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….
UpToDate
Let’s look higher in the
evidence pyramid….
PubMed – Prognosis Studies
Let’s look even higher in the
evidence pyramid….
PubMed Systematic Reviews
Finished here
Modern Medical Library
• Electronic….
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–
–
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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
– PubMed
• Journal article database - 5000 journals back to 1950’s
– MD Consult
• Books, Journals, Monographs, Patient Education,
Guidelines
– UpToDate
• Clinical decision support
Ugh…which one should I
use?…
Why not just use Google?
• Plus’s
– It includes PubMed 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
PubMed Article Citation
Breast cancer
Buystuff.com
Blah blah blah blah breast Blah
Blah blah cancer blah blah blah
Blah blah blah 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
• NetID/ password
– Off campus
access
• Hours
 Group study rooms
 Wireless access
 IS Lab - Computers
• “Ask a Health
Librarian” service
• Print vs. E-Reserves
• DocOrder
• Coffee bar
 Comfy furniture as
well as tables
Thanks!