Introduction
This workshop will:
• Goal
o Create Research OSCE
at your institution
• Objectives
o Identify collaborative
opportunities
o Brainstorm necessary
institutional resources
How does this process work?
Educational
Goals
• To assess a patient’s condition
via examination and differential diagnosis
•
To ask a primary question about the case
•
To acquire information via
exploration of the literature
•
To appraise information for level of
evidence and relevance to the case
•
To apply information in order to
establish treatment plan
Objectives
• Create a focused, well-articulated question
using the PICO (patient, intervention,
comparison, and outcome) model
• Distinguish between the various
point–of–care tools, the types of data
retrieved from each tool, and incorporate
their use into daily practice
• Search PubMed effectively
Objectives
• During the OSCE (objective structured
clinical exam), the participant will
select various point–of–care tools and
assess the data retrieved to determine
the best answer to the test question
• *Integrate the EBM (evidence–based
medicine) process with clinical
expertise and the patient's values
*Glasziou, Paul. Centre for Evidence-Based
Medicine, Downloads. Hp. July, 2003.
Powerpoint: Introduction to EBM. University of
Oxford and Queensland.
Available:
http://www.cebm.net/learning_ebm.asp. 10
Apr. 2005
The student will:
• ASK a PICO patient clinical question
o Receive instruction
on EBM & PubMed databases
o Practice PICO question with new knowledge
• Acquire the information from each
point–of–care database and compare
• Appraise and compare information
retrieved from point–of–care databases
• Apply new skills and knowledge
PICO
What is it?
How do you apply it?
Define PICO
PICO is an acronym
that describes the elements of a
well-formed clinical question.
PICO: 1st determine the type of question
• Clinical Question:
o Therapy
o Diagnosis
o Harm
o Prognosis
PICO
P= Patient
• Patient, population or
problem being addressed
o What are the characteristics
of the patient or population?
o What is the condition or
disease?
PICO
P= Patient
I= Intervention
• Intervention being considered
which could include:
o Exposure
o Diagnostic test
o Prognostic factor
o Therapy
o Patient perception
PICO
P= Patient
I= Intervention
• Intervention:
o What do you want to do
with/for the patient?
• Medication option?
• Surgical option?
• No treatment?
PICO
• What is the alternative
to the intervention?
P= Patient
I= Intervention
C= Comparison of
interventions or
exposures
o Medication option?
o Surgical option?
o No treatment?
PICO
P= Patient
I= Intervention
C= Comparison of
interventions or
exposures
O= Outcome of
interest
• What are the relevant
clinical outcomes of interest
to your patient and you?
o Full/partial recovery?
• Remission
o Complications?
• Morbidity?
• Death?
Focused, well–built question
• Once you fill out
PICO form
• Then you can formulate an
answerable question
ASK
Student will identify a search
question based on a patient case
PICO
• P= 35 yr old smoker
35 yr. old man with
2 pack/week smoking habit.
Promised fiancé that he
would quit smoking before
their wedding next year.
• I= medication
Should medication and/or
lifestyle changes be
suggested?
