<<  Apple 2012   >>
Kick Your Textbooks to the Curb: Finding Clinically Relevant
Kick Your Textbooks to the Curb: Finding Clinically Relevant
Too much info, too little time, chatter and hyperbole (
Too much info, too little time, chatter and hyperbole (
Your sources count
Your sources count
Walter Cronkite
Walter Cronkite
Ron Burgundy
Ron Burgundy
The difference is VALIDITY
The difference is VALIDITY
No free lunch: You need a level of evidence (LOE)
No free lunch: You need a level of evidence (LOE)
Making Decisions
Making Decisions
Need answers at point-of-care
Need answers at point-of-care
Information Mastery Slawson and Shaugnessy, et al
Information Mastery Slawson and Shaugnessy, et al
Usefulness of Info= (Relevance x Validity) Work
Usefulness of Info= (Relevance x Validity) Work
Critical appraisal is a total drag, but
Critical appraisal is a total drag, but
Evidence Based Medicine Steps
Evidence Based Medicine Steps
The Evidence Hierarchy From: http://www
The Evidence Hierarchy From: http://www
Levels of Evidence Pyramid Example
Levels of Evidence Pyramid Example
Patient Oriented Evidence that Matters: POEMs
Patient Oriented Evidence that Matters: POEMs
POEM Requirement Number 1:
POEM Requirement Number 1:
POEM Requirement Number 2:
POEM Requirement Number 2:
POEM Requirement Number 3:
POEM Requirement Number 3:
DOE
DOE
Comparing DOES and POEMs Slawson, D.C. & Shaughnessy, A. 2003
Comparing DOES and POEMs Slawson, D.C. & Shaughnessy, A. 2003
Hunting and Foraging
Hunting and Foraging
Tips on keeping validity
Tips on keeping validity
Immediate Gratification
Immediate Gratification
Part 1: Summary
Part 1: Summary
Part 2, Hunting Sources:
Part 2, Hunting Sources:
Cochrane Systematic Reviews
Cochrane Systematic Reviews
Links To Video Tutorial Playlist
Links To Video Tutorial Playlist
Clinical Question
Clinical Question
PICO(T) Format
PICO(T) Format
Clinical Question in PICO format
Clinical Question in PICO format
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
DynaMed
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 (PubMed)
MEDLINE (PubMed)
MEDLINE: Clinical Queries Search Terms
MEDLINE: Clinical Queries Search Terms
MEDLINE: Limits
MEDLINE: Limits
MEDLINE: Display Settings -- Abstract
MEDLINE: Display Settings -- Abstract
?
?
References
References
References
References
Bonus!
Bonus!
The NNT Groups
The NNT Groups
More on Information Mastery
More on Information Mastery
More Foraging-many are both: sign up for emails to forage
More Foraging-many are both: sign up for emails to forage

: Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly. : Childs,Gary. : Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly.ppt. zip-: 4318 .

Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly

Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly.ppt
1 Kick Your Textbooks to the Curb: Finding Clinically Relevant

Kick Your Textbooks to the Curb: Finding Clinically Relevant

Information Quickly

Adrian Banning, MMS, PA-C Gary M. Childs, MS

2 Too much info, too little time, chatter and hyperbole (

Too much info, too little time, chatter and hyperbole (

We are bombarded with information. You have to sift the good from the bad. You cant give up and read nothing. Where would you prefer to get your daily news?

3 Your sources count

Your sources count

Morning news? Journal in the office? Colleagues? Buzz? Patients? Conferences?

4 Walter Cronkite

Walter Cronkite

Walter Cronkite was a real news anchor. http://www.theatlantic.com/international/archive/2012/07/is-it-walter-cronkites-fault-why-olympic-announcers-keep-saying-beizhing/260556/

5 Ron Burgundy

Ron Burgundy

Not a real news anchor, even though he looks like one. Source: http://cdn.sheknows.com/articles/2013/08/ron-burgundy-memoir.jpg

6 The difference is VALIDITY

The difference is VALIDITY

In desperation, you may listen to buzz as fact-thats how rumors get started and we dont have time or leeway for that. Something has to be relevant to you, be good info and take little time to find.

