Find the Evidence, Sean Elliott, MD Annabel Nunez, MLIS, Medical Student

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  • 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 Louffle-Whalley procedure?!
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  • 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 Patient: HIV Intervention: HAART (Highly Active Antiretroviral Therapy) Comparison: Placebo? Other drugs/ combinations? Outcome: Clinical improvement
  • 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
  • 11.URL: www.ahsl.arizona.edu
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  • 15.EBM Search Strategies
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  • 18.Learning Issue: When does “acute retroviral syndrome” typically occur?
  • 19.Let’s go back to the search results and try another source…. UpToDate
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  • 26.Let’s look higher in the evidence pyramid…. PubMed – Prognosis Studies
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  • 30.Let’s look even higher in the evidence pyramid…. PubMed Systematic Reviews
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  • 32.Finished here
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  • 34.Modern Medical Library Electronic…. Books Journals (thousands of full-text titles) Reserve readings Videos Software Multimedia Library Catalog / print format materials
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  • 36.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
  • 37.Ugh…which one should I use?…
  • 38.Why not just use Google? Plus’s It includes PubMed citations Its HUGE - you always find SOMETHING Easy to remember web address FAST!
  • 39.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
  • 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 headings Book: Harrison’s Principles of Internal Medicine ALL full-text Breast cancer Breast cancer Buystuff.com 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 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
  • 42.Thanks!