Advanced Information Mastery Deborah R Erlich MD MMed

Advanced Information Mastery Deborah R. Erlich, MD MMed. Ed Assistant Professor, Tufts University School of Medicine Assistant Clerkship Director, Family Medicine

Aims • Review Information Mastery Concepts • Practice: apply concepts to real clinical questions • Try some new resources

Objectives • Name 5 different EBM sources and identify when each is most useful • Perform an effective search… fast! • Categorize quality of an answer using the Usefulness Equation

What makes a “good” question? • For a specific population • Compares Intervention to Comparator • Outcome of interest is patient-oriented • (can ask about intervention, prognosis or diagnosis)

What makes a “good” answer? • Patient-oriented • Valid – Systematic review – Meta-analysis – Single study (RCT) – Guidelines – Expert opinion • Relevant • Reliable • Supported by Level of Evidence

What makes a “good” resource? • Work – Long? Painful? – Expensive? – Inaccessible? Usefulness • Relevance – Answers your question • Validity • Transparency – Grade/level of evidence = Relevance x Validity _______ Work

Question #1 • Need L. Fobia is a 62 year old male with osteoarthritis of the knee. • Another doctor recommended a steroid injection but Mr. Fobia is terrified of needles and is only willing to undergo the procedure if it will really help him. • What is your advice?

Question #2 • Wedd Mibed is a 7 year old boy with nocturnal enuresis. • His mother heard from her neighbor that an antidepressant called imipramine might cure the problem. She also saw an ad online for a bed alarm and a dry bed training program and wants to know which treatment is best for Wedd’s problem. • What does the evidence say?

Question #3 • Mary Mee is a 28 year old female with a bump on her hand. She is hoping for an engagement ring soon so she desperately wants this gone! • What’s the most effective way to get rid of it?

A few more… • Mr. O. Beece is a 48 year old male with blood pressure 149/88, HR 80, and weight 205 pounds. He wants to know if he should be checked for diabetes.

• Tina Bopper is a 17 year old female who had all of her early childhood vaccines on time. She also had the Menactra vaccine 4 years ago and the Tdap vaccine 6 years ago. • She asks if she needs any shots today.

• Mr. N. Gola is a 38 year old planning to travel to Africa. He wants to know if he needs any vaccines before his trip.

• Background • Treatments for common conditions • Systematic review • • • Free / no TUSK access Immunizations Travel Screening / preventive care Medications • Esoterica / rare conditions / specific paper • Up. To. Date • BMJ Clinical Evidence • Cochrane (gold standard) • Dynamed (more recently updated, easier? ) • TRIP database • Shots app (STFM) / CDC. gov • USPSTF • Epocrates (no LOE or NNT) • Micromedex • Medline

Thanks • Allen Shaughnessy Pharm. D MMed. Ed • Kristen Goodell MD • Molly Cohen-Osher MD