literature search exercise sebma f2
TRANSCRIPT
HealthCare Informatics: The big picture 1
HEALTH CARE LITERACY IS ESSENTIAL TO THE MEDICAL TEAM
Secrets In Literature Searching: Implementing Evidence &
Transforming Healthcare ProvisionDr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MemAcadMedEd MSc (UK) MBBS
Consultant Physician & PulmonologistDepartment of Medical Protocol
KAMC, RiyadhKingdom of Saudi Arabia
Knowledge: Foreground/Background
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novice expert
Foreground questions
Background
question
Types of Literature
Types of Literature
Primary (Original) Pubmed Embase CINAHL
Secondary (Appraised) Guidelines Systematic Reviews Critically appraised Topics CATs
Levels of Evidence: Hierarchy Pyramid
What is Best Evidence? Hierarchy of Levels of Evidence
Sources of Evidence
Types of Resources Primary (Original)
Pubmed Embase CINAHL
Secondary (Appraised) Guidelines websites: Guideline Clearinhouse Systematic Review Websites: Cochrane Library CAT websites: BestBets
Tertiary (Access to both) (meta search engines, databases of databases): TRIP+ (Translating Research Into Practice) SumSearch
Exercises for Practice
• During the ward round, a medical student inquired about EBM and what it means.
• How can you guide him/her if he/she asks you about some literature information?
The Answer
• Google it!• YouTube it!• Ask an Expert:
– Oxford Center for EBM: http://www.cebm.net/– KT Clearinghouse: http://ktclearinghouse.ca/
Self-Education & Training in EBM
• EBM Resources: – http://guides.mclibrary.duke.edu/c.php?
g=158178&p=1035956– http://library.medicine.yale.edu/tutorials/subjects/
evidence-based-practice
• CEBM Website: – http://www.youtube.com/user/cebmed,– http://www.cebm.net/index.aspx?o=1965
• YouTube:– http://www.youtube.com/watch?v=odfo9CQGi0c
Exercises for Practice
• During the ward round, an R1 inquired about Pubmed and how to use it.
• How can you guide him/her on the practicalities of using it?
The Answer
• Google it!• YouTube it!• Ask an Expert:
– Every Literature Searching Website/Database has its own “How to Use Stuff”
– Pubmed: https://www.nlm.nih.gov/bsd/disted/pubmed.html
– Cochrane: http://www.cochranelibrary.com/help/how-to-use-cochrane-library.html
Exercises for Practice: Guidelines
• Exercise: 1• “What is the evidence-based management of
Appendicitis?"• Exercise: 2• “What is the evidence-based management of
eclampsia?
Looking for EBM information in Guideline Clearinghouse directly from Google
Exercises for Practice: Therapy
• Exercise: 1• "In elderly patients with congestive heart failure, is
digoxin effective in reducing the need for re-hospitalization?"
• Exercise: 2• "In a patient with COPD which is more effective in
symptom control: LABA or LAMA?
The AnswerPrimary Resources• Pubmed via PICO: http://pubmedhh.nlm.nih.gov/• Pubmed Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical
• Pubmed Search Box & Limits options: http://www.ncbi.nlm.nih.gov/pubmed/?querykey=4%26dbase=pubmed%26querytype=eSearch%26
Secondary Resources• Point of Care Resources e.g. UpToDate• Cochrane Library• Guidelines Websites: https://www.guideline.gov/Tertiary Resources• TRIP Database: https://www.tripdatabase.com/ (plus PICO)
PubMed for Handhelds ** (Download iOS App or Android App )
a.PICO search Patient, Intervention, Comparison, Outcome
b.askMEDLINE free-text, natural language search
c.Consensus Abstracts *
d.MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts
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The answer Digoxin initiation is associated with lower risk of all-cause readmission after hospitalisation
for heart failure.Hernandez AF; DeVore ADEvid Based Med; 2014 Aug; 19(4):153. PubMed ID: 24639395[No Abstract] [Full Text] [Related]
Drug therapy to reduce early readmission risk in heart failure: ready for prime time?Vaduganathan M; Fonarow GC; Gheorghiade MJACC Heart Fail; 2013 Aug; 1(4):361-4. PubMed ID: 24621940[TBL]Readmission for heart failure remains a major focus of policymakers, clinicians, and patients. Despite meeting key national performance measures and frequent use of evidence-based therapies, rates of 30-day post-discharge rehospitalization may be as high as 25%. Digoxin and mineralocorticoid antagonists are known to reduce admissions for heart failure, but are significantly underused in current clinical practice despite their proven benefits.
