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Walter Cronkite
Walter Cronkite
Ron Burgundy
Ron Burgundy
The Evidence Hierarchy From: http://www
The Evidence Hierarchy From: http://www
Levels of Evidence Pyramid Example
Levels of Evidence Pyramid Example
Immediate Gratification
Immediate Gratification
Cochrane Library: Search Terms
Cochrane Library: Search Terms
CDSR: Systematic Review Length
CDSR: Systematic Review Length
CDSR: Plain Language Summary
CDSR: Plain Language Summary
CDSR: Conclusions
CDSR: Conclusions
CDSR: References
CDSR: References
TRIP: Turning Research Into Practice
TRIP: Turning Research Into Practice
TRIP: Article Abstracts
TRIP: Article Abstracts
DynaMed: Search - Autocomplete
DynaMed: Search - Autocomplete
DynaMed: Search With Records & Level of Evidence (LOE)
DynaMed: Search With Records & Level of Evidence (LOE)
DynaMed: LOE Defined
DynaMed: LOE Defined
DynaMed: Calculators
DynaMed: Calculators
National Guideline Clearinghouse (NGC)
National Guideline Clearinghouse (NGC)
NGC: Search Terms
NGC: Search Terms
NGC: Results
NGC: Results
NGC: Guideline Summaries
NGC: Guideline Summaries
NGC: LOE (not standardized
NGC: LOE (not standardized
NGC: Not All Guidelines Include LOE
NGC: Not All Guidelines Include LOE
MEDLINE: Clinical Queries Search Terms
MEDLINE: Clinical Queries Search Terms
MEDLINE: Display Settings -- Abstract
MEDLINE: Display Settings -- Abstract
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Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly

содержание презентации «Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly.ppt»
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1Kick Your Textbooks to the Curb: 25research, PPV/NPV, odds and risk ratios
Finding Clinically Relevant Information Does the patient see the difference-can
Quickly. Adrian Banning, MMS, PA-C Gary M. you bring them the evidence and make them
Childs, MS. part of their own team? Application of EBM
2Too much info, too little time, is not cookbook.
chatter and hyperbole (!). We are 26Part 2, Hunting Sources: Finding
bombarded with information. You have to Clinically Relevant Information Quickly.
sift the good from the bad. You can’t give 27Cochrane Systematic Reviews. A study
up and read nothing. Where would you done in 1972 showed inexpensive
prefer to get your daily news? corticosteroids beneficial in preterm
3Your sources count. Morning news? delivery. No systematic review of the
Journal in the office? Colleagues? Buzz? literature was done until 1989. Had it
Patients? Conferences? been it would have shown that infant
4Walter Cronkite. Walter Cronkite was a mortality is reduced 30-50% using this
real news anchor. evidence that was already on hand. VERY
http://www.theatlantic.com/international/a comprehensive analysis of the research.
chive/2012/07/is-it-walter-cronkites-fault 28Links To Video Tutorial Playlist.
why-olympic-announcers-keep-saying-beizhin http://tinyurl.com/m22fosh -OR-
/260556/. https://www.youtube.com/playlist?list=PLkr
5Ron Burgundy. Not a real news anchor, XTH_bktjgj4V9mxflVvBz7wAkAPIL.
even though he looks like one. Source: 29Clinical Question. Suzy, the mother of
http://cdn.sheknows.com/articles/2013/08/r a 2 y/o girl with asthma is concerned
n-burgundy-memoir.jpg. about the upcoming cold and flu season.
6The difference is VALIDITY. In She’s interested in having her child
desperation, you may listen to buzz as receive the influenza vaccine, but she’s
fact-that’s how rumors get started and we afraid that the vaccine could trigger her
don’t have time or leeway for that. daughter’s asthma. What does the current
Something has to be relevant to you, be available evidence suggest?
good info and take little time to find. 30PICO(T) Format. P: Patient,
7No free lunch: You need a level of population, “problem” I: Intervention C:
evidence (LOE). Beware things that are Comparison Intervention O: Outcome (T):
mailed to you for free or that can’t Time.
account for their levels of evidence 31Clinical Question in PICO format. P: 2
(LOE). You’ll need to search out what you y/o girl with asthma I: influenza vaccine
have at your disposal and the quality of C: no influenza vaccine O: possible asthma
it-or else you’re just doing more of the exacerbation risk (T): immediately
same Look at free mailers with lots of ads following vaccination.
skeptically. Pharm reps. 32Cochrane Library: Search Terms.
