Finding Reliable Clinical
Information Online
An Introduction
Nancy Clark, M.Ed.
Director of Medical Informatics Education
FSU College of Medicine
http://www.med.fsu.edu/informatics/MedicalReferences.asp
Summer 2010
1
Major Competency

Students will
• Demonstrate the ability to acquire new data
and information and to critically appraise its
validity and applicability.
Summer 2010
2
Objectives of Session

Students will
• Demonstrate ability to locate quality clinical
information on the web utilizing a variety of
strategies
• Assess the reliability and validity of clinical
information found using search engines on
the web
• Begin to utilize the FSU COM virtual library
resources to locate medical information for
clinical decision support [Old and new]
Summer 2010
3
Resources


http://www.med.fsu.edu/informatics/
Medical References
• PowerPoint
• Assessing the Validity of Online Medical
•
•
Information
Decision Support
Using Drug Resources
Summer 2010
4
Review

What is the most efficient, unbiased way
to keep up to date?
1. Go to conferences
2. Read 20-30 journal articles a week
3. Look up answers to clinical questions when
they occur in a reliable, current resource
Summer 2010
5
In the Beginning…
Journals
Text Books
Peer Reviewed
Summer 2010
Pocket Manuals
Drug Info
Note Cards
6
“Textbooks don’t smell as their
contents rot, so readers will need to
develop alternative crap detectors to
avoid poisoning their minds and
robbing their patients of current best
care.”
David Sackett, MD
Pioneer of Evidence Based Medicine (EBM)
The half life of medical information
is estimated at 5 years.
Summer 2010
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21st Century Medical Information
Journals
Text Books
Pocket Manuals
Drug Info
Note Cards
Summer 2010
8
Here is the Problem…
Which of these sites are accurate?
Which of these sites are reliable?
Which of these sites are up to date?
Which of these sites are not biased?
Summer 2010
9
Assessing the Validity of
Information on the Web


AMA Guidelines for Medical and Health
Information Sites on the Internet
Health on the Net Code of Conduct HON
Summer 2010
10
Assessing the Validity of
Information on the Web

Site ownership/domain
• Gov
–
–
–
–
–
–
CDC
AHRQ
NLM.NIH
DHHS
FDA
States fl.us
• Edu
– Medical Centers
Summer 2010
• Org
– Associations
• AAFP
• ACP
• ACOG
– Disease orgs
• ADA
• ALA
• Com
– Commercial
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Assessing the Validity of
Information on the Web





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Site ownership/domain
Contributors listed, credentials, contact info
Highly referenced, linked to primary literature
• MEDLINE Abstracts/Journal Articles
• Proceedings from scientific meetings
Timeliness: date posted, revised
Viewer access, payment and privacy
Funding and sponsorship
Summer 2010
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Wikipedia

List 5 ways Wikipedia does not fit the
criteria as a reliable site.
Summer 2010
13
Exercise


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
Search Google for treatment of back pain
Rate the first 20 hits
• Sponsor? Advertisements?
• Audience?
• Authors?
• Links?
• Date Revised?
Do advanced search limit to .gov domain and
compare results
Search for prostate cancer screening
Summer 2010
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Types of Information Found Free on
the Web

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Information for/by students
Information for/by patients
Information for/by clinicians
Information for/by researchers
Sales pitches, ads
Quacks who want to sell something
Unproven, unsubstantiated nonsense
Summer 2010
15
Assessing the Validity of
Information on the Web

Library subscription resource = reliable
Summer 2010
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Be Skeptical
You will be taught the principles of
critical review of the literature in your
second year along with Evidence
Based Medicine (EBM)
Summer 2010
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What Kind of Question Do I Have?

Basic science or background question?

