Session 2: Finding Medical Information in a Clinical Context

1. October 22, 2008 Session 2: Finding Medical Information in a Clinical Context Leilani St. Anna, MLIS, AHIP Information Management Librarian, Health Sciences Library healthlinks.washington.edu/hsl/liaisons/stanna

2. Information Pyramid

3. Types of information sources • Primary Literature • Original research/journal articles • Review articles • Summarize information on topic • May be evidence-based

4. Types of information sources (cont.) • Systematic reviews • Literature review which tries to identify, appraise, select and synthesis all high quality research evidence relevant to that question. • Use explicit methods to identify, select, and critically evaluate relevant research. • Meta-Analyses • Systematic review that uses quantitative methods to synthesize/summary the results (Evidence-Based Medicine, 3rd edition, 2005)

5. Types of information sources (cont.) • Guidelines • Systematically developed statements using varying standards. Cost may be considered as well as health outcomes. • May be evidence-based. • Book chapters • Summary of information on topic. • May be evidence-based • Print book chapters typically out-of-date/ • Textbooks vs spiral manuals (overview/educate vs quick reference)

6. Patients & Health Information • Coming to you with information from a wide variety of sources • Point out reliable, reputable sources

7. Cochrane Librarywww3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME • The Cochrane Collaboration: international not-for-profit organization, providing up-to-date information about the effects of health care • Cochrane Database of Systematic Reviews (Clinical Reviews) • 'Gold Standard' for high-quality systematic reviews • Includes full-text • Abstracts available in PubMed, other sources

8. Cochrane Library (cont.) • Database of Abstracts of Reviews of Effects (Other Reviews) • Selection of quality assessed reviews for topics where there is no Cochrane review • Brief critical appraisals of previously published reviews of the effects of health care • Structured abstracts, not full-text • Clinical Trials • Citations from databases (notably MEDLINE and EMBASE), and other published and unpublished sources • Does not contain the full text of the article

9. Cochrane Library (cont.) • Systematic reviews; RCTs, Case cohorts, control studies • Advantages • Clinical Reviews: Very high quality systematic reviews • DARE/Clinical Trials: Identify evidence-based articles from PubMed plus other databases • Disadvantages • Limited number of Cochrane-produced systematic reviews • Very specific questions • Answer often more research needed

14. BMJ Clinical Evidencewww.clinicalevidence.com/ • Compendium of evidence on the effects of clinical interventions. • Summarizes the current state of knowledge, including knowns and unknowns, based on thorough search. • Categorizes interventions as beneficial, likely beneficial, no known benefit, harmful ...

15. BMJ Clinical Evidence • Evidence summaries • Advantages • Decision-support tool for clinical settings • Disadvantages • Limited number of topics covered • Limited for diagnosis

17. PubMedwww.ncbi.nlm.nih.gov/sites/entrez/query.fcgi?myncbishare=uwonlinePubMedwww.ncbi.nlm.nih.gov/sites/entrez/query.fcgi?myncbishare=uwonline • Service of the U.S. National Library of Medicine • Includes over 18 million citations from MEDLINE and other life science journals for biomedical articles back to the late 1940s • Includes links to full text articles and other related resources. • MedlinePlus, consumer health source (link in blue column on left) • UW access for more full-text links • Abstracts supplied by authors/journals

18. PubMed:Tools for Evidence-Based Retrieval • Clinical Queries: etiology, diagnosis, therapy, prognosis, clinical prediction guides • Systematic Reviews • Limits: publication types

19. PubMed • Systematic reviews & meta-analyses; RCTs, case cohorts, control studies; Case Reports, Case Series, Other Articles, Practice Guidelines, etc. • Advantages: • Huge database of biomedical literature • Advanced searching available • Lots of links to full-text • Available at no-charge anywhere • Disadvantages: • No separate evaluation of quality of research • May be too slow for clinical use

