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Page 1: Psychiatry clerkship

RESOURCES FOR CLINICAL REASONING EXERCISE

KSOM Psychiatry Clerkship, 2014-2015

Lynn Kysh, MLIS

Information Services Librarian

Page 2: Psychiatry clerkship

LEARNING OBJECTIVES

Formulate a clinical research question from clerkship experience

Identify databases relevant to psychiatry and conduct an effective search

Apply basic criteria to appraise evidence

Retrieve available resources for more information on citation styles, search strategies, etc.

Page 3: Psychiatry clerkship

MEDICAL STUDENTS YEARS 3-4 PORTALAvailable on the

Norris Medical

Library Homepage

usc.edu/nml

norris.usc.libguides.

com/medyrs3-4

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Background Questions

Foreground Questions

Experience with condition

What 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 TYPES

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FORMULATE A CLINICAL RESEARCH QUESTION

Scenario:

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.

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FORMULATE A CLINICAL RESEARCH QUESTION: THERAPY

Problem/Patient/Population

Intervention/Indicator

Comparison/Control (if any)

Outcome

Weight gain with anti-psychotic olanzapine

Nutrition therapy

None

Continued treatment with olanzapine while managing healthy weight

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FORMULATE RESEARCH QUESTION

How effective is nutrition therapy in reducing weight gain caused by olanzapine?

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TYPES OF CLINICAL QUESTIONS

How 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?

Therapy

Etiology, Risk Factors

Frequency

Diagnosis

Prognosis, Prediction

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AN IDEA FOR AN ETIOLOGY QUESTION

Does the recreational use of marijuana increase the incidence of psychosis among adult men?

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FORMULATE A CLINICAL RESEARCH QUESTION: ETIOLOGY

Problem/Patient/Population

Intervention/Indicator

Comparison/Control (if any)

Outcome

Adult men

Recreational use of marijuana

No recreational use of marijuana

Increased incidence of psychosis

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COMMON MISTAKE IN FORMULATING A RESEARCH QUESTION

What 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 questions

Consider background information tools (UpToDate, AccessMedicine, etc.)

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Biomedical information database

Search with automatic term mapping or Medical Subject Headings (MeSH)

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Psychiatry-specific database

Search with synonyms and narrower terms

Quotes to search as phrase; * to truncate

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Journal articles, meeting abstracts, dissertations, book chapters

Search with synonyms and narrower terms

Quotes to search phrase; * for truncation

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SELECT 5 BEST ARTICLES

1. Does this article address my research question (PICO)?

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

3. Does this article rely on sound research methodologies?

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1.DOES THIS ARTICLE ADDRESS MY RESEARCH QUESTION (PICO)?

Remember…

Problem/Patient

Intervention

Comparison

Outcome

Source: Flahery, RJ. “A simple method for evaluating the clinical literature.” Family Practice Management. May 2004.

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Patient

Problem

Interventio

n

Compariso

n

(if any)

Outcome

Schizophrenia or schizoaffective disorder (DSM IV)

Men and women; 19-64 y/o

Olanzapine for 12 weeks

7% or more weight gain

Associated weight gain with olanzapine

Diet management: food diary, dietician consultation

Exercise management: exercise diary, exercise manager

None

Physical exam (BMI measurement)

Pulse rate

Blood pressure

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2. IS THIS THE BEST ARTICLE FOR MY RESEARCH QUESTION?Remember…

Problem/Patient

Intervention

Comparison

Outcome

Source: Flahery, RJ. “A simple method for evaluating the clinical literature.” Family Practice Management. May 2004.

Add…

Date of Publication

Times cited (Web of Knowledge, PSYCinfo, Google Scholar)

Publication Type

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TIMES CITED

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PYRAMID OF PUBLICATION TYPES

Guidelines

Systematic

Reviews

Randomized

Controlled Trials

Cohort Studies

Case Series, Case Reports

Higher Quality of InformationFewer Articles

Lower Quality of InformationMore Articles

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Date

Times Cited

Publication Type

April 2006

69 (Web of Science)

71 (PsycINFO)

101 (Google Scholar)

Randomized Control Trial (RCT)

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3. DOES THIS ARTICLE RELY ON SOUND RESEARCH METHODOLOGIES? Critical Appraisal Charts for...

• Systematic Reviews

• Therapy Studies

• Diagnosis Studies

• Prognosis Studies

• Harm/Etiology

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Randomization

Allocation

Concealment

Similar Baseline

Characteristics

Blinding

To what extent?

Follow up

Intention to Treat

Yes (maybe); methods not described

Not described

Yes

No

Not described

Yes

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SELECT 5 BEST ARTICLES

1. Does this article address my research question (PICO)?

YES

2. Is this the best type of article for my research question?

YES

3. Does this article rely on sound research methodologies?

MOSTLY

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WHAT I AM LOOKING FOR ON THE ASSIGNMENT

1 Point – Reference 5 Articles

1

.75

.5

.25

0

List 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.

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WHAT I AM LOOKING FOR ON THE ASSIGNMENT

1 Point – Provide One Article that Meets Assessment Criteria

1

.5

0

At 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.

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RESOURCES

Citation 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 mentioned

http://norris.usc.libguides.com/psychiatry

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CONTACT

Lynn Kysh, MLIS

Information Services Librarian

(323) 442-1124

[email protected]

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LEARNING OBJECTIVES

Formulate a clinical research question from clerkship experience

Identify databases relevant to psychiatry and conduct an effective search

Apply basic criteria to appraise evidence

Retrieve available resources for more information on citation styles, search strategies, etc.

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QUESTIONS?

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THANK YOU!


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