QCOM Library Resources
Rick Wallace, Nakia Woodward, Katie Wolf
EBM is the Basis of Library Resources
• EBM is "the conscientious, explicit and judicious
use of current best evidence in making decisions
about the care of the individual patient. It means
integrating individual clinical expertise with the
best available external clinical evidence from
systematic research."
[Sackett D, BMJ Jan 13 1996;312:71-73]
Why important
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Unanswered questions
Studies of information-seeking habits of physicians have shown that, when asked, physicians
reported that their practice generated about 2 questions for every 3 patients. It has also been
reported that only about 30% of physicians' information needs are met during the patient visit.
Reasons for not pursuing answers to questions included office textbook collections too old, lack of
knowledge of appropriate resources, and lack of time to find the needed information. [Covell DG,
Ann Intern Med. 1985 Oct;103(4):596-9]
When observed, investigators found that physicians actually had about 5 questions for each patient.
52% of these questions could be answered by the medical record or hospital information system.
Information resources such as textbooks or MEDLINE could have answered another 25% of these
questions. [Osheroff JA, Ann Intern Med. 1991 Apr 1;114(7):576-81]
However, studies have also shown that when clinicians have access to information, it changes their
patient care management decisions. In 1998, David Sackett, using an “evidence cart” on rounds,
reported that of 71 information searches to answer clinical questions, 37 (52%) confirmed the
management decision, but 18 (25%) lead to a new therapy or diagnostic test and 16 (23%) corrected
a previous plan. [Sackett, D, 1998 Oct 21;280(15):1336-8]
Crowley et al reported similar results. The CAR study reported on 520 clinical questions for which
residents sought answers in the medical literature. In 53% of the cases the literature confirmed the
management decision, but in 47% of these cases the literature changed the resident’s orders for
medication, diagnostic test, or prognostic information given to the patient. [Crowley S, Acad Med.
March 2003 78(3):270-4]
Database Pyramid
Best Type of Study
5 steps
Step 1- Start with the PatientAssess
• Start with the patient -- a clinical
problem /question arises out of the
care of the patient
Step 2- Ask
• Construct a relevant, answerable question
derived from the case
PICO
• Background questions:
– What’s the latest on treating otitis media?
• Foreground questions:
– (P) patient and/or problem
– (I) intervention
– (C) comparison intervention (if relevant)
– (O) clinical outcomes.
More on PICO
• Formulating the clinical question is done to
focus the information need and to facilitate
searching the literature. So when you
define your PICO think about it in terms of
searching the literature. You want to end
up with a question that makes sense and
can be effectively searched.
More on PICO
• You might not need to use all the terms in
the PICO for the search strategy, but they
can help you decide which specific articles
are most appropriate for your case.
Step 3- Acquire
• Select the appropriate resources and
conduct a search
• (much more later)
Ideal Resource
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What is the ideal resource?
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Allows the separation of ‘junk” from “gold”
(quality of the search interface)
• Provides or reviews the primary data
Step 4- Critical Appraisal
• Appraise that evidence for its validity
(closeness to the truth) and
applicability (usefulness in clinical
practice)
Therapy Appraisal
• Key issues for evaluating therapy studies:
• FRISBE
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Follow-up (80% or better)
Randomization and concealed allocation
Intention to Treat
Same at Baseline (established at the start of the trial)
Blinding (the more blinding the better)
Equal Treatment
Step 5- Application
• Return to the patient -- integrate that evidence
with clinical expertise, patient preferences and
apply it to practice
Evaluate Performance with Patient
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Did I ask the right question?
Were the necessary EBM resources readily available?
Did I know how to access and use them?
Was I able to obtain full text information?
Did I find a useful answer?
Did I actually use the findings in your clinical practice?
What could I have done better?
Specific Resources
• PubMed
This will send term
to search box
Subheading
Major MeSH
Secondary-DynaMed
Secondary- Essential Evidence
Secondary- UpToDate
Secondary- Cochrane
Books- StatRef
Books- R2
GUIDELINES FOR
WOMEN'S HEALTH
CARE
Books- MD Consult
Books, etc.- Clinical Key
First Consult- Clinical Key
Clinical Key- videos
Books- Access Medicine
Books- Access Medicine
Conclusion
• We will work one on one with you at any time
• We will load clinical databases on your
smartphone
• We check out laptops, projectors, Nooks, mp3
players, iPads
• We stay open 24/7
Contact
• Rick Wallace, wallacer@etsu.edu
• Nakia Woodward, woodwardn@etsu.edu
• Katie Wolf