Welcome
Internal Medicine Clerkship
Orientation
EBM Resources Course
Peggy Edwards, AMLS
TTUHSC - Preston Smith Library
Lubbock, Texas 79430
July 28, 2014
Welcome to the
Internal Medicine Clerkship Orientation
EBM Searching Component!
Introductory Orientation- Mandatory Attendance J
• how to use four Point of Care EBM tools
• PowerPoint lecture, hands-on follow along, practice questions
• discuss how to formulate PICO questions
• how to determine which tools to use for background or
foreground questions
Syllabus
Why are the point of care tools
important?
So why learn about 4 tools?
Give me an example of how you could
have used one of these tools to help you
if you had known about it.
EBM Point of Care Tools
partial preparation for the EBM literature searching station in the OSCE
EBM Point of Care Tools
decision support information accessible at the patient’s bedside or the “point of care”
EBM Point of Care Tools
data that is evaluated and rated with levels of evidence
EBM Point of Care Tools – Disease Overview
Signs & Symptoms
Differential Dx
Follow-up
H&P, Diagnosis,
Questions to Ask Patient
Therapy
www.ttuhsc.edu/libraries
Mouse over
Databases
Click Evidence Based
Click ACP’s Smart Medicine©
ACP’s Smart
®
Medicine
ACP = The American College of Physicians
each guidance statement is rated with a level of evidence
and includes the rationale
Enter search query
Results from all e-books in
STAT!Ref
Select
ACP’s Smart Medicine
To establish the diagnosis of hepatitis C,
what is the rationale for testing first for
anti-HCV and then for HCV RNA? What
is the Level of Evidence?
Level of Evidence
Click Clinical Key
Clinical Key/ First Consult
Clinical Key: content from books, journals, and videos
First Consult: point of care decision support tool within Clinical Key
* main source of information is from the Cochrane Collaboration where possible
Click Search
Enter topic
Click Fc First Consult
Click DynaMed
DynaMed
Updated daily
Monitors the content of over 500 medical journals
New evidence is integrated with existing content
Overall conclusions represent a synthesis of the
best available evidence.
What is the latest recommendation from
the American College of Physicians
regarding pelvic exams for ovarian cancer
screening in asymptomatic non-pregnant
adult women?
What is the date of the recommendation?
Enter search query
Home Page
Click
Links to
Topic
What is the latest recommendation from
the American College of Physicians
regarding pelvic exams for ovarian cancer
screening in asymptomatic non-pregnant
adult women?
What is the date of the recommendation?
Document Text
Notice!
Click Essential Evidence Plus
ESSENTIAL EVIDENCE PLUS
• over 13,000 topics
• Systematic Reviews from Cochrane Collaboration
• Daily POEMS – email update alerts
• Calculators
• Derm Expert
Home Page
Enter asthma and
click SEARCH
asthma
To access the disease information overview module,
always select from Essential Evidence Topics
Click link
Information Index
Click to return to home page
Calculators
Derm Expert
What do current guidelines define as the diagnosis of type 2
diabetes mellitus? (Hint: Diagnosis Bottom Line)
Locate a calculator that will help you determine if a patient
has type 1 or type 2 diabetes.
What variables forecast the absolute risk of a first stroke in
patients with type 2 diabetes?
(Hint: find a calculator)
Using Derm Expert, locate a picture of a diabetic foot ulcer.
Practice Guidelines
www.guideline.gov
Access Medicine
a collection of information resources and tools
www.ttuhsc.edu/libraries
Click
Popular Resources by School
Click Access Medicine
Major Medical Electronic Textbooks – free!
Access
Click Quick Reference
Quick Dx & Rx
Guidelines
Algorithms
DDx
Diagnostic Tests
Calculators
Click Cases
Case Files®
Pathophysiology Cases
Hurst’s Imaging Cases
Look!
1) According to Current Medical Diagnosis & Treatment in
Cardiology 2014, what are the essentials for diagnosing acute
myocardial infarction?
2) What is the differential diagnosis for chest pain?
3) What does early congestive heart failure sound like?
4) Locate an image of a 12-lead EKG.
5) In Clinician’s Pocket Reference
, what does an ECG reading
of a myocardial infarction with inverted T waves look like?
Answer to 1
According to Current Medical Diagnosis & Treatment in
Cardiology 2014, what are the essentials for diagnosing acute
myocardial infarction?
Answer to 2
What is the differential diagnosis for chest pain?
Answer to 3
What does early congestive heart failure sound like?
Answer to 4
Locate an image of a 12-lead EKG.
Answer to 5
In Clinician’s Pocket Reference
, what does an ECG reading
of a myocardial infarction with inverted T waves look like?
Many Information Resources
are Mobile!
www.ttuhsc.edu/libraries
Click Mobile
Resources
Click appropriate icon for download instructions
Background and Foreground Questions
Background Questions are general:
What is a disorder?
What causes It?
How does it present?
What are some treatment options?
Resources that answer background questions:
Textbooks
Narratives that give a general overview
Background and Foreground Questions
Foreground Questions answer:
specific questions
about a specific patient
Resources that answer foreground questions:
Primary sources – original research articles
Secondary sources – systematic reviews, synopses, and
reviews of individual studies
from SUNY Downstate Medical Center, Medical Research Library of Brooklyn
One-on-One
Teaching Session
In adult male patients with recent myocardial infarction, does a
single daily dose of 300 mg of aspirin prevent re-infarction?
P
I
C
O
adult male patients with recent MI
daily dose of 300 mg of aspirin
placebo
prevent re-infarction
Study Category
Suggested Best Method of Investigation
Therapy
RCT>cohort>case control>case series
Diagnosis
prospective, blind comparison to a gold standard
Etiology/Harm
RCT>cohort>case control>case series
Prognosis
cohort>case control>case series
Prevention
RCT>cohort>case control>case series
Clinical Exam
prospective, blind comparison to a gold standard
Cost
Economic Analysis
Medical Library Association. MLANET, Education, Web-based Learning. Hp. Nov, 2001.
Web-based Courses: EBM and the Medical Librarian.
Available: http://www.mlanet.org/education/web/web_courses.html
10 Apr. 2005.
PubMed Searching Class - Mandatory Attendance J
• one-on-one teaching session with a reference librarian
• in the Preston Smith Library – assigned reference librarian’s office
• how to search PubMed using advanced search techniques
• other resources
• PowerPoint lecture and hands-on practice
• search for article(s) that answer your PICO question
Please contact us at:
Lubbock
(806) 743-2200
Amarillo
(806) 354-5448
El Paso
(915) 545-6652
Odessa
(432) 335-5171
www.ttuhsc.edu/libraries
Ask-ALibrarian
Please…
locate the Evaluations icon on your desktop and fill it out.
Date: Month Day, 2014
Time: orientation started
Instructor:
 Peggy Edwards
Rovers:
 Jennifer Teichelman
 Margaret Vugrin
 Micah Walsleben
ThankYou!
July 2010
MICROMEDEX
• Authoritative drug information
• Entire US National Formulary
www.ttuhsc.edu/libraries
Mouse over
Databases
Click MicroMedex
warfarin
Begin entering drug name.
Select correct drug.
Select links
or detailed
document
Drug Monograph
Select Drug
Interactions
Special Tools
A
Interactions table includes:
MICROMEDEX – drug identification
MICROMEDEX: also includes
Diseases & Acute Care
Toxicology & Product Info
Alternative Medicines
Patient Education