Clinical question?
• What is an olecranon?
• What are the risk factors for hypertension?
• Which is better for diagnosing pneumonia: x-ray,
•
•
CT or MRI?
How should I treat otitis media?
How much does amoxicillin cost?
Summer 2010
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Answering a Background Question

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Searching most efficient
Google/Wikipedia (assess the validity)
Use Medical Dictionary
Basic Science Textbooks
• Access Medicine
• Thieme
Summer 2010
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Searching with Google
$ubscription
Free
Web Based
Medical Information
Google Search
Summer 2010
20
Your eBookshelf
Summer 2010
21
Medical Dictionaries


Stedman’s is at eMedicine, in PEPID
Dorland’s at Merck
Summer 2010
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Exercises for Practice

Using Stedman’s Medical Dictionary

Look up:
dyspnea
teratogenic
epistaxis
cyanosis
• eMedicine online
• PEPID online and PDA
Summer 2010
nephrolithiasis
iatrogenic
23
Books on the Library Web Page
Summer 2010
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When to Use
eBooks versus Quick References

Background information on topic
• Basic science question instead of disease
specific question

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Detailed information/explanations versus
bottom line
Lots of time versus short on time
Zebras versus common problems
Summer 2010
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WebFeat Search
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Searches Library Resources
Pick the type of resources to
search
Groups by resource
Uses resource search engine
Summer 2010
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New Website Searches
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
Multi-Search =
Webfeat
Changing to
SerialSolutions
360, August 2010
Only eBooks and
Patient Education
Summer 2010
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Access Medicine



Best selection of all basic science books
Combined with good clinical medicine
books
Search productive
Summer 2010
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Answering Clinical
Questions
At the Point of Care
Summer 2010
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Answering Clinical Questions



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Quickest method: Browse to specific
resource
Requires: knowing the content of
sites/resources
Starting point: Library web page or your
handheld (iPod or cell phone)
Learn to use subscription resources
Summer 2010
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Current Library Web Site
Summer 2010
(Sum 2010)
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New Library Webpage
Summer 2010
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Access Issues
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IP address verification
Limited simultaneous users
Special URL issues
Bottom Line
• Use links on Library Homepage
Summer 2010
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Off Campus Access
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IP authentication
Proxy server – EZProxy
FSU COM ID and password
Use links on library page
Summer 2010
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Current Site
Summer 2010
-
New Site
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Primary Resources of the
Maguire Medical Library
Summer 2010
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Summer 2010
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Differential Diagnosis
Tools
DxPlain
PEPID
Summer 2010
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Differential Diagnosis Tools

Enter symptoms or
chief complaint

PEPID ***

eMedicine **
Access Medicine’s
• Get a differential
• Get more info on
disease

DxPlain *****
• Harvard
• Allows for multiple
•
symptoms and lab
results
Drawback: Slow
Summer 2010

• Multiple symptoms
• Lab Results
• Age, gender, duration
• Diagnosaurus* (DDX
tab)
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Exercises for Practice

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Using DxPlain or PEPID
Patient 35 yr old female
Chief complaint – fatigue, duration 2
months
• Other symptoms: throat pain, cold intolerance,
weight gain, bradycardia, and constipation,

Differential?
• Add lab:
Summer 2010
elevated TSH
40
Drug Information
Epocrates Online
PEPID
Harrison’s Practice
Summer 2010
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Epocrates Online

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Rx, OTC and Alternative
medicines by brand name,
generic, and by class
Formularies
Drug Interaction tool
Disease reference, pill identifier,
medical calculators, tables
Constantly updated
Summer 2010
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Epocrates Drug Interaction
MultiCheck Tool


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Add all the drugs on the patients
medications list (Rx, OTC, Alt) plus drug
considering
Look to see if any interactions
What is the severity of interaction
PEPID CRC Suite

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Rx, OTC and Alternative
medicines by brand name,
generic, and by class
Drug Interaction tool
DDx, Disease reference, Lab
manual, medical calculators,
clerkships, images
Constantly updated
Summer 2010
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PEPID Drug Interaction Tool

