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Enhance Your Practice Enhance Your Practice through Efficient Use of through Efficient Use of Professional and Client Professional and Client LiteratureLiterature

Kristine M. Alpi, MLS, MPH, AHIP Kristine M. Alpi, MLS, MPH, AHIP Carol E. Vreeland, DVM, MLS, AHIP Carol E. Vreeland, DVM, MLS, AHIP

William Rand Kenan, Jr. Library of Veterinary Medicine William Rand Kenan, Jr. Library of Veterinary Medicine libraryvetmed@ncsu.edulibraryvetmed@ncsu.edu or 919or 919--513513--62186218http://www.lib.ncsu.edu/vetmed/ http://www.lib.ncsu.edu/vetmed/

ObjectivesObjectives• Increase awareness of veterinary health-related content in

free and subscription resources for…– Your own knowledge and individual animal care practice

– Practice purchasing decisions

– Staff training for your colleagues

– Client support and decision makingpp g

• Find and assess diagnosis, treatment or prevention literature for sample small animal health questions

• Discuss an information management strategy for your practice

Resource Resource AwarenessAwareness

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Potential ResourcesPotential Resources• VetMed Resource (aka CAB Abstracts)

• International Veterinary Information Service (IVIS)

• VML’s “Keeping Up with Veterinary Knowledge” Web page (links to dvm360 and other publications)

• NC LIVE for Clinical and Business Databases• NC LIVE for Clinical and Business Databases

• PubMed and other Literature Databases

• Drug Information and Recalls

• Pet Owners Demographics and Survey Statistics

• Client Education Resources

VetMed ResourceVetMed ResourceFee-based veterinary version of CAB Abstracts content. Provides abstracts, some full-text articles, reviews, news, and datasheets for a variety of species' medical needs.

International Veterinary Information International Veterinary Information Service (IVIS)Service (IVIS)

•http://www.ivis.org•Access to textbooks, proceedings, association news online course andnews, online course and research materials. •Free to veterinarians, veterinary students, and animal health professionals; registration required.

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International Veterinary Information International Veterinary Information Service (IVIS), contd.Service (IVIS), contd.

Full text In VetMed Resource and in IVIS. Indexed in Google Scholar. Not indexed in PubMed.Full text unique to IVIS.

Not indexed in VetMed Resource, PubMed, or Google Scholar.

Keeping Up with Veterinary KnowledgeKeeping Up with Veterinary Knowledge• Veterinary Medicine Library’s Web page:

http://www.lib.ncsu.edu/vetmed/research/keepingup

Industry NewsIndustry News• http://www.dvm360.com/

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NC LIVENC LIVE• http://www.nclive.org/

• North Carolina residents have free access to many full-text articles through databases in NC LIVE.

Academic Search Complete, for example, includes full-text (as of 2/21/13) for the following veterinary titles:

– American Journal of Traditional Chinese Veterinary Medicine – Available from 02/01/2011.

– Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine Series C - Available from 02/01/1998. Most recent 12 months not available.

– Equine Veterinary Education – Available from 01/01/2010. Most recent 12 months not available.

– Journal of Veterinary Emergency & Critical Care - Available from 03/01/2003. Most recent 12 months not available.

– Journal of Veterinary Internal Medicine - Available from 01/01/2008. Most recent 12 months not available.

– Journal of Veterinary Medicine Series A - 02/01/1998 to present

– Journal of Veterinary Medicine Series B - 02/01/1998 to present

– Journal of Veterinary Pharmacology & Therapeutics - Available from 01/01/1998. Most recent 12 months not available.

– Medical & Veterinary Entomology - Available from 01/01/1998. Most recent 12 months not available.

– Veterinary Anesthesia & Analgesia - Available from 01/01/2000. Most recent 12 months not available.

– Veterinary & Comparative Oncology - Available from 03/01/2003. Most recent 12 months not available.

– Veterinary Dermatology - Available from 03/01/1998. Most recent 12 months not available.

– Veterinary Nursing Journal – Available from 01/01/2011. Most recent 12 months not available.

– Veterinary Ophthalmology - Available from 03/01/1998. Most recent 12 months not available.

NC LIVENC LIVE

NC LIVENC LIVE

Veterinary Technician Nat’l Exam practice

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Current and Old Literature for Recurring Current and Old Literature for Recurring ConditionsConditionsFairly comprehensive searching - three sets of databases:Also Google Scholar (google.com/scholar) and regular Google for industry and government publications. Database Name Coverage Search System

AGRICOLA 1970 to present EBSCO or Free

CAB Abstracts 1973 to present EBSCO

CAB Abstracts Archive 1910 to 1972 EBSCO

Wildlife & Ecology Studies Worldwide 1971 to present (full); 1935 to ( l )

EBSCO1970 (selective)

PsycInfo (for pig behavior and welfare) 1887 to present EBSCO

Animal Behavior Abstracts 1982 to present CSA Illumina

PubMed (MEDLINE) 1948 to present (older for PMC titles)

PubMed (Free) or EBSCO or Web of Knowledge

BIOSIS Previews 1926 to present Web of Knowledge

Web of Science (Science Citation Index) **No taxonomy search**

1900 to present Web of Knowledge

Zoological Record 1864 to present Web of Knowledge

Strategies for Finding Strategies for Finding and Evaluating and Evaluating Diagnosis LiteratureDiagnosis Literature

Find and assess diagnosis/screening or Find and assess diagnosis/screening or treatment/prevention literaturetreatment/prevention literature

• Do you have a specific question in mind? Or are you reviewing the literature in an area of practice to stay up-to-date?

