Resources for Clinical Reasoning Exercise

Resources for Clinical Reasoning ExerciseKSOM Psychiatry Clerkship, 2014-2015Lynn Kysh, MLISInformation Services LibrarianLearning ObjectivesFormulate a clinical research question from clerkship experienceIdentify databases relevant to psychiatry and conduct an effective searchApply basic criteria to appraise evidenceRetrieve available resources for more information on citation styles, search strategies, etc. Medical Students Years 3-4 Portal

Available on the Norris Medical Library Homepageusc.edu/nml

norris.usc.libguides.com/medyrs3-4

Background QuestionsForeground QuestionsExperience with conditionWhat is the disorder?What causes it?How does it present?How can it be prevented?What are treatment options?Clinical research questionInformation for an actual patientPICO based

Refresher: Question TypesFormulate a clinical Research QuestionScenario:Patient diagnosed with schizophrenia is being treated with an anti-psychotic drug (olanzapine).

This drug is causing patient to gain weight. You wonder if nutrition therapy would be effective for weight loss.

Formulate a clinical Research Question: therapyProblem/Patient/PopulationIntervention/IndicatorComparison/Control (if any)OutcomeWeight gain with anti-psychotic olanzapineNutrition therapyNoneContinued treatment with olanzapine while managing healthy weightFormulate Research QuestionHow effective is nutrition therapy in reducing weight gain caused by olanzapine?

Types of Clinical QuestionsHow is the problem treated?What causes the problem? What is the frequency of the problem? Does this person have the problem? Who will get the problem? TherapyEtiology, Risk FactorsFrequencyDiagnosisPrognosis, PredictionAn Idea for an Etiology QuestionDoes the recreational use of marijuana increase the incidence of psychosis among adult men?

Formulate a clinical Research Question: EtiologyProblem/Patient/PopulationIntervention/IndicatorComparison/Control (if any)OutcomeAdult menRecreational use of marijuana No recreational use of marijuanaIncreased incidence of psychosisCommon Mistake in Formulating a research questionWhat is the most effective treatment of schizophrenia?

Who is the patient?Age, gender, comorbidities, etc. What treatments are known to be effective? Primary research does not answer general questionsConsider background information tools (UpToDate, AccessMedicine, etc.)

Biomedical information databaseSearch with automatic term mapping or Medical Subject Headings (MeSH)

Psychiatry-specific databaseSearch with synonyms and narrower termsQuotes to search as phrase; * to truncate

Journal articles, meeting abstracts, dissertations, book chaptersSearch with synonyms and narrower termsQuotes to search phrase; * for truncation

Select 5 Best ArticlesDoes this article address my research question (PICO)?Is this the best article for my research question?Does this article rely on sound research methodologies?

Does this article address my research question (PICO)?RememberProblem/PatientInterventionComparisonOutcome

Source: Flahery, RJ. A simple method for evaluating the clinical literature. Family Practice Management. May 2004.PatientProblemInterventionComparison (if any)OutcomeSchizophrenia or schizoaffective disorder (DSM IV)Men and women; 19-64 y/oOlanzapine for 12 weeks7% or more weight gainAssociated weight gain with olanzapineDiet management: food diary, dietician consultationExercise management: exercise diary, exercise manager

NonePhysical exam (BMI measurement)Pulse rateBlood pressure

2. Is this the best article for my research question?RememberProblem/PatientInterventionComparisonOutcome

Source: Flahery, RJ. A simple method for evaluating the clinical literature. Family Practice Management. May 2004.AddDate of PublicationTimes cited (Web of Knowledge, PSYCinfo, Google Scholar)Publication Type

18Times cited

Pyramid of Publication TypesHigher Quality of InformationFewer ArticlesLower Quality of InformationMore ArticlesDateTimes Cited

Publication TypeApril 200669 (Web of Science)71 (PsycINFO)101 (Google Scholar)Randomized Control Trial (RCT)3. Does this article rely on sound research methodologies? Critical Appraisal Charts for... Systematic Reviews Therapy Studies Diagnosis Studies Prognosis Studies Harm/Etiology

22RandomizationAllocation ConcealmentSimilar Baseline CharacteristicsBlinding To what extent?Follow upIntention to TreatYes (maybe); methods not described

Not described

YesNo

Not described

YesSelect 5 Best Articles1. Does this article address my research question (PICO)?YES2. Is this the best type of article for my research question?YES3. Does this article rely on sound research methodologies? MOSTLY

What I am Looking for on the assignment1 Point Reference 5 Articles1.75.5.250List four or five articles that relate to the research question and relevant PICO elements.List three articles that relate to the research question and relevant PICO elements.

List two articles that relate to the research question and relevant PICO elements.

List one article that relates to the research question and relevant PICO elements.

List no articles that relate to the research question and relevant PICO elements.What I am Looking for on the assignment1 Point Provide One Article that Meets Assessment Criteria1.50At least one article listed meets assessment criteria of high quality evidence (combination of publication type, currency, statistics, times cited, appraisal).At least one article listed meets some assessment criteria ranking it as medium quality evidence (combination of publication type, currency, statistics, times cited, appraisal).No articles listed meet any assessment criteria ranking all articles as low quality evidence.ResourcesCitation Style LibGuideSample paper, cheat sheet, useful websites, examples, etc.http://norris.usc.libguides.com/citation Psychiatry LibGuide (Clerkship Resources)Download PowerPoint, download Simple Method for Evaluating Clinical Literature article, access databases mentionedhttp://norris.usc.libguides.com/psychiatry

ContactLynn Kysh, MLISInformation Services Librarian(323) 442-1124kysh@usc.edu

Learning ObjectivesFormulate a clinical research question from clerkship experienceIdentify databases relevant to psychiatry and conduct an effective searchApply basic criteria to appraise evidenceRetrieve available resources for more information on citation styles, search strategies, etc. Questions?

Thank You!