RESOURCES FOR CLINICAL REASONING EXERCISE
KSOM Psychiatry Clerkship, 2014-2015
Lynn Kysh, MLIS
Information Services Librarian
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.
MEDICAL STUDENTS YEARS 3-4 PORTALAvailable on the
Norris Medical
Library Homepage
usc.edu/nml
norris.usc.libguides.
com/medyrs3-4
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
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.
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
FORMULATE RESEARCH QUESTION
How effective is nutrition therapy in reducing weight gain caused by olanzapine?
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
AN IDEA FOR AN ETIOLOGY QUESTION
Does the recreational use of marijuana increase the incidence of psychosis among adult men?
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
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.)
Biomedical information database
Search with automatic term mapping or Medical Subject Headings (MeSH)
Psychiatry-specific database
Search with synonyms and narrower terms
Quotes to search as phrase; * to truncate
Journal articles, meeting abstracts, dissertations, book chapters
Search with synonyms and narrower terms
Quotes to search phrase; * for truncation
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?
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.
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
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
TIMES CITED
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
Date
Times Cited
Publication Type
April 2006
69 (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
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
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
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.
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.
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
CONTACT
Lynn Kysh, MLIS
Information Services Librarian
(323) 442-1124
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.
QUESTIONS?
THANK YOU!