Find the Evidence!

Sean Elliott, MD

Annabel Nunez, MLIS

Medical Student! You incompetent moron!What do you mean you have no ideawhich incision is most appropriate to begin the Louffle-Whalley procedure?!

A great relationship…

Learning Issues as QuestionsHow are you doing so far?

• Did you focus your searching instead of browsing?

• Have you framed questions to get at your knowledge gap?

• Have you learned to use technology better? • Are to trying to apply the BEST evidence

available to answer questions?

5 Steps to Evidence Based Clinical Practice

1. Construct a relevant, answerable question from a clinical case.

2. Plan and carry out a search of the literature for the best external evidence.

3. Critically appraise the literature for validity and applicability.

4. Apply the evidence to your patient.

5. Evaluate your performance.

Translating Clinical Case details into a Search

• Step 1: Create a focused, answerable question:

• “When is it appropriate to commence Highly Active Antiretroviral Therapy (HAART) in the HIV infected patient?”

• PICO format can help…Patient, Intervention, Comparison, Outcome

Creating a PICO helps you isolate concepts, & choose search keywords

• Patient: – HIV

• Intervention: – HAART (Highly Active Antiretroviral

Therapy)

• Comparison: – Placebo? Other drugs/ combinations?

• Outcome: – Clinical improvement

Step 2: Research your focused, answerable question• EBM Search tool

– Searches the BEST e-resources available from the library

– Includes Hierarchy of Evidence learning tool/ ranking system

– EBM tool, but can also be used for researching learning issues

URL: www.ahsl.arizona.edu

EBM Search Strategies

Learning Issue: When does “acute retroviral syndrome” typically occur?

Let’s go back to the search results and try another

source….

UpToDate

Let’s look higher in the evidence pyramid….

PubMed – Prognosis Studies

Let’s look even higher in the evidence pyramid….

PubMed Systematic Reviews

Finished here

Modern Medical Library

• Electronic….– Books – Journals (thousands of full-text titles)– Reserve readings– Videos– Software– Multimedia

• Library Catalog / print format materials

Medical Education andClinical Research Tools

• Examples of Databases – Stat!Ref

• mainly full-text books

– PubMed• Journal article database - 5000 journals back to 1950’s

– MD Consult • Books, Journals, Monographs, Patient Education,

Guidelines

– UpToDate• Clinical decision support

Ugh…which one should I use?…

Why not just use Google?

• Plus’s– It includes PubMed citations– Its HUGE - you always find SOMETHING – Easy to remember web address– FAST!

Why not just use Google?

• Downside– Is simply finding SOMETHING, enough?– No filtering – you get information from

biased, commercial sites– No ranking of evidence strength– Despite fast search speeds, it takes TIME

to sift through results– If its good, you have to often have to pay

Google EBM Search

• Searches full-text of entire web pages– Search results by

keyword location(s) in web page

• Searches select databases plus Google– Results ranked by quality

PubMed Article Citation

SEARCHES: Title, Abstract, subject headings

Book: Harrison’s Principles of Internal Medicine

ALL full-text

Breast cancer

Breast cancer

Buystuff.com

Blah blah blah blah breast BlahBlah blah cancer blah blah blah Blah blah blah blah blah blah blah

Arizona Health Sciences Library: Services Overview

• NetID/ password– Off campus

access• Hours

Group study rooms Wireless access IS Lab - Computers

• “Ask a Health Librarian” service

• Print vs. E-Reserves• DocOrder• Coffee bar

Comfy furniture as well as tables

Thanks!