• Who is likely producing the research? Is there a lot of it?

• Where to search with limited time?

• Sample topics:

– Diagnosis/Screening: Are there more effective ways than urine dipsticks to measure ketones in diabetic cats?

– Treatment: Is what the vendor says about Epi-Otic being the most effective topical ear cleaner true?

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Quickly Assess Relevance Quickly Assess Relevance –– Use PICOUse PICO

Are there more effective ways than urine dipsticks to measure ketones in diabetic cats?

• Think of your case/situation in terms of….

P = Patient, Population, Problemp

I = Intervention or Item of Interest

C = Comparison (when deciding between options)

O = Outcomes

• Use these components in searching.

• Look for these elements in assessing papers

Searching Concepts to Consider Searching Concepts to Consider • Controlled vocabulary can be most useful for retrieving all

relevant papers in PubMed or other databases. – Taxonomy Searching when searching for a broader subject such as an

organism at the family level or higher (e.g., Canidae)

– Class of diseases (e.g., neoplastic disease)

– Pharmacological action – e.g., antipyretics, antifungals

• Too much human literature? use PubMed’s veterinary subset• Too much human literature? – use PubMed s veterinary subset• Natural language topic searching

– International spellings in keyword searching

– Truncation – use * to pick up variations on word ending

– Abbreviations, acronyms, spelling things out

• Searching full text (Google/Google Scholar) – abstracts are scarce in the older literature and in short case reports

Are there any ways other than urine dipsticks to measure ketones in cats?

• PubMed strategy example: ketone* and (diabetes or diabetic)/veterinary

– Could add and (cat or cats or feline*), but would miss relevant articles that just mention dogs

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Think about the PICO for your info needThink about the PICO for your info need

P = Patient, Population, Problem (diabetic cats)

I = Intervention or Item of Interest (way to measure ketones)

C = Comparison (when deciding between options) (urine dipsticks)

O = Outcomes (precision and accuracy of ketone measurement, prevention of diabetic ketoacidosis deaths)

• Look for these elements in assessing papers

Screen shot of Screen shot of PubMedPubMed SearchSearch

• (

Discussion QuestionsDiscussion Questions

• Do the PICO characteristics of the abstract match the PICO of your initial concern in terms of population and intervention?

N = stop here, not relevant Y = continue• What have you learned from reading this

abstract? – Does this test seem to work? Can you diagnose

diabetic ketoacidosis with it?

• Would you read this entire paper? – Why or why not? Looking for what information?

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Weingart C, Lotz F, Kohn B. Validation of a portable hand-held whole-blood ketone meter for use in cats. Vet Clin Pathol. 2012;41(1):114-8.

BACKGROUND: Urinary dipsticks are the most frequent method used for screening of ketones in animals, but this method has many drawbacks. In human medicine, portable meters that measure ketones in whole blood have largely replaced urinary dipsticks. [C-your PICO]

OBJECTIVE: The aim of this prospective study was to validate a portable whole-blood ketone meter [I] for use in cats.

METHODS: Sixty-two cats (11 clinically healthy, 51 with diabetes mellitus) [P] were included in the study. The concentration of β-hydroxybuyrate (β-HB) was measured in venous and capillary blood with a hand-held ketone meter (Precision Xceed; assay range 0-8 mmol/L) and compared with a spectrophotometric method [C]. Precision, accuracy, and the effects of hematocrit and anticoagulants [O] were evaluated.

RESULTS B t i i i l d hi h t ti t l l ti 8 1% dRESULTS: Between-run precision using low- and high-concentration control solutions was 8.1% and 2.6%, respectively; within-run coefficient of variation determined using 12 feline blood samples was 2.8%. In the 62 cats, β-HB concentrations measured with the portable ketone meter ranged from 0-7.4 mmol/L (median 0.9 mmol/L). When β-HB concentrations measured by the portable meter were < 4.0 mmol/L there was good agreement with the reference method, but concentrations > 4.0 mmol/L were lower than those obtained by the reference method in 20 of 24 cats (83%). [O – Quantified] There was good correlation between capillary and venous measurements. Results were not affected by hematocrits from 0.17 to 0.50 L/L, but EDTA was not a suitable anticoagulant.

CONCLUSION: Measurement of β-HB concentration in peripheral or capillary blood by an easy-to-use portable ketone meter was suitable for detecting ketonemia in cats. [O-Summarized] Underestimation of β-HB concentration was observed at higher values, but results were sufficiently high to aid in diagnosing diabetic ketoacidosis.