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Select all drugs on
list
Say Done
Click Interactions
Click specific
interaction to read
details
Summer 2010
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Exercises for Practice
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Using Epocrates Online
How should you prescribe acyclovir for
chicken pox in an immunocompromised
patient? (dose)
How much do 9 (50 mg) tablets of
Imitrex cost? (common migraine drug)
Are there any drug interactions between
Lexapro, Lortab, Xanax and Zocor?
Summer 2010
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Disease Quick References
DynaMed (Web and PDA)
eMedicine (Web and PDA)
Harrison’s Practice (Web and PDA)
Epocrates Dx
PEPID
Summer 2010
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Types of Questions Best Answered by
Disease Quick References
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Description/background
Epidemiology
Diagnosis
Treatment
Ongoing management
Prognosis/outcomes
Prevention
Summer 2010
Bottom
Line
48
DynaMed
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Most comprehensive disease reference
Summarizes all the latest research on topic
Very detailed
Well organized
Links out to full text articles if more details
needed
Includes both diseases and symptoms like
chest pain
PDA and Online
Summer 2010
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DynaMed
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Organization:
Includes History and
Physical sections (why am I
asking these questions)
Expand or collapse
sections
Use CTRL-F to search
page
Summer 2010
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Exercises
Dynamed Exercise
for Practice



Using Dynamed -- Question: What is the
typical history of present illness for
someone with SARS?
Type in SARS or use alphabetical listing
Explode History
Summer 2010
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Use FireFox
eMedicine
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Moderate amount of detail and information
Several monographs on one topic by
different specialties
Google searches it
Now owned by WebMD/Medscape. Suggest
registering.
One of Student’s favorite
iPhone version in Medscape
Summer 2010
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eMedicine Monographs
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

Subscription eliminates ads found on
free Medscape site
One long page of information
Navigation clunky, inconsistent
CTRL-F
Summer 2010
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Exercises for Practice



Using eMedicine - Question: What is the
functional anatomy when you have a
Rotator Cuff Injury?
Search or browse to Rotator Cuff Injury.
Use Sports Medicine article.
Select Introduction
Summer 2010
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Harrison’s Practice

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Internal Medicine focus
Linked to Access
Medicine content
Has drug information from
GoldStandard
Nice navigation on left
side
PDA and Online
Summer 2010
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Exercises for Practice

Using DynaMed, eMedicine, Epocrates and/or
Harrison’s Practice:
• Develop a scenario for CSSC practice
• Complete form provided
• (optional) Pick from diseases top 10 DDx in primary
•
•
•
care or top 20 diagnoses seen by students
Complete electronically (form on Blackboard)
Change file name to your name (John_Doe.doc)
Upload to Blackboard Assignments Tab on D101 BB
by Friday the 7/23/09, by midnight
Summer 2010
56
Top 10 Chief Concerns
1.
2.
3.
4.
5.
Cough
Fatigue
Low Back Pain
Fever
Dyspnea
6.
7.
8.
9.
10.
Generalized
Abdominal Pain
Headache
Vertigo
Chest Pain
Edema
Ponka, D., et al. Top Ten Differential Diagnoses in Primary Care. [Web
Resource] U of Ottowa. 2006. Accessed at www.familymedicine.uottawa.ca/
Summer 2010
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Top 20
Diseases
Recorded by FSU CoM Students in 3
1. Hypertension
2. Depression
3. Hyperlipidemia
4. Diabetes Type 2
5. Bipolar disorder
6. Anxiety disorder
7. Cold/URI
8. ADHD
9. Otitis media
10. Schizophrenia
Summer 2010
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
rd
year Clerkships
Obesity
Gall Bladder disease
GERD
Asthma
Sinusitis
Substance abuse
COPD
Coronary Artery Disease
Peripheral vascular disease
Pneumonia
58
iPod/iPhone/iPad Versions

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•
•
Clinical Evidence
DynaMed
Epocrates Essentials
Essential Evidence+
Harrison’s Practice
PEPID
Geriatrics at Your
Fingertips

Free resources
• ePSS USPSTF Tool
• Mobile Merck
•
Medicus
Medscape
PDAs to be distributed in August 25-27
Summer 2010
59
Review



Name three things you should look for in a
web site with medical information that would
make you feel more confident about the
content of that website.
What resources are going to be the most
accurate, reliable, and up to date?
Name a library drug reference, a differential
diagnosis resource, and a disease quick
reference
Summer 2010
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