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Finding Reliable Clinical Information Online

Finding Reliable Clinical Information Online. An Introduction. Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine. http://www.med.fsu.edu/informatics/MedicalReferences.asp. Major Competency. Students will

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Finding Reliable Clinical Information Online

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  1. Finding Reliable Clinical Information Online An Introduction Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine http://www.med.fsu.edu/informatics/MedicalReferences.asp

  2. Major Competency • Students will • Demonstrate the ability to acquire new data and information and to critically appraise its validity and applicability.

  3. Objectives of Session • Students will • Demonstrate ability to locate quality clinical information on the web utilizing a variety of strategies • Assess the reliability and validity of clinical information found using search engines on the web • Begin to utilize the FSU COM virtual library resources to locate medical information for clinical decision support [Old and new]

  4. Resources • http://www.med.fsu.edu/informatics/ • Medical References • PowerPoint • Assessing the Validity of Online Medical Information • Decision Support • Using Drug Resources

  5. Review • What is the most efficient, unbiased way to keep up to date? • Go to conferences • Read 20-30 journal articles a week • Look up answers to clinical questions when they occur in a reliable, current resource

  6. In the Beginning… Journals Pocket Manuals Drug Info Text Books Note Cards Peer Reviewed

  7. “Textbooks don’t smell as their contents rot, so readers will need to develop alternative crap detectors to avoid poisoning their minds and robbing their patients of current best care.” David Sackett, MDPioneer of Evidence Based Medicine (EBM) The half life of medical information is estimated at 5 years.

  8. 21st Century Medical Information Journals Pocket Manuals Drug Info Text Books Note Cards

  9. Here is the Problem… Which of these sites are accurate? Which of these sites are reliable? Which of these sites are up to date? Which of these sites are not biased?

  10. AMA Guidelines for Medical and Health Information Sites on the Internet Health on the Net Code of Conduct HON Assessing the Validity of Information on the Web

  11. Assessing the Validity of Information on the Web • Site ownership/domain • Gov • CDC • AHRQ • NLM.NIH • DHHS • FDA • States fl.us • Edu • Medical Centers • Org • Associations • AAFP • ACP • ACOG • Disease orgs • ADA • ALA • Com • Commercial

  12. Assessing the Validity of Information on the Web • Site ownership/domain • Contributors listed, credentials, contact info • Highly referenced, linked to primary literature • MEDLINE Abstracts/Journal Articles • Proceedings from scientific meetings • Timeliness: date posted, revised • Viewer access, payment and privacy • Funding and sponsorship

  13. Wikipedia • List 5 ways Wikipedia does not fit the criteria as a reliable site.

  14. Exercise • Search Google for treatment of back pain • Rate the first 20 hits • Sponsor? Advertisements? • Audience? • Authors? • Links? • Date Revised? • Do advanced search limit to .gov domain and compare results • Search for prostate cancer screening

  15. Types of Information Found Free on the Web • Information for/by students • Information for/by patients • Information for/by clinicians • Information for/by researchers • Sales pitches, ads • Quacks who want to sell something • Unproven, unsubstantiated nonsense

  16. Assessing the Validity of Information on the Web • Library subscription resource = reliable

  17. Be Skeptical You will be taught the principles of critical review of the literature in your second year along with Evidence Based Medicine (EBM)

  18. What Kind of Question Do I Have? • Basic science or background question? • What is an olecranon? • Clinical question? • What are the risk factors for hypertension? • Which is better for diagnosing pneumonia: x-ray, CT or MRI? • How should I treat otitis media? • How much does amoxicillin cost?

