swomen retreat oct 2009
DESCRIPTION
Presentation given to clinical preceptors as part of the SWOMEN (Southwestern Ontario Medical Education Network) Teaching Retreat, held on October 24, 2009 at the Elm Hurst Inn in Ingersoll, OntarioTRANSCRIPT
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Information Rx: Western Libraries’ Prescription for Accessing Clinical
Evidence
SWOMEN/Family Medicine Teaching Retreat
Robin Featherstone, BA, MLISClinical Medicine Librarian University of Western [email protected]
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Disclosure
I received fellowship funding from the National Library of Medicine (who produces PubMed)
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Agenda• Library services• Accessing Western Libraries’ collections• Using Western’s collections to answer
background questions• Using Western’s collections to answer clinical
questions
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Library Services
1. Canadian Library of Family Medicine
2. Hospital Libraries
3. Leddy Library
4. Western Libraries
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Western Libraries: What we’ve got Journals
and databases
Books
Clinical Tools
Learning modules
Calculators
Drug Identification Tools
Images
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Medicine Information: How to access- Go to: http://www.lib.uwo.ca/
-Log in to Off-Campus Access with your UWO username and password (same as your UWO email account)
jsmith27sdK?8N*5
- Select Browse by Program
- Select Medicine and Dentistry
- Select Clinical Outreach
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http://www.lib.uwo.ca/programs/clinicaloutreach/Use this page to find selected medical resources
Electronic Books
Point of Care & EBM Tools
Databases
Image and video collections
And more...
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How to search our collectionsSelect “Catalogue”
Search the Catalogue to find anything Western Libraries owns or subscribes to
...including:
• Journals• Books• Databases• Point of Care Tools
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Catalogue Searching
You can even search for electronic full-text journals.
Select “Journal Title”
Then enter the name of the journal
And select “Go”
Tip: For best results, use the Advanced Search
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Parts of a Catalogue Record
Full title of the journal
Links to electronic articles
Coverage dates
Call # & location of print volumes
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Other ways to access electronic full text
• When searching for articles in databases, use the button to link to full-text
Tip: To see the buttons in PubMed • Use the PubMed links from the library website• Change the display in PubMed to Abstract or AbstractPlus
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Using the button
Select the “Go” button to link to full text
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Access Exercise 1
• How would you get a hold of this article?
Weber M. Achieving blood pressure goals: should angiotensin II receptor blockers become first-line treatment in hypertension? J Hypertens. 2009 Jul;27 Suppl 5:S9-14.
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Access Exercise 2
• How would you get a hold of this article?
Olsson SB, Orndahl G, Erneström S, Eskilsson J, Persson S, Grennert ML, Johansson BW. Spontaneous reversion from long-lasting atrial fibrillation to sinus rhythm. Acta Med
Scand. 1980;207(1-2):5-20. PubMed PMID: 7368973.
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Access Key Points
• Off-Campus Access – Remember to log in• Browse by Program > Clinical Outreach• Search the catalogue to find anything UWO
owns or subscribes to• Use Getit@Western button to access full-text• Select “Request Item” from the catalogue to
request ARCC and RDL items for Desktop Delivery
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Answering questions using Western’s collections
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Background Questions
What are the general preventative measures for otitis externa?
What are the mechanisms of Gabapentin?
What conditions are in the differential diagnosis for atrial fibrillation?
What are current guidelines for use of carotid endarterectomy?
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Resources for Background Questions
Textbooks• Library Catalogue (can limit to electronic)• Books@Ovid (623 clinical textbooks)• Harrison’s Online (AccessMedicine)• STAT!Ref (27 clinical textbooks)
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Clinical/Foreground Questions
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Using the Evidence to Answer Clinical Questions
Identify your problem
Define a structured question
Find the best evidence
How valid is the evidence?
What are the results?
How should I apply the results to patient care?1
1 Guyatt, Gordon, Drummond Rennie, Evidence-Based Medicine Working Group, and American Medical Association. Users‘Guides to the Medical Literature :A Manual for Evidence-Based Clinical Practice. Chicago, IL: AMA Press, 2002.
We’ll be focusing on two steps
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Case study
Using the PICO model, formulate an answerable question
A patient with chronic asthma and a BMI of 36 asks if the low-calorie diet that you’ve recommended may also help with her asthma.
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Create an answerable question
In patients with asthma, does a low-calorie diet help to decrease symptoms?
Population Patients with asthma
Intervention Low-calorie diet
Comparison
Outcomes Decreased symptoms
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6 Question Types
1. Aetiology: the causes of the disease and their modes of operation
2. Diagnosis: signs, symptoms or tests for diagnosing a disorder
3. Prognosis: the probable course of the disease over time4. Therapy: selection of effective treatments which meet
you patient’s values.5. Cost-effectiveness: is one intervention more cost-
effective than another?6. Quality of life: what will be the quality of life of the
patient? 3
3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
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Find the Best Evidence
• Studies which best answer each question type
Type of Question Type of Evidence
Aetiology Case-control or cohort study
Diagnosis Diagnostic validation study
Prognosis Inception cohort study
Therapy Randomized controlled trial
Cost-effectiveness Economic evaluation
Quality of life Qualitative study4
4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
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Evidence PyramidLess timeLess work
Less evidence
More timeMore work
More evidence
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Exercise
Search the following resources to answer the question: In patients with asthma, does a low-calorie diet help to alleviate symptoms associated with the condition?
1. Cochrane Library2. Essential Evidence Plus3. PubMed4. SCOPUS
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Conclusions
• Number of results
Source Hits
Cochrane Library 7
Essential Evidence Plus 23
PubMed 949 (75 if using Clinical Queries)
SCOPUS 2010
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Evidence Pyramid
Cochrane Library
EMBASE
PubMed
SCOPUS
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Summary & Key Points• Library Services• Access
– Log in to off-campus access– Browse by Program > Clinical Medicine– Search the Catalogue (use the Advanced search)– Access full text by using the Get it @ Western button
• Searching– Use textbooks to answer background questions– Use PICO to formulate answerable clinical questions– Save time by searching filtered information sources first
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QUESTIONS?