Evidence Based Practice
(with Librarians)
Disclosures
• Robert Johnson, MLIS
• Financial relationships
• Employed by the University of Southern
California’s Norris Medical Library
• Nonfinancial relationships
• I have no financial relationship with any
product/service discussed
• I do not negotiate licenses for any
product/service discussed
Goals
• Overview of librarian’s role in EBP
• Mobile apps in clinical practice
• Information resources for residents/students
EBP
• Evidence Based Practice
Clinical
Expertise
Best
Evidence
Patient’s
Needs
Straus, S. E. (2011). Evidence-based
medicine: How to practice and teach
EBM. Edinburgh: Elsevier
Churchill Livingstone.
Information Barriers
• Ely, et. al. describe 59 barriers to information.
These are broken down into 6 types of barriers:
• Time required
• Original question was often vague and open to interpretation
• Optimal search strategy
• Finding appropriate resource
• Uncertainty about when the search can stop
• Synthesizing evidence into a clinically useful statement
Ely, J. W., Osheroff, J. A., Ebell, M. H., Chambliss, M. L., Vinson, D. C.,
Stevermer, J. J., & Pifer, E. A. (2002). Obstacles to answering doctors’
questions about patient care with evidence: qualitative study. BMJ :
British Medical Journal 324(7339), 710.
Information Barriers
• Ely, et. al. describe 59 barriers to information.
These are broken down into 6 types of barriers:
• Time required
• Original question was often vague and open to interpretation
• Optimal search strategy
• Finding appropriate resource
• Uncertainty about when the search can stop
• Synthesizing evidence into a clinically useful statement
Ely, J. W., Osheroff, J. A., Ebell, M. H., Chambliss, M. L., Vinson, D. C.,
Stevermer, J. J., & Pifer, E. A. (2002). Obstacles to answering doctors’
questions about patient care with evidence: qualitative study. BMJ :
British Medical Journal 324(7339), 710.
Why work with a librarian?
• Expertise in navigating information
resources
• Librarians build/maintain sites you use to access
information
• Life cycle of information
• We’re NOT specialists in your field!
• Explaining a search helps clarify the search
• Unbiased
Librarians In The Clinic
• Just In Time (fast answers)
• PubMed, Cochrane, UpToDate, Stat!Ref, National
Guidelines Clearinghouse, etc.
• Shortcuts and work-arounds
• Mobile resources
• Just In Case (further research)
• Island of Misfit Toys: Gideon, Visual Dx, Read by
QXMD, EndNote, etc.
• Productivity: CamScanner, iAnnotate, Evernote, etc.
• Publishing: Impact factors, systematic reviews, etc.
Asking the question
• What is the best evidence?
• Depends on your question
• Diagnosis
• Therapy
• Prognosis
• Harm/Etiology
Asking the question
Most common type of questions:
Type of study:
Diagnosis
How to select and interpret diagnostic tests
Prospective, blind comparison to a gold
standard or cross-sectional
Therapy
How to select treatments that do more good
than harm and that are worth the efforts and
costs of using them
Randomized controlled trial > cohort study
Prognosis
How to estimate the patient’s likely clinical
course over time (based on factors other than
the intervention) and anticipate likely
complications of disease
Cohort study > case control > case series
Harm/Etiology
How to identify causes for disease (including
iatrogenic forms)
Cohort > case control > case series
From: Duke University Medical Center Library: Introduction to Evidence Based Practice
http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036067
Asking the question
• PICO
• Can children’s anxiety about upcoming cancer
treatments be reduced by listening to music?
Asking the question
12
• P = Pediatric oncology patients
• I = Music therapy
• C=
• O = Reduced anxiety
• Therapy Question
PubMed Clinical Queries
PubMed Clinical Queries
PubMed4Hh
• Freely available product
from National Library of
Medicine
• Includes Clinical Queries
function
PubMed4Hh
• Not intuitive
• If used properly, same
initial results as browser
interface
• No limit filters
But sometimes
you will get a
PDF!
Background vs. Foreground Info
Straus, S. E. (2011). Evidence-based medicine:
How to practice and teach EBM. Edinburgh:
Elsevier Churchill Livingstone.
ACP Smart Medicine
ACP Smart Medicine
ACP Smart Medicine
STAT!Ref
Contains 115 ebooks such as:
• AAFP Conditions A to Z
• ACP Medicine
• ACP Smart Medicine
• ACS Surgery: Principles and
Practice
• Current Diagnosis &
Treatment Critical Care
• Delmar’s Guide to
Laboratory and Diagnostic
Tests
• Red Book Atlas of Pediatric
Infectious Diseases
• Stedman’s Medical
Dictionary
UpToDate
VisualDx
CDC Vaccine Schedules
Epocrates
QxCalculate
AHRQ ePSS
Electronic Preventive Services Selector (ePSS) from
Agency for Healthcare Research and Quality (AHRQ)
Figure 1
Read by QXMD
Browzine
Questions?
43
Robert Johnson, MLIS
Norris Medical Library
robertej@usc.edu
323.442.1121
http://www.usc.edu/hsc/nml/