  19. Answering a Background Question • Searching most efficient • Google/Wikipedia (assess the validity) • Use Medical Dictionary • Basic Science Textbooks • Access Medicine • Thieme

  20. Searching with Google $ubscription Web Based Medical Information Free Google Search

  21. Your eBookshelf

  22. Medical Dictionaries • Stedman’s is at eMedicine, in PEPID • Dorland’s at Merck

  23. Exercises for Practice • Using Stedman’s Medical Dictionary • eMedicine online • PEPID online and PDA • Look up: dyspnea nephrolithiasis teratogenic iatrogenic epistaxis cyanosis

  24. Books on the Library Web Page

  25. When to Use eBooks versus Quick References • Background information on topic • Basic science question instead of disease specific question • Detailed information/explanations versus bottom line • Lots of time versus short on time • Zebras versus common problems

  26. WebFeat Search • Searches Library Resources • Pick the type of resources to search • Groups by resource • Uses resource search engine

  27. New Website Searches • Multi-Search = Webfeat • Changing to SerialSolutions 360, August 2010 • Only eBooks and Patient Education

  28. Access Medicine • Best selection of all basic science books • Combined with good clinical medicine books • Search productive

  29. Answering Clinical Questions At the Point of Care

  30. Answering Clinical Questions • Quickest method: Browse to specific resource • Requires: knowing the content of sites/resources • Starting point: Library web page or your handheld (iPod or cell phone) • Learn to use subscription resources

  31. Current Library Web Site (Sum 2010)

  32. New Library Webpage

  33. Access Issues • IP address verification • Limited simultaneous users • Special URL issues • Bottom Line • Use links on Library Homepage

  34. Off Campus Access • IP authentication • Proxy server – EZProxy • FSU COM ID and password • Use links on library page

  35. Current Site - New Site

  36. Primary Resources of the Maguire Medical Library

  37. Differential Diagnosis Tools DDx DxPlain PEPID

  38. Differential Diagnosis Tools • Enter symptoms or chief complaint • Get a differential • Get more info on disease • DxPlain ***** • Harvard • Allows for multiple symptoms and lab results • Drawback: Slow • PEPID*** • Multiple symptoms • Lab Results • Age, gender, duration • eMedicine ** • Access Medicine’s • Diagnosaurus* (DDX tab)

  39. Using DxPlain or PEPID Patient 35 yr old female Chief complaint – fatigue, duration 2 months Other symptoms: throat pain, cold intolerance, weight gain, bradycardia, and constipation, Differential? Add lab: elevated TSH Exercises for Practice

  40. Drug Information Rx Epocrates Online PEPID Harrison’s Practice

  41. Epocrates Online • Rx, OTC and Alternative medicines by brand name, generic, and by class • Formularies • Drug Interaction tool • Disease reference, pill identifier, medical calculators, tables • Constantly updated

  42. Epocrates Drug Interaction MultiCheck Tool • Add all the drugs on the patients medications list (Rx, OTC, Alt) plus drug considering • Look to see if any interactions • What is the severity of interaction

  43. PEPID CRC Suite • Rx, OTC and Alternative medicines by brand name, generic, and by class • Drug Interaction tool • DDx, Disease reference, Lab manual, medical calculators, clerkships, images • Constantly updated

  44. PEPID Drug Interaction Tool • Select all drugs on list • Say Done • Click Interactions • Click specific interaction to read details

  45. Exercises for Practice • Using Epocrates Online • How should you prescribe acyclovir for chicken pox in an immunocompromised patient? (dose) • How much do 9 (50 mg) tablets of Imitrex cost? (common migraine drug) • Are there any drug interactions between Lexapro, Lortab, Xanax and Zocor?

  46. Disease Quick References DynaMed (Web and PDA) eMedicine (Web and PDA) Harrison’s Practice (Web and PDA) Epocrates Dx PEPID

  47. Types of Questions Best Answered by Disease Quick References • Description/background • Epidemiology • Diagnosis • Treatment • Ongoing management • Prognosis/outcomes • Prevention Bottom Line

  48. DynaMed • Most comprehensive disease reference • Summarizes all the latest research on topic • Very detailed • Well organized • Links out to full text articles if more details needed • Includes both diseases and symptoms like chest pain PDA and Online

  49. DynaMed • Organization: • Includes History and Physical sections (why am I asking these questions) • Expand or collapse sections • Use CTRL-F to search page

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