to link to full-text
Tip: To see the buttons in PubMed • Use the PubMed links from the library website• Change the display in PubMed to Abstract or AbstractPlus
Exercise
• How would you get a hold of this article?
1: Olsson SB, Orndahl G, Erneström S, Eskilsson J, Persson S, Grennert ML, Johansson BW. Spontaneous reversion from long-lasting atrial fibrillation to sinus rhythm. Acta Med
Scand. 1980;207(1-2):5-20. PubMed PMID: 7368973.
Searching
Exercise 1
• Answer the following background question using the library website:
What conditions are in the differential diagnosis for atrial fibrillation?
(hint: check AHA Clinical Cardiac Consult)
Clinical Questions
Using the Evidence to Answer Clinical Questions
Identify your problem
Define a structured question
Find the best evidence
How valid is the evidence?
What are the results?
How should I apply the results to patient care?1
1 Guyatt, Gordon, Drummond Rennie, Evidence-Based Medicine Working Group, and American Medical Association. Users‘Guides to the Medical Literature :A Manual for Evidence-Based Clinical Practice. Chicago, IL: AMA Press, 2002.
We’ll be focusing on two steps
Case study
Using the PICO model, formulate an answerable question
A patient with atrial fibrillation wishes to discontinue taking warfarin. You consider aspirin as an alternative therapy for reducing the patient’s risk of stroke when a colleague suggests you prescribe both aspirin and clopidogrel
Create an answerable question
In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?
Population Patients with atrial fibrillation
Intervention Aspirin alone
Comparison Aspirin combined with clopidogrel
Outcomes Prevention of stroke
Clarify the question type
In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?
What kind of question is this?
6 Question Types
1. Aetiology: the causes of the disease and their modes of operation
2. Diagnosis: signs, symptoms or tests for diagnosing a disorder
3. Prognosis: the probable course of the disease over time4. Therapy: selection of effective treatments which meet
you patient’s values.5. Cost-effectiveness: is one intervention more cost-
effective than another?6. Quality of life: what will be the quality of life of the
patient? 3
3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
Find the Best Evidence
• Studies which best answer each question type
Type of Question Type of Evidence
Aetiology Case-control or cohort study
Diagnosis Diagnostic validation study
Prognosis Inception cohort study
Therapy Randomized controlled trial
Cost-effectiveness Economic evaluation
Quality of life Qualitative study4
4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
Evidence Pyramid
Less time
More time
http://www.mh.org.au/royal_melbourne_hospital/www/353/files/pyramidopt.jpg
Formulating your search
• State the search question• Isolate the main concepts (keywords)• Search each concept separately• Use controlled vocabulary if available (MeSH)• Combine search sets to get final results• Apply limits (language, age group)
Exercise
• In groups, search the following resources to answer the question: In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?
1. Cochrane Library2. Micromedex3. PubMed4. EMBASE5. e-CPS
Conclusions
• Number of results
Source Hits
PubMed 100 (11 if searching narrow/therapy study category)
Cochrane Library 6
Embase 256
Micromedex 2
e-CPS 1 drug monograph
Evidence Pyramid
Cochrane Library
Micromedexe-CPS
PubMed
EMBASE
Summary & Key Points
• “Off campus access” • Browse by Program pages• The Library Catalogue• Clinical Questions• Constructing a search• Levels of Evidence
And, finally...• Who to call for help:
– Research Help: General or access type questions• Service Desk• Phone: 519 661 3168• Email, Chat: http://www.lib.uwo.ca/taylor/researchhelp.shtml
– Subject Librarian (Robin): Specific searching questions• Phone: 519 661 2111 ext: 86383• Email: [email protected]• Chat: http://www.lib.uwo.ca/programs/generalmedicine/
Questions?