8Making Decisions. How do we know what 33CDSR: Systematic Review Length.
to do? Knowledge>Fear Find good 34CDSR: Plain Language Summary.
evidence (and experience and opinions), 35CDSR: Conclusions.
combine with patient risk and values to 36CDSR: References.
give us options We then weigh the options 37TRIP: Turning Research Into Practice.
with the patient and make a decision 38TRIP: Article Abstracts.
Science and Art How do we do this. . . in 39DynaMed.
reality? 40DynaMed: Search - Autocomplete.
9Need answers at point-of-care. 41DynaMed: Search With Records &
Internal med residents had 2 questions for Level of Evidence (LOE).
every 3 pts seen Background = epi, 42DynaMed: LOE Defined.
pathophys, presentation, requires 43DynaMed: Calculators.
textbooks Foreground information is 44National Guideline Clearinghouse
testing, diagnosis, treatment, Need EBM (NGC).
summaries or research Residents asked 45NGC: Search Terms.
mostly about therapy and diagnosis and 46NGC: Results.
asked more foreground than background 47NGC: Guideline Summaries.
questions as training progressed Pursued 48NGC: LOE (not standardized!).
29% of their questions Used textbooks, 49NGC: Not All Guidelines Include LOE.
original articles, and attendings Pursued 50MEDLINE (PubMed).
an answer if they thought pt wanted it for 51MEDLINE: Clinical Queries Search
in fear of malpractice. Terms.
10Information Mastery Slawson and 52MEDLINE: Limits.
Shaugnessy, et al. Finding high quality 53MEDLINE: Display Settings -- Abstract.
information to answer YOUR question, 54? Questions?
quickly. You may not be an appraisal 55References. Claude Moore Health
expert, but they exist You need a level of Sciences Library. Information mastery:
evidence (LOE) Information sources are not navigating the maze. University of
all equal(different databases, journals, Virginia Health System Web site.
experts) Go for patient-oriented evidence www.hsl.virginia.edu/collections/ebm/pyram
first POEM vs DOE Hunting vs foraging. d.cfm. Accessed May 11, 2012. Dartmouth
11Usefulness of Info= (Relevance x Biomedical Libraries. Evidence-based
Validity) Work. Information Mastery. medicine (EBM) Resources. Dartmouth
12Critical appraisal is a total drag, College Library Web site.
but. . . Ask, find, assess validity, http://www.dartmouth.edu/~biomed/resources
synthesize RECRUITEMENT, Randomized htmld/guides/ebm_resources.shtml. Accessed
ALLOCATION, ACCOUNTED (ITT), May 11, 2012. Ebell MH, Barry HC, Slawson
IM lets the experts assess for you. Are the medical literature. J Fam Pract.
you sure you can assess this expertly? 1999;48(5):350-355. Ebell M, Shaughnessy
Allocation concealment? You must stay an A. Information mastery: integrating
expert on the interpretations AND how to continuing medical education with the
interpret AND see patients AND eat AND information needs of clinicians. J Cont Ed
sleep AND. . . Health Prof [serial online]. April 2,
13Evidence Based Medicine Steps. Have a 2003;23:S53-62. Available from: CINAHL
question (put it into PICO) Search the with Full Text, Ipswich, MA. Accessed May
literature from the top of the pyramid 30, 2013. Johnson CA. The Information
(next slide) Find a study/find evidence Diet. Sebastopol, CA; O’Reilly Media,
Perform appraisal /find level of evidence Inc.; 2011 Marks S, McKibbon KA. Posing
and look for bias Determine how the clinical questions: Framing the question
results help you-how will you use them for scientific inquiry. AACN Clin Issues.
with your patient in their lives using 2001;12(4):477-481. Mayer, D. (2009).
your/others’ experience Are the above Essential Evidence-Based Medicine. Oxford,
steps working? UK. Oxford University Press. McConaghy JR.
14The Evidence Hierarchy From: Evolving medical knowledge: moving toward
http://www.dartmouth.edu/~biomed/services. efficiently answering questions and
tmld/EBP_docs/pyramid-loaded.pdf. keeping current. Prim Care: Clin in Office
15Levels of Evidence Pyramid Example. Prac. 2006 December; 33(4): 831-837.
http://www.hsl.virginia.edu/collections/eb 56References. Pearce-Smith N, Hunter J.
/pyramid.cfm. The introduction of librarian tutors into
16Patient Oriented Evidence that the teaching evidence-based medicine week
Matters: POEMs. DOE = Disease Oriented in Oxford, UK. Health Info Libr J.