24. Google Scholarscholar.google.com/ • Beta product • Searches specifically for scholarly literature such as peer-reviewed papers, theses, technical reports, preprints and abstracts • Find articles from academic publishers, professional societies, universities, etc. as well as scholarly articles available on the web • A "Cited by" link identifies other papers that have cited the original one listed • Now links to full text articles the UW subscribes to (Select UW Libraries from the Scholar Preferences link. Enter Washington in the search box, select UW from the list, and save preferences)

25. Google Scholar • Evidence-based literature; journal articles; books,etc • Advantages • Huge and easy of use • Search full-text within articles • Disadvantages • Access to full text only available with subscription • Fielded searching not available SeeGoogle vs PubMed searchinghttp://healthlinks.washington.edu/howto/googlechart.html • Updating inconsistent

26. National Guideline Clearinghousewww.guideline.gov • Initiative of the Agency for Healthcare Research and Quality (AHRQ) • Available at no charge • Updated weekly with new and changed guidelines. • Database of clinical practice guidelines and related documents. Voluntary participation.

27. National Guideline Clearinghouse • Advantages • Largest guidelines database • Side-by-side comparison of guidelines available • Disadvantages • Level of evidence dependent on producer

30. UpToDatewww.uptodateonline.com/ • Concise comprehensive reviews of clinical topics in multiple specialties • New generation of electronic textbooks

31. UpToDate • Clinical Reference Text • Advantages • Scope: many topics covered • Ease-of-use • Disadvantages • Not always current • Evidence-base not always explicit or consistent across all topics • [library pt of view] – cost; individual $495/yr

33. MD Consulthome.mdconsult.com/groups/uwash8783.html • Electronic ‘bookshelf’ • Includes textbooks in major specialties; drug information; patient ed materials; limited journals; practice guidelines

34. MD Consult • Clinical Reference text • Advantages • Continuously updated collection • Single search interface • Disadvantages • Not all evidence-based materials • [library pt of view] – cost; individual ~$350/yr

36. TRIP Databasewww.tripdatabase.com • TRIP: Turning Research Into Practice • Meta-search engine from UK • Searches over 70 sites of evidence-based information • Includes links to peer-reviewed journals and other publications

37. TRIP Database • Meta-search engine • Advantages • Search multiple sources at one time • Disadvantages • May have more UK focus than desired • Not all links to full-text

39. Information Pyramid

40. Types of Databases • Primary research database (articles) • PubMed, PsycINFO, Cochrane Clinical Trials Database • Secondary research databases (synthesis) • Cochrane Library, Clinical Evidence, UpToDate • Tertiary resources (meta search engines, databases of databases) • TRIP See http://healthlinks.washington.edu/ebp/ebptools.html

41. healthlinks.washington.edu/care_provider

42. Role of Librarians • Experts on finding & organizing information and using resources • Locate/license reliable, reputable sources • Produce finding tools (eg HealthLinks) • 15 minute rule: if you don’t find something quickly, ask us

43. Additional Resources … • Care Provider Toolkit • healthlinks.washington.edu/care_provider • Evidence-Based Practice Tools Summary • healthlinks.washington.edu/ebp/ebptools.html • Evidence-Based Practice • healthlinks.washington.edu/ebp • Finding Medical Information Resources • healthlinks.washington.edu/hsl/liaisons/stanna/midm.html • Contact your library liaison: • Leilani St.Anna: lstanna@u.washington.edu | 206.543.926 • Lisa Oberg: lisanne@u.washington.edu | 206.543.7474 • QUESTIONS?

44. Small Group Session 3:Monday, 10/27, 2:00-2:50 • In preparation for the 10/27 small group session students look for answers to the PICOSS topic assigned to them in the 10/22 small group session in 3 of the resources listed below: • Cochrane • Clinical Evidence • PubMed or Google Scholar • UpToDate or MD Consult • National Guideline Clearinghouse • TRIP • Students report what they have found in resources and any questions they have on what they have found.  Group discusses findings for the 2 topics identified in the 10/22 small group session.

45. Small Group Session 3 (cont.) : • Small group leaders give examples of clinical situations where they had to search for information & how they approached the search & what they found • Librarians, students, and small group leaders together in parallel find different types of documents from different medical information resource(s) that may address the clinical question. • Remember to bring your laptops.