• [Abstract] [Full Text] [Related]
• TBL= The Bottom Line
Exercises for Practice: Diagnosis
• You are seeing a patient with breathlessness. She is seventy year old and has a known history of Asthma and ischemic heart disease. Her BNP is 122 (N up to 30). Does she have LVF or bronchial asthma exacerbation?
The AnswerPrimary Resources• Pubmed via PICO• Pubmed Clinical Queries• Pubmed Search Box & Limits optionsSecondary Resources• Point of Care Resources e.g. UpToDate• Cochrane Library• Guidelines WebsitesTertiary Resources• TRIP Database
Exercises for Practice: Diagnosis & Risk Assessment
You are seeing a patient with COPD exacerbation. ABG is as follows: PaO2: 44 mmHg, PaCO2: 62mmHg, pH 7.32, Bicarbonate 34 mmol/l. What is her acid-base diagnosis?
You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Is warfarin therapy indicated? What is her risk of bleeding on warfarin?
How to assess for a DVT risk? How to assess the severity of acute pancreatitis? Calculate your own ATPIII 10 year risk for heart disease based
on your age, gender, cholesterol and smoking status.
The Answer
Decision Support Calculators• Point of Care Resources e.g. UpToDate• Medscape
Exercises for Practice
• You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Her family brought her to ER and was found to have acute kidney injury.
• Where would you find guidance and a tool for implementing an evidence-based approach to her care?
The Answer
NICE Pathways: guidance at your fingertips- www.nice.org.uk
Society of Hospital Medicine: http://www.hospitalmedicine.org/
AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov/
Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/
ICSI Institute for Clinical Systems Improvements http://www.icsi.org/index.aspx
Exercises for Practice
• Your mentor passed a new article for a new anti-migraine medication.
• You have been told to appraise the article and tell the team about this new medication.
• How are you going to do it?• How are you going to calculate the number needed
to treat?
The Answer
• Oxford Centre for EBM: http://www.cebm.net/?o=1023
http://www.gla.ac.uk/departments/generalpracticeprimarycare/ebp/checklists/#d.en.19536 Checklist for an article on treatment or prevention Checklist for an article on qualitative research Checklist for an article on decision analysis Checklist for an article on an educational intervention Checklist for an article on prognosis Checklist for an article on harm or causation Checklist for an article on guidelines Checklist for an article on diagnosis or screening Checklist for a systematic review Checklist for economic evaluations
Exercises for Practice
• Diagnosis: What is the sensitivity, specificity and LR for procalcitonin in acute infections?
• Diagnosis: What is the sensitivity, specificity and LR for BNP in heart failure?
• Therapy: Which is more effective beta-blockers or ACEI in Systolic heart failure:
The Answer
• LR & NNT Websites– http://ktclearinghouse.ca/cebm/toolbox– http://www.thennt.com/
Exercises for Practice
Following a non-ST segment elevation myocardial infarction, a man was admitted to the hospital and placed on a telemetry monitor. As the monitor was constantly sounding with "low voltage" and "asystole" alerts and the patient was well each time clinicians checked, they silenced the alarms. The patient was found dead 4 hours later.
What will you do?
Exercises for Practice
A man with cirrhosis and abdominal distension was found to have significant ascites. The emergency department providers performed a large volume paracentesis to relieve his symptoms, but, as the 10th liter of fluid was removed, the patient became acutely hypotensive.
What will you do?
The Answer
WebM&M Morbidity & Mortality Rounds:
http://www.webmm.ahrq.gov/
With its PowerPoint presentation
Exercises for Practice
Medication Side-Effect: A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 12.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor?
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The Answer
Go to pubmed & Use Subheadings
Exercises for Practice
Audit & Quality Assessment: Which Quality Indicators/Audit criteria can you use in COPD care.
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The Answer
National Quality Measures Clearinghouse
http://www.qualitymeasures.ahrq.gov/search/search.aspx?term=copd
NICE Website Audit Toolshttp://www.nice.org.uk/about/what-we-do/into-practice/audit-and-service-improvement
Exercises for Practice
Quality Improvement: How do I improve my use of antibiotics at my
hospital? Critical lab. reporting? Reducing length of Stay? Reducing readmissions? Reducing PEG-site infections? Innovations in practice?