Evidence You will likely have to 2005;22(2):146-149. Shaughnessy A, Gupta
differentiate POEMs vs DOE yourself P, Erlich D, Slawson D. Ability of an
Specialists and researchers may need DOE information mastery curriculum to improve
as well if highly specialized, but DOE residents' skills and attitudes. Fam Med.
doesn’t change your immediate clinical 2012 April; 44(4): 259-64. Shaughnessy AF,
decision with a patient. Slawson DC, & Bennett JH. Becoming an
17POEM Requirement Number 1: Address a information master: A guidebook to the
frequently encountered clinical question medical information jungle. J Fam Pract.
(in your realm of 1994;39(5):489-499. Slawson DC,
medicine-family/cardio/oncology). Not too Shaughnessy AF, & Bennett JH. Becoming
rare and about something you’ll need to a a medical information master: Feeling good
make a decision on. about not knowing everything. J Fam Pract.
18POEM Requirement Number 2: Measures a 1994;38(5):505-513. Slawson, D.C. &
patient oriented outcome like: mortality Shaughnessy, A. Information mastery:
morbidity quality of life reduction in evidence-based medicine in everyday
symptoms other endpoints that are practice. 2003. Accessed May 11, 2012 from
important to the patient and you. Not a http://www.bibalex.org/supercourse/bmj/bmj
disease-oriented outcome like LV pumping htm. Slawson, D.C. & Shaughnessy, A.
or neuronal death. Intermediate or 2003. Information Mastery: Evidence-Based
premature evidence is not helpful here-too Medicine in Everyday Practice. PowerPoint
early in the process. file retrieved February 17, 2011 from
19POEM Requirement Number 3: Results http://www.bmj.com.
will require a change in your practice (M) http://www.theatlantic.com/international/a
Confirming what you already know and do is chive/2012/07/is-it-walter-cronkites-fault
a waste of time. One person’s POEM may be why-olympic-announcers-keep-saying-beizhin
another’s POE depending on your practice. /260556/
20DOE. Increase our knowledge of a http://cdn.sheknows.com/articles/2013/08/r
disease DOE= prognosis, prevalence, n-burgundy-memoir.jpg.
pathophysiology, pharmacology, etiology, 57Bonus! http://www.thennt.com/.
etc. DOEs are crucial to medicine and we 58The NNT Groups. Thennt.com How many
can’t dx, tx or prevent a disease before people without heart disease need to be on
we understand it. the Mediterranean diet for 5 years before
21“Comparing DOES and POEMs” Slawson, one person doesn’t have a CVA, MI or die?
D.C. & Shaughnessy, A. 2003. http://www.thennt.com 61 and no one gets
Information Mastery: Evidence-Based hurt.
Medicine in Everyday Practice. PowerPoint 59More on Information Mastery? Tufts
file retrieved February 17, 2011 from Health Care Institute Conference:
http://www.bmj.com. Slide 12. http://www.thci.org/educational-activities
22Hunting and Foraging. Forage- have conferences/information-mastery UVA School
information come to you POEM of the Week of Medicine:
Podcast! Emails! Hunting-looking for http://www.medicine.virginia.edu/clinical/
evidence Databases. epartments/familymed/information_mastery/i
23Tips on keeping validity. Go to fo_mastery-page.
trusted sources (use the pyramid). Go to 60More Foraging-many are both: sign up
relevant items (POEMs). Look for LEVELS OF for emails to forage. Journal Watch (NEJM)
EVIDENCE, resources, someone who is ACCESSSS Federated Search, free, register.
accountable. A.K.A. “WHO WROTE THIS?” Hunting and foraging:
Don’t contribute to chatter if you haven’t http://plus.mcmaster.ca/accessss/Default.a
checked the facts. Read the article. px?Page=1 ACP Journal Club (Annals of
Brush-up on how to read a research Internal Medicine)
article. It’s ok. We all forget some http://www.essentialevidenceplus.com/
things, sometimes. National Prescribing Centre (UK):
24Immediate Gratification. Many http://www.npc.nhs.uk/
resources can provide an immediate answer EssentialEvidencePlus POEM of the week
at the point-of-care! Yes! podcasts (iTunes) Agency for Healthcare
25Part 1: Summary. Find a realistic way Research and Quality subscriptions
to use evidence You DO need the skills to http://www.ahrq.gov/ National Guidelines
be able to read technical medical Clearinghouse: http://www.guidelines.gov/.
information type of article, type of
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