• C= lifestyle change
• O= quit smoking
ACQUIRE
Using point–of–care databases,
student will locate information
to answer PICO question
DATABASES
Point–of–Care
•
•
•
•
•
ACP PIER
DynaMed
Essential Evidence Plus
First Consult
National Guideline
Clearinghouse
• PubMed Clinical Queries
• MedlinePlus (Patient education database)
©
©
©
©
©
©
©
ACP PIER
• Over 400 disease
based modules
• Covers Diseases,
Procedures, Screening
and Prevention,
Complementary/
Alternative Medicine,
Ethical and Legal issues
• Includes level of evidence
indicators
DynaMed
• Clinically-organized summaries for
more than 3,000 topics
• Monitors the content of over
500 medical journals and
systematic evidence review
databases by using many
journal review services
• Includes level of evidence indicators
and updated daily
Essential
Evidence Plus
(EE+)
• Online repository of content from
2,500 journals, books,
reference works, databases,
laboratory manuals and
The Cochrane Library
• Decision support calculators
and clinical tools
• Includes level of evidence indicators
First Consult
• Evidence–based portion of
MD Consult
• Information is based on multiple
sources, reviewed and edited by
opinion leaders in clinical practice
• Includes medical topics, procedures
and differential diagnoses
National
Guideline
Clearinghouse
• Public resource provided by the
federal government
• Evidence–based clinical practice
guidelines
• www.guideline.gov
PubMed
Clinical
Queries
• Public resource provided by the
federal government
• Provides access to specialized
PubMed searches designed to
quickly connect clinicians with
evidence-based clinical literature
• Has five study categories – Etiology,
Diagnosis, Prognosis,
Clinical Prediction Guidelines
and Therapy
• www.ncbi.nlm.nih.gov/pubmed/
clinical
MedlinePlus
• Public resource provided by the
federal government
• National Institutes of Health's
website for patient education
• Joint project with National
Library of Medicine
• About diseases, conditions, and
wellness issues in language that
the general public can understand
• www.medlineplus.gov
DATABASES
• PubMed
Specialized
• Gold Rush
PubMed
• Public resource provided by the
federal government
• Comprises approximately
20 million citations for
biomedical literature from
MEDLINE, life science journals,
and online books
• Includes medicine, nursing,
dentistry, veterinary medicine,
health care systems,
preclinical sciences,
NCBI molecular biology and
genetic resources
• www.pubmed.gov
Gold Rush
• Most complete listing of our
TTUHSC print and online journals
• Includes almost 20,000 print and
online journals
• View TTUHSC purchased articles
with password and ID
Foundations
of searching
PubMed
(Hands-on)
MeSH
Boolean Logic (AND OR)
Subheadings
Explode feature
Checklist info
MeSH vs. Major topic
Limits and Advanced Search
Publication Types, MeSH Terms, Substances,
Grant Support
Foundations
of searching
PubMed
(Hands-on)
Checklist info
continued
Abstract format
Clipboard
E-mail
Full-text icons
Type of Article; Subsets: Systematic Reviews
My NCBI (set up Search Filters)
Export (Brief Intro to RefWorks)
In smokers what medication and/or life style
changes are effective to stop smoking?
ACP PIER, DynaMed, EE+, First Consult, NGC,
Medlineplus, PubMed Clinical Queries, PubMed
Medication
(MeSH) =
Pharmaceutical
Preparations
Lifestyle changes
(MeSH) = life
change events
Stop
smoking
(MeSH) =
Smoking
cessation
ACP PIER
DynaMed
Essential Evidence Plus (EE+)
First Consult
National Guideline Clearinghouse (NGC)
MedlinePlus (Patient Education)
PubMed Clinical Queries
PubMed
"Pharmaceutical
Preparations”
[Mesh] OR
"Life Change
Events"[Mesh]
AND
"Smoking
Cessation”[Majr]
AND
"humans"[MeSH
Terms] AND
English[lang]
APPRAISE
Student will review data and explain
relevance to librarian –
during one–on–one session and OSCE
APPLY
Student will present how the
information is applicable to case
DEBRIEFING
Student will review with physician
http://www.ttuhsc.edu/libraries
http://www.ttuhsc.edu/libraries
Small group discussions
Where are you at the moment:
Small group discussions
Goal/Idea:
Small group discussions
Persons to contact:
Small group discussions
Persons/Departments to contact:
Small group discussions
Resources needed:
Small group discussions
Facilities/Locations:
Small group discussions
Time:
Small group discussions
How to evaluate performance:
Small group discussions
How to assess class:
???
Contact Information
Andrew Neal Dentino, M.D.
Texas Tech University Health Sciences Center
School of Medicine – Lubbock
Department of Internal Medicine
3601 4th St Stop 9410
Lubbock, TX 79430-9410
andrew.dentino@ttuhsc.edu
806-743-3155 x221
Stephanie Shippey, MLS, AHIP
Dawn Kruse, MSIS
Margaret Vugrin, MSLS, AHIP
Texas Tech University Health Sciences Center
Preston Smith Library of the Health Sciences – Lubbock
806–743-2208
mylibrary@ttuhsc.edu
Thank you!