Find the Evidence Sean Elliott MD Annabel Nunez

Find the Evidence! Sean Elliott, MD Annabel Nunez, MLIS

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

A great relationship…

Learning Issues as Questions How 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…. Up. To. Date

Let’s look higher in the evidence pyramid…. Pub. Med – Prognosis Studies

Let’s look even higher in the evidence pyramid…. Pub. Med 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 and Clinical Research Tools • Examples of Databases – Stat!Ref • mainly full-text books – Pub. Med • Journal article database - 5000 journals back to 1950’s – MD Consult • Books, Journals, Monographs, Patient Education, Guidelines – Up. To. Date • Clinical decision support

Ugh…which one should I use? …

Why not just use Google? • Plus’s – It includes Pub. Med 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 • Searches full-text of entire web pages – Search results by keyword location(s) in web page EBM Search • Searches select databases plus Google – Results ranked by quality Breast cancer Pub. Med Article Citation Breast cancer Buystuff. com Blah blah breast Blah blah cancer blah Blah blah blah SEARCHES: Title, Abstract, subject headings Book: Harrison’s Principles of Internal Medicine ALL full-text

Arizona Health Sciences Library: Services Overview • Net. ID/ password – Off campus access • Hours · Group study rooms · Wireless access · IS Lab - Computers • “Ask a Health Librarian” service • Print vs. E-Reserves • Doc. Order • Coffee bar · Comfy furniture as well as tables

Thanks!