1.Find the Evidence!
Sean Elliott, MD
Annabel Nunez, MLIS
2.Medical Student! You incompetent moron!
What do you mean you have no idea
which incision is most appropriate to begin the
5.A great relationship…
6.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?
7.5 Steps to Evidence Based Clinical Practice
Construct a relevant, answerable question from a clinical case.
Plan and carry out a search of the literature for the best external evidence.
Critically appraise the literature for validity and applicability.
Apply the evidence to your patient.
5. Evaluate your performance.
8.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
9.Creating a PICO helps you isolate concepts, & choose search keywords
HAART (Highly Active Antiretroviral Therapy)
Placebo? Other drugs/ combinations?
10.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
15.EBM Search Strategies
18.Learning Issue: When does “acute retroviral syndrome” typically occur?
19.Let’s go back to the search results and try another source….
26.Let’s look higher in the evidence pyramid….
PubMed – Prognosis Studies
30.Let’s look even higher in the evidence pyramid….
PubMed Systematic Reviews
34.Modern Medical Library
Journals (thousands of full-text titles)
Library Catalog / print format materials
36.Medical Education andClinical Research Tools
Examples of Databases
mainly full-text books
Journal article database - 5000 journals back to 1950’s
Books, Journals, Monographs, Patient Education, Guidelines
Clinical decision support
37.Ugh…which one should I use?…
38.Why not just use Google?
It includes PubMed citations
Its HUGE - you always find SOMETHING
Easy to remember web address
39.Why not just use Google?
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
40.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
Book: Harrison’s Principles of Internal Medicine
Blah blah blah blah breast Blah
Blah blah cancer blah blah blah
Blah blah blah blah blah blah blah
41.Arizona Health Sciences Library: Services Overview
Off campus access
· Group study rooms
IS Lab - Computers
“Ask a Health Librarian” service
Print vs. E-Reserves
· Comfy furniture as well as tables