7 No free lunch: You need a level of evidence (LOE)

No free lunch: You need a level of evidence (LOE)

Beware things that are mailed to you for free or that cant account for their levels of evidence (LOE). Youll need to search out what you have at your disposal and the quality of it-or else youre just doing more of the same Look at free mailers with lots of ads skeptically. Pharm reps

8 Making Decisions

Making Decisions

How do we know what to do? Knowledge>Fear Find good evidence (and experience and opinions), combine with patient risk and values to give us options We then weigh the options with the patient and make a decision Science and Art How do we do this. . . in reality?

9 Need answers at point-of-care

Need answers at point-of-care

Internal med residents had 2 questions for every 3 pts seen Background = epi, pathophys, presentation, requires textbooks Foreground information is testing, diagnosis, treatment, Need EBM summaries or research Residents asked mostly about therapy and diagnosis and asked more foreground than background questions as training progressed Pursued 29% of their questions Used textbooks, original articles, and attendings Pursued an answer if they thought pt wanted it for in fear of malpractice

10 Information Mastery Slawson and Shaugnessy, et al

Information Mastery Slawson and Shaugnessy, et al

Finding high quality information to answer YOUR question, quickly. You may not be an appraisal expert, but they exist You need a level of evidence (LOE) Information sources are not all equal(different databases, journals, experts) Go for patient-oriented evidence first POEM vs DOE Hunting vs foraging

11 Usefulness of Info= (Relevance x Validity) Work

Usefulness of Info= (Relevance x Validity) Work

Information Mastery

12 Critical appraisal is a total drag, but

Critical appraisal is a total drag, but

. .

Ask, find, assess validity, synthesize RECRUITEMENT, Randomized ALLOCATION, ACCOUNTED (ITT), MAINTENANCE/MEASURMENT BLINDING, OUTCOME IM lets the experts assess for you. Are you sure you can assess this expertly? Allocation concealment? You must stay an expert on the interpretations AND how to interpret AND see patients AND eat AND sleep AND. . .

13 Evidence Based Medicine Steps

Evidence Based Medicine Steps

Have a question (put it into PICO) Search the literature from the top of the pyramid (next slide) Find a study/find evidence Perform appraisal /find level of evidence and look for bias Determine how the results help you-how will you use them with your patient in their lives using your/others experience Are the above steps working?

14 The Evidence Hierarchy From: http://www

The Evidence Hierarchy From: http://www

dartmouth.edu/~biomed/services.htmld/EBP_docs/pyramid-loaded.pdf

15 Levels of Evidence Pyramid Example

Levels of Evidence Pyramid Example

http://www.hsl.virginia.edu/collections/ebm/pyramid.cfm

16 Patient Oriented Evidence that Matters: POEMs

Patient Oriented Evidence that Matters: POEMs

DOE = Disease Oriented Evidence You will likely have to differentiate POEMs vs DOE yourself Specialists and researchers may need DOE as well if highly specialized, but DOE doesnt change your immediate clinical decision with a patient.

17 POEM Requirement Number 1:

POEM Requirement Number 1:

Address a frequently encountered clinical question (in your realm of medicine-family/cardio/oncology). Not too rare and about something youll need to a make a decision on

18 POEM Requirement Number 2:

POEM Requirement Number 2:

Measures a patient oriented outcome like: mortality morbidity quality of life reduction in symptoms other endpoints that are important to the patient and you. Not a disease-oriented outcome like LV pumping or neuronal death. Intermediate or premature evidence is not helpful here-too early in the process.

19 POEM Requirement Number 3:

POEM Requirement Number 3:

Results will require a change in your practice (M) Confirming what you already know and do is a waste of time. One persons POEM may be anothers POE depending on your practice.

20 DOE

DOE

Increase our knowledge of a disease DOE= prognosis, prevalence, pathophysiology, pharmacology, etiology, etc. DOEs are crucial to medicine and we cant dx, tx or prevent a disease before we understand it.

21 Comparing DOES and POEMs Slawson, D.C. & Shaughnessy, A. 2003

Comparing DOES and POEMs Slawson, D.C. & Shaughnessy, A. 2003

Information Mastery: Evidence-Based Medicine in Everyday Practice. PowerPoint file retrieved February 17, 2011 from http://www.bmj.com. Slide 12.

