Clinical Information Resources
Sandra A. Martin, M.L.I.S.
Health Sciences Resource Coordinator
Instructor of Library Services
John Vaughan Library Room 305B
marti004@nsuok.edu – 918-444-3263
Learning Objectives
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To familiarize residents with the information retrieval
process for evidence-based patient care
To enable residents to use synthesized/filtered/preappraised resources to answer clinical questions
To enable residents to use the 6S hierarchy of
organization of evidence to plan search strategies
Information Retrieval for Evidence
Based Patient Care
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Using research findings versus conducting research
Retrieving and evaluating information that has direct
application to specific patient care problems
Selecting resources that are current, valid and available
at point-of-care
Developing search strategies that are feasible within
time constraints of clinical practice
Clinical Applications of EBM
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Convert information needs into focused questions.
Efficiently track down the best evidence to answer the
questions.
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Consult pre-appraised evidence resources for answers that are
directly useful for clinical practice decisions, or
Critically appraise the evidence found in other clinical information
resources for validity and clinical usefulness
Apply the results in clinical decision making.
Evaluate usefulness of the evidence in clinical
application.
Answers to Clinical Questions
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Require:
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precise information about complex issues
trustworthy clinical research data with direct
application to patient problems
Fill gaps in clinical knowledge pertinent to:
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Therapy/prevention
Diagnosis
Prognosis
Etiology
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Search Strategy for EBM Retrieval
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Derive search terms from clinical question
Match best study design to type of question
Begin search at highest level of evidence
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Extract search terms from question
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Therapy/Prevention Question
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In patients with primary open angle glaucoma
or ocular hypertension [Patient/Population],
do topical medications to reduce intraocular
pressure [Intervention] versus no treatment
[Comparison Intervention], delay visual field
defect progression [Outcome]?
1. Search Terms
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Primary open angle glaucoma, POAG
Ocular hypertension, OHT
Intraocular pressure, IOP
Visual fields, VF
Limit search results to “therapy” studies
2. Best Study Design for Type of Question
Type of Question
Study Design
Therapy/prevention
Randomized controlled
trials
Diagnosis
Prospective cohort, blind
comparison to a gold
standard
Prognosis
Cohort, Case Control, Case
Series
Etiology/Harm
Cohort, Case Control, Case
Series
Search First at Top Levels of 6S
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MEDLINE - major source of “primary” literature
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Process of searching, selecting, evaluating original research is
time consuming
Requires critical appraisal skills
Filtered/Synthesized/Evaluated resources - “secondary”
literature
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Speed application of evidence at “point-of-care”
Grade strength of treatment recommendations
Rate quality of research evidence
Top of 6S – Point-of-Care Resources
Evidence based textbooks
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Provide rapid access to concise information to clinicians at the
point of care
Not a database of articles from books, journals, or guidelines
Original, current, summaries written by experts
Formal systems used to grade strength of recommendations
and quality of evidence
Available from Optometry web page
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UpToDate
First Consult
Summaries
• UptoDate
– Evidence based summaries of over 9,500
topics in over 22 specialties
– 8,500 Treatment Recommendations
– GRADE System used to score
recommendations and strength of evidence
– Practice changing updates; Updated
continuously
– Drug database; Patient education materials
– The Gold Standard of summaries
Clinical Question
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Therapy/Prevention
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In patients with primary open angle glaucoma
or ocular hypertension [Patient/Population],
do topical medications to reduce intraocular
pressure [Intervention] versus no treatment
[Comparison Intervention], delay visual field
defect progression [Outcome]?
Simple UTD Search Answers
Clinical Question in Seconds
Summaries
• FirstConsult
– Search online in Clinical Key
– App available through NSU subscription to
Clinical Key for iPhone or iPad only
– Create a personal account in Clinical Key
– Download the app from the Apple app store
– Login with your CK username and password
– Concise summaries; sections on differential
diagnosis; quality of evidence graded
– Not updated as rapidly as UTD
Synopsis of Syntheses
• Database of Abstracts of Reviews of
Effects DARE
– Search online in OVID
– Part of OVID’s evidence based medicine
reviews collection
– Full text database contains critical
assessments of systematic reviews published
in various medical journals
Systematic Review
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Analyzes data from several primary studies to
answer a specific clinical question
Provides search strategies and resources used
to locate studies
Includes specific inclusion and exclusion criteria
(results in less bias)
Meta-Analysis (subclass) statistically
summarizes results of several individual studies
Critical Assessment of Systematic Review cited in UTD and FC
Syntheses
• Cochrane Database of Systematic
Reviews (DSR)
– Part of the Cochrane Library (1996)
– Over 900 completed reviews, 1900 protocols
– Among the highest level of evidence upon
which to base treatment decisions
– Includes Dx since 2008
– Eyes & Vision Research Group
• Contains over 200 reviews
– Full Text Available in Ovid
Synopses of Studies
• ACP Journal Club
– Contains abstracts of studies selected by ACP
editors as valid and clinically relevant
– Part of OVID’s evidence based medicine
reviews collection
– Primary care focus
Primary Care Focus
When other S’s do not provide
answers, search for original studies
Primary (Original) Studies
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Articles that report results of original
research investigations
Conclusions supported by data and
reproducible methodology
Require time to acquire and appraise
Best Sources: Ovid MEDLINE and
Clinical Key
“Do it yourself” Appraisal Territory
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You must appraise quality of the study or
find analysis in evidence based summary
Limit search results to “Clinical Queries” in
Ovid MEDLINE or “Study Type” in Clinical
Key Journal Search
Databases
• MEDLINE
– Premiere biomedical database from the NLM
(National Library of Medicine)
– Covers 1946-present
– Indexes >5000 international biomedical
journals
– Full text available for many articles
– Access through Ovid and Clinical Key
Search of Current MEDLINE files yields 49
studies to scan and appraise
Clinical Key
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Full text access to 1,000 books and 500 journals in every
medical and surgical specialty
Ophthalmology – Over 60 full text books
Includes 12 Content Types
Access to information at all levels from topic overview to
evidence-based data in one search
Smart search engine matches first few letters of search
word/words to relevant clinical content
No complicated search strategies or Boolean connectors
CK MEDLINE Yields 89 RCTS in last 5 Years to
Scan and Appraise
Take Home Points
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Focused clinical question (PICO) reveals your
search terms and best type of studies
Start your search at top of 6S hierarchy and
work down (UpToDate, First Consult)
Be aware of the filters: levels of evidence,
graded recommendations, speed of updating
Look at more than one resource in the
hierarchy. Findings may differ
Apply in clinical settings; assess your progress
Information is Ever Changing
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