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The Answer
Agency for Healthcare Research & Quality AHRQ: http://www.ahrq.gov/
The National Institute for Health and Care Excellence (NICE): https://www.nice.org.uk/
Innovation Exchange: https://innovations.ahrq.gov/
Pubmed
Exercises for Practice
• Your patient; a newly diagnosed diabetic wants to know more about his disease and the medications.
• How would you explain to him?• He is worried about weight gain with treatment.
How would you approach this?
The Answer
• Patient Education Websites• Shared-Decision-making Websites
WebMD: http://www.webmd.com/
PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/s/diseases_and_conditions/a/
MedlinePlus: http://www.nlm.nih.gov/medlineplus/
NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.aspx
The NNT: •http://www.medicine.ox.ac.uk/bandolier/band50/b50-8.html
•http://www.thennt.com/•http://www.nntonline.net/visualrx/v3/display.aspx
King Abdullah Encyclopedia: عبدالله الملك موسوعة
عبدالعزيزالعربية بن الصحي للمحتوى
http://www.kaahe.org/ar/
Point of Care Clinical Resources: Patient Education
Patient-Centered Shared Decision Making
Mayo Clinic: http://shareddecisions.mayoclinic.org/
Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_Choice.pdf
Patient Decision Aidshttp://decisionaid.ohri.ca/AZlist.html
Shared Decision Making Resources
DHMC Center for Shared Decision Making http://www.dhmc.org/dept/csdm
Ottawa Health Research Institute http://decisionaid.ohri.ca/index.html
Healthwise Preferred Care http://www.healthwise.net/preferredcare
WebMD http://www.webmd.com/
Foundation for Informed Medical Decision Making http://www.informedmedicaldecisions.org
Health News Review http://www.healthnewsreview.org
Exercises for Practice
• You have a male 42 yr old present in the ER with a severe headache, nausea, myalgia, malaise, prostration. This just started suddenly a day or so ago. Physical exam reveals generalized macules that are red, fever, skin erythema, generalized papules that are small red, rash on his palms and soles of his feet. He thinks he has had insect bites while camping recently.
• What could this be? – http://www.ddderm.blogspot.com/
Looking for Nation-Wide Evidence-based Policies
• National Guidelines Clearinghouse: http://www.guideline.gov/ Guideline International Network GIN http://www.g-i-n.net/library • NICE National Institute for Health and Clinical Excellence: www.nice.org.uk,
http://pathways.nice.org.uk/ NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder • Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html • Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm Health-Evidence-ca: http://health-evidence.ca/ • MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html • ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx
• Health Care Improvement Skills Centre: http://improvementskills.org/
Looking for Nation-Wide Evidence-based Policies
National Guidelines Clearinghouse: http://www.guideline.gov/
Guideline International Network GIN http://www.g-i-n.net/library
NICE National Institute for Health and Clinical Excellence: www.nice.org.uk, http://pathways.nice.org.uk/
NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder
Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html
Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm
Health-Evidence-ca: http://health-evidence.ca/
MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html
ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx
Health Care Improvement Skills Centre: http://improvementskills.org/
http://pubmedhh.nlm.nih.gov/nlm/PubMed for Handhelds (PubMed4Hh): Download to
your device from Play Store
• MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts
• PICO search Patient, Intervention, Comparison, Outcome
• askMEDLINE free-text, natural language search
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SOFTWARE PUBLISHERS• Apps for Healthcare Professionals Collection
Apple's App Store has put together a collection to make it easier for healthcare professionals to find apps for their mobile devices. It includes six categories: reference apps, educational apps, EMR & patient monitoring apps, imaging apps, point of care apps, and personal care apps (which is actually aimed for consumers.)See the link above for a review by iMedicalApps.
• Medical WizardsSoftware for medical professionals by medical professionals. Not free.
• QxMDAuthored by clinician experts, QxMD’s authoritative free and inexpensive mobile apps are relied upon by physicians, nurses and other health care professionals.
• Skyscape - 25% discount- Skyscape offers medical references for mobile devices.- Available for Windows Mobile, Palm, iPhone, BlackBerry, Android.- In collaboration with the University of Calgary Libraries, Skyscape now offers a 25% discount on the purchase of Skyscape resources for mobile devices.
• Unbound MedicineUnbound Medicine offers medical references for purchase for mobile devices.
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