22 Hunting and Foraging

Hunting and Foraging

Forage- have information come to you POEM of the Week Podcast! Emails! Hunting-looking for evidence Databases

23 Tips on keeping validity

Tips on keeping validity

Go to trusted sources (use the pyramid). Go to relevant items (POEMs). Look for LEVELS OF EVIDENCE, resources, someone who is accountable. A.K.A. WHO WROTE THIS? Dont contribute to chatter if you havent checked the facts. Read the article. Brush-up on how to read a research article. Its ok. We all forget some things, sometimes.

24 Immediate Gratification

Immediate Gratification

Many resources can provide an immediate answer at the point-of-care! Yes!

25 Part 1: Summary

Part 1: Summary

Find a realistic way to use evidence You DO need the skills to be able to read technical medical information type of article, type of research, PPV/NPV, odds and risk ratios Does the patient see the difference-can you bring them the evidence and make them part of their own team? Application of EBM is not cookbook

26 Part 2, Hunting Sources:

Part 2, Hunting Sources:

Finding Clinically Relevant Information Quickly

27 Cochrane Systematic Reviews

Cochrane Systematic Reviews

A study done in 1972 showed inexpensive corticosteroids beneficial in preterm delivery. No systematic review of the literature was done until 1989. Had it been it would have shown that infant mortality is reduced 30-50% using this evidence that was already on hand. VERY comprehensive analysis of the research

28 Links To Video Tutorial Playlist

Links To Video Tutorial Playlist

http://tinyurl.com/m22fosh -OR- https://www.youtube.com/playlist?list=PLkr8XTH_bktjgj4V9mxflVvBz7wAkAPIL

29 Clinical Question

Clinical Question

Suzy, the mother of a 2 y/o girl with asthma is concerned about the upcoming cold and flu season. Shes interested in having her child receive the influenza vaccine, but shes afraid that the vaccine could trigger her daughters asthma. What does the current available evidence suggest?

30 PICO(T) Format

PICO(T) Format

P: Patient, population, problem I: Intervention C: Comparison Intervention O: Outcome (T): Time

31 Clinical Question in PICO format

Clinical Question in PICO format

P: 2 y/o girl with asthma I: influenza vaccine C: no influenza vaccine O: possible asthma exacerbation risk (T): immediately following vaccination

32 Cochrane Library: Search Terms

Cochrane Library: Search Terms

33 CDSR: Systematic Review Length

CDSR: Systematic Review Length

34 CDSR: Plain Language Summary

CDSR: Plain Language Summary

35 CDSR: Conclusions

CDSR: Conclusions

36 CDSR: References

CDSR: References

37 TRIP: Turning Research Into Practice

TRIP: Turning Research Into Practice

38 TRIP: Article Abstracts

TRIP: Article Abstracts

39 DynaMed

DynaMed

40 DynaMed: Search - Autocomplete

DynaMed: Search - Autocomplete

41 DynaMed: Search With Records & Level of Evidence (LOE)

DynaMed: Search With Records & Level of Evidence (LOE)

42 DynaMed: LOE Defined

DynaMed: LOE Defined

43 DynaMed: Calculators

DynaMed: Calculators

44 National Guideline Clearinghouse (NGC)

National Guideline Clearinghouse (NGC)

45 NGC: Search Terms

NGC: Search Terms

46 NGC: Results

NGC: Results

47 NGC: Guideline Summaries

NGC: Guideline Summaries

48 NGC: LOE (not standardized

NGC: LOE (not standardized

49 NGC: Not All Guidelines Include LOE

NGC: Not All Guidelines Include LOE

50 MEDLINE (PubMed)

MEDLINE (PubMed)

51 MEDLINE: Clinical Queries Search Terms

MEDLINE: Clinical Queries Search Terms

52 MEDLINE: Limits

MEDLINE: Limits

53 MEDLINE: Display Settings -- Abstract

MEDLINE: Display Settings -- Abstract

54 ?

?

Questions?

