PDA Resources for Evidence-Based Medicine The Welch Medical Library May 6, 2004

1. Cindy Sheffield, MBA, MLS Claire Twose, MLIS Brian Pinto, PharmD Mark Dodd PDA Resources for Evidence-Based Medicine The Welch Medical Library May 6, 2004

2. Today�s Lecture Intro to Evidence-Based Medicine Intro to Personal Digital Assistants Resources Government Guidelines Clearinghouse PubMed FIRSTConsult mobileMICROMEDEX Lexi-COMP (fee) PICO Maker EBM Calc Other Learning Opportunities Other Resources Questions and Answers

3. EBM Definition Evidence-Based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Glossary, Centre for Evidence Based Medicine, Oxford accessed April 28, 2004 http://www.cebm.net/glossary.asp DON�T CLICK History: McMaster University, Guyatt, Haynes, 1980s, seminal article published 1992: went on to produce a series called the Users� guides to the medical literature (any body know the first historical rct? First RCT: 1747, citrus fruit and scurvy ) --as the literature was growing in leaps and bounds, and McMaster was creating an innovative problem-based curriculum the biostats department was looking at innovative ways Overwhelming growth in medical literature Doubles in size every 19 years (J. Wyatt, Lancet, 338, Nov 30 1991) Limitations of traditional sources Need new way to stay up-to-date What�s the evidence for evidence based medicine, well, could we ethically do a randomized controlled trial What we can point to is evidence that evidence based practice is effective, and not following the evidence is harmful --Myocardial Infarction survivors treated with aspirin and beta blockers have lower mortality; --Carotid surgery�if they meet evidence based requirements 3 times less likely to have stroke or die in next month than those operated on who didn�t. DON�T CLICK History: McMaster University, Guyatt, Haynes, 1980s, seminal article published 1992: went on to produce a series called the Users� guides to the medical literature (any body know the first historical rct? First RCT: 1747, citrus fruit and scurvy ) --as the literature was growing in leaps and bounds, and McMaster was creating an innovative problem-based curriculum the biostats department was looking at innovative ways Overwhelming growth in medical literature Doubles in size every 19 years (J. Wyatt, Lancet, 338, Nov 30 1991) Limitations of traditional sources Need new way to stay up-to-date What�s the evidence for evidence based medicine, well, could we ethically do a randomized controlled trial What we can point to is evidence that evidence based practice is effective, and not following the evidence is harmful --Myocardial Infarction survivors treated with aspirin and beta blockers have lower mortality; --Carotid surgery�if they meet evidence based requirements 3 times less likely to have stroke or die in next month than those operated on who didn�t.

5. Managing the Literature Overwhelming growth in medical literature Doubles in size every 19 years (J. Wyatt, Lancet, 338, Nov 30 1991) Limitations of traditional sources Need new way to stay up-to-dateOverwhelming growth in medical literature Doubles in size every 19 years (J. Wyatt, Lancet, 338, Nov 30 1991) Limitations of traditional sources Need new way to stay up-to-date

6. Levels of Evidence: study design

7. Welch�s EBM Page: Quicklinks, EBM

8. Intro to PDAs: Palm vs. Pocket PCOperating Systems

9. Intro to PDAs: Palm vs. Pocket PC

10. Introduction to PDAs � more info Jim�s Palm Pages http://www.jimthompson.net/palmpda/ Dalhouise http://handheld.medicine.dal.ca/introduction/index.htm pdaMD.com Learning Center http://www.pdamd.com/vertical/features/wireless_2.xml Etopicbrain http://pbrain.hypermart.net/basics.html

11. Government Guidelines Clearinghouse Public resource for evidence-based clinical practice guidelines NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ) Can use a Reader with Palm; wireless direct access available on Pocket PC http://www.guideline.gov/

12. Government Guidelines Clearinghouse

13. PubMed Search in Medline for citations and abstracts Will provide interactive access in a wireless environment http://certif.nlm.nih.gov:8080/nlm/ Can use same address as Avantgo Channel Project called PubMed on Tap http://archive.nlm.nih.gov/proj/pmot/pmot.php

14. PubMed

15. FIRSTConsult 330 Differential Diagnoses 450 Medical Conditions 3 Different download sizes Updated quarterly http://www.welch.jhu.edu/internet/ebr.html#PDAs

16. FIRSTConsult

17. mobileMICROMEDEX Drug information and interactions Alternative medicine information Acute care Toxicology information Formulary advisories http://jhmcis.jhmi.edu/mdxcgi/mdxhtml.exe?&tmpl=mobile.tm1&SCRNAME=mobile&CTL=E:\mdx\mdxcgi\megat.sys

18. mobileMICROMEDEX

19. Lexi-COMP Provides drug interaction information JHH Formularies www.lexi.com

20. Lexi-COMP

21. PICO Maker Store queries in PICO format for later Assist students and clinicians with evidence based practice. Palm based http://www.library.ualberta.ca/pdazone/pico/

22. PICO Maker

23. EBM Calc Statistics for Diagnostic, Prospective, Case Control & Randomized studies Can graph pre- and post test probability with likelihood ratio for Diagnostic Studies. Can save results and view at another time EBM Calculator � Centre for EBM � University Health Network http://www.cebm.utoronto.ca/palm/ebmcalc

24. EBM Calc

25. Other Learning Opportunities Library Classes (Resources for Research and Information Management & Presentations): Evidence-Based Health Care � 6/24/04 pm Pharmacology Resources � 8/12/04 am Evidence-Based Critical Appraisal for Patient Care - 7/27/04 am Registration @ http://www.welch.jhu.edu/classes

26. October 12th All Day Event See http://mobileathopkins.jhu.edu/ For details

27. Other PDA Resources of Interest Avantgo � host server https://my.avantgo.com/home/ Hopkins Antibiotic Guide http://hopkins-abxguide.org ePocrates www.epocrates.com MedCalc http://www.collectivemed.com/jump/medca.shtml

28. Where to find PDA Resourceshttp://www.welch.jhu.edu/classes/elearning/pdaresources.html Dalhousie University Handheld Recommendations - Organized set of hardware descriptions and software specifically for medicine with informative recommendations ectopicbrain - List of medical applications with descriptions for each handheldmed - Delivers point of care content and applications for healthcare professionals pdaMD.com - Premier website providing tutorials, forums, news, and software for health care professionals who use PDAs Skyscape - Extensive list of medical reference titles

29. Where to find PDA Resources CollectiveMed - Owned and operated by healthcare professionals MedicalPocketPC - Software, news, and reviews for PocketPC and WinCE medical users HealthyPalmPilot - Over 700 downloadable healthcare resources from pdaMD.com Memoware Medical Downloads - Over 300 downloads for medical specialties Johns Hopkins Office of Academic Computing � Several medical applications for the Palm OS. WelchWeb�s Personal Digital Assistants � A guide to resources for healthcare.

30. How to Evaluate PDA Resources Knowing What�s What and What�s Not http://www.media-awareness.ca/english/resources/educational/handouts/internet/5ws_cyberspace.cfm Ten C�s for Evaluating Internet Sources http://www.uwec.edu/Library/Guides/tencs.html