Strategies for Finding Strategies for Finding and Evaluating and Evaluating TreatmentTreatmentLiteratureLiteratureLiteratureLiterature

Using PICO for a treatment questionUsing PICO for a treatment questionIs what the vendor says about Epi-Otic being the

most effective topical ear cleaner true?

P = Patient, Population, Problem

I = Intervention or Item of Interest

C = Comparison ( h d idi b t ti )C = Comparison (when deciding between options)

O = Outcomes

• Use these components in searching.

• Look for these elements in assessing papers

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Do topical ear cleaners work?

Discussion QuestionsDiscussion Questions

• Do the PICO characteristics of the abstract match the PICO of your initial concern in terms of population and intervention?

N = stop here, not relevant Y = continue• What have you learned from reading this

abstract? – Does this test seem to work? Can you diagnose

diabetic ketoacidosis with it?

• Would you read this entire paper? – Why or why not? Looking for what information?

Analyze Structured Abstract ComponentsAnalyze Structured Abstract Components

• Does the title accurately reflect the abstract?

• Is it valid science?

• Background or Objectives (also Context, Aim)

• Methods– More specifically: Design, Setting, Participants,

Population, Intervention or Exposure, Main Outcome Measures

• Results (also Findings): Analyses, Follow-Up

• Conclusions (also Interpretation)

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Analyzing the Abstract: Analyzing the Abstract: Results and ConclusionsResults and Conclusions• Results

– What percentage participated?

– Was the intervention effective?

– What types of analyses were done? yp y

– Was follow-up sufficient?

• Conclusions –– Were all important outcomes considered?

– Are the likely intervention benefits worth the potential harms and costs?

Drug Information and Drug Information and Recalls Recalls

FDA Animal and Veterinary TopicsFDA Animal and Veterinary Topics• http://www.fda.gov/AnimalVeterinary/

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Animal Drugs @ FDAAnimal Drugs @ FDA• http://www.accessdata.fda.gov/scripts/animaldrugsatfda/

DailyMedDailyMed• http://dailymed.nlm.nih.gov/dailymed/

• FDA labels (package inserts)

Pet Owners Demographics Pet Owners Demographics and Survey Statisticsand Survey Statistics

“The rise of the almighty pet owner”—from dvm360.com. Accessed 3/04/13

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APPA National Pet Owners SurveyAPPA National Pet Owners SurveyPublished by the American Pet Products Association

U.S. Pet Ownership & Demographics U.S. Pet Ownership & Demographics Sourcebook Sourcebook

Published by the AVMA

Sample table

List of contents available at https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-Pet-Ownership-Demographics-Sourcebook.aspx

Information Management Information Management Strategy for your PracticeStrategy for your Practice

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Info Management Strategies Info Management Strategies ––Coherence for all aspects of the practiceCoherence for all aspects of the practice

• What are common presenting problems in the practice?

• What products and services/procedures do you sell? – Does each of those products have an informational brochure that is

not too aggressively promotional?

C t ff l i h h th d t d t th ?– Can staff explain why you have these products and not others?

• What foods and products do your clients use that you do not sell? Is that data easily searchable in your practice management system?

• What is available for reading in your waiting room?

• What questions do owners ask the reception staff, technicians, or assistants that could be made into an FAQ on your website?

Practice Management: Business ResourcesPractice Management: Business Resources

• Marketing, HR/Personnel, Retail, Materials Mgmt

From NC LIVE

Retail Retail Competition Competition for Products for Products

• Do you sell Cosequin?

• Did you know that yWalmart is selling Cosequin?

• Do you think it makes a difference if they can pick it up at Walmart when they buy their own vitamins?

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EpiEpi--OticOtic ExampleExampleDo you see lots of ear

cases?

Do you sell Epi-Otic traditional or Advanced?

Do you distribute the Your Pet’s Ear Care brochure? What does it say about the products you sell?

Did your Virbac rep give you copies of any of the items referenced?

www.lib.ncsu.edu/www.lib.ncsu.edu/

vetmedvetmed/research//research/

infoforyourpracticeinfoforyourpractice

What about Client/Pet Health Info?What about Client/Pet Health Info?

• Grassmere

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AAHA AAHA Healthy Healthy Pet Pet

healthyhealthypet.compet.com

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Common Procedures and TopicsCommon Procedures and Topics

The NCSU Libraries can help you!The NCSU Libraries can help you!

• Free Services– Confidential reference and literature searching support

via email, phone or in-person

– On-site usage of materials—use free overhead scanner

Lending of our books or media to your public library for– Lending of our books or media to your public library for your use via interlibrary loan. If we don’t own a relevant item, please recommend it for purchase!

• Fee-Based Services– Document delivery of articles and chapters for vets and

vet techs from our collection for $8 per item

– Borrower card can be purchased annually for $50 by Friends of the Library members

QUESTIONS?QUESTIONS?

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