55 References

References

Claude Moore Health Sciences Library. Information mastery: navigating the maze. University of Virginia Health System Web site. www.hsl.virginia.edu/collections/ebm/pyramid.cfm. Accessed May 11, 2012. Dartmouth Biomedical Libraries. Evidence-based medicine (EBM) Resources. Dartmouth College Library Web site. http://www.dartmouth.edu/~biomed/resources.htmld/guides/ebm_resources.shtml. Accessed May 11, 2012. Ebell MH, Barry HC, Slawson DC, & Shaughnessy AF. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355. Ebell M, Shaughnessy A. Information mastery: integrating continuing medical education with the information needs of clinicians. J Cont Ed Health Prof [serial online]. April 2, 2003;23:S53-62. Available from: CINAHL with Full Text, Ipswich, MA. Accessed May 30, 2013. Johnson CA. The Information Diet. Sebastopol, CA; OReilly Media, Inc.; 2011 Marks S, McKibbon KA. Posing clinical questions: Framing the question for scientific inquiry. AACN Clin Issues. 2001;12(4):477-481. Mayer, D. (2009). Essential Evidence-Based Medicine. Oxford, UK. Oxford University Press. McConaghy JR. Evolving medical knowledge: moving toward efficiently answering questions and keeping current. Prim Care: Clin in Office Prac. 2006 December; 33(4): 831-837

56 References

References

Pearce-Smith N, Hunter J. The introduction of librarian tutors into the teaching evidence-based medicine week in Oxford, UK. Health Info Libr J. 2005;22(2):146-149. Shaughnessy A, Gupta P, Erlich D, Slawson D. Ability of an information mastery curriculum to improve residents' skills and attitudes. Fam Med. 2012 April; 44(4): 259-64. Shaughnessy AF, Slawson DC, & Bennett JH. Becoming an information master: A guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499. Slawson DC, Shaughnessy AF, & Bennett JH. Becoming a medical information master: Feeling good about not knowing everything. J Fam Pract. 1994;38(5):505-513. Slawson, D.C. & Shaughnessy, A. Information mastery: evidence-based medicine in everyday practice. 2003. Accessed May 11, 2012 from http://www.bibalex.org/supercourse/bmj/bmj.htm. Slawson, D.C. & Shaughnessy, A. 2003. Information Mastery: Evidence-Based Medicine in Everyday Practice. PowerPoint file retrieved February 17, 2011 from http://www.bmj.com. http://www.theatlantic.com/international/archive/2012/07/is-it-walter-cronkites-fault-why-olympic-announcers-keep-saying-beizhing/260556/ http://cdn.sheknows.com/articles/2013/08/ron-burgundy-memoir.jpg

57 Bonus!

Bonus!

http://www.thennt.com/

58 The NNT Groups

The NNT Groups

Thennt.com How many people without heart disease need to be on the Mediterranean diet for 5 years before one person doesnt have a CVA, MI or die? http://www.thennt.com 61 and no one gets hurt

59 More on Information Mastery

More on Information Mastery

Tufts Health Care Institute Conference: http://www.thci.org/educational-activities/conferences/information-mastery UVA School of Medicine: http://www.medicine.virginia.edu/clinical/departments/familymed/information_mastery/info_mastery-page

60 More Foraging-many are both: sign up for emails to forage

More Foraging-many are both: sign up for emails to forage

Journal Watch (NEJM) ACCESSSS Federated Search, free, register. Hunting and foraging: http://plus.mcmaster.ca/accessss/Default.aspx?Page=1 ACP Journal Club (Annals of Internal Medicine) http://www.essentialevidenceplus.com/ National Prescribing Centre (UK): http://www.npc.nhs.uk/ EssentialEvidencePlus POEM of the week podcasts (iTunes) Agency for Healthcare Research and Quality subscriptions http://www.ahrq.gov/ National Guidelines Clearinghouse: http://www.guidelines.gov/

Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly
http://900igr.net/prezentacija/anglijskij-jazyk/kick-your-textbooks-to-the-curb-finding-clinically-relevant-information-quickly-167350.html
c

29
900igr.net > > > Kick Your Textbooks to the Curb: Finding Clinically Relevant Information Quickly