Need to Know: Western LibrariesAnesthesiology Residents

Robin Featherstone, MLIS Clinical Medicine Librarian, University of Western Ontariorfeathe@uwo.ca

Agenda

• Library services• How to access the evidence • How to search the evidence

Library Services

• Hospital Libraries – Brad Dishan • Academic Libraries

1. Western Libraries: What we’ve got Journals

and databases

Books

Clinical Tools

Learning modules

Calculators

Drug Identification Tools

Images & Videos

2. Anesthesiology Info: How to access- Go to: http://www.lib.uwo.ca/

- Log in to Off-Campus Access with your UWO username and password (same as email)

- Select Browse by Program

- Select Medicine and Dentistry

- Select Anesthesiology and Perioperative Medicine

http://www.lib.uwo.ca/programs/anesthesiaandperioperativemedicine/

Use this page to find selected resources for anesthesiology

Electronic Books

Point of Care Tools

Databases

Image and video collections

And more...

2. How to search our collectionsSelect “Catalogue”

Search the Catalogue to find anything Western Libraries owns or subscribes to

...including:

• Journals• Books• Databases• Point of Care Tools

http://alpha.lib.uwo.ca

You can even search for electronic full-text journals.

Select “Journal Title”

Then enter the name of the journal

And select “Go”

Tip: Use the Advanced Search

Parts of a Catalogue Record

Full title of the journal

Links to electronic articles

Coverage dates

Call # & location of print volumes

Other ways to access electronic full text

• When searching for articles in databases, use the button to link to full-text

Tip: To see the buttons in PubMed • Use the PubMed links from the library website• Change the display in PubMed to Abstract or AbstractPlus

Exercise 1

• How would you get a hold of this article?

Tian Q, Gomersall CD, Leung PP, Choi GY, Joynt GM, Tan PE, Wong AS. The adsorption of vancomycin by polyacrylonitrile, polyamide, and polysulfone hemofilters. Artif Organs. 2008 Jan;32(1):81-4. PubMed PMID: 18181809.

Exercise 2

• How would you get a hold of this article?

Kroh UF, Holl T, Feussner KD. Pharmacokinetics and dosage adjustment of antibiotics during continuous extracorporeal lung assistance and hemofiltration. Artif Organs. 1992 Oct;16(5):457-60.

Exercise 3

• How would you get a hold of this article?

Duffy BL. Vancomycin reaction during spinal anaesthesia.

To Register for RACER (InterLibrary Loan ordering system)

http://www.lib.uwo.ca/ill/firsttimeracer.shtml

Access Key Points

• Off-Campus Access – Remember to log in• Browse by Program > Anesthesiology• Search the catalogue to find anything UWO owns

or subscribes to• Use Getit@Western button to access full-text• Request electronic copies of ARCC (storage) items

for desktop delivery• Request items using ILL (InterLibrary Loan) -

RACER

Searching

Exercise 1

• Answer the following background question using the library website:

Which coexisting diseases influence anesthesia management?

Clinical Questions

Using the Evidence to Answer Clinical Questions

Identify your problem

Define a structured question

Find the best evidence

How valid is the evidence?

What are the results?

How should I apply the results to patient care?1

1 Guyatt, Gordon, Drummond Rennie, Evidence-Based Medicine Working Group, and American Medical Association. Users‘Guides to the Medical Literature :A Manual for Evidence-Based Clinical Practice. Chicago, IL: AMA Press, 2002.

We’ll be focusing on two steps

Case study

Using the PICO model, formulate an answerable question

A patient expresses concern before cataract surgery about the amount of pain they will experience. You consider administering intracameral anaesthetic (lidocaine) as a supplement to topical anaesthetic, but you’re not sure if the additional anaesthesia will reduce intraoperative pain perception compared with topical anaesthetic alone.

Create an answerable question

Population Cataract surgery patients

Intervention Topical anaesthesia alone

Comparison Topical anaesthesia with intracameral lidocaine

Outcomes Reduction of pain perception

In cataract surgery patients, does topical anaesthetic alone reduce pain perception when compared to topical anaesthetic supplemented by intracameral lidocaine?

Clarify the question type

In cataract surgery patients, does topical anaesthetic alone reduce pain perception when compared to topical anaesthetic supplemented by intracameral lidocaine?

What kind of question is this?

6 Question Types

1. Aetiology: the causes of the disease and their modes of operation

2. Diagnosis: signs, symptoms or tests for diagnosing a disorder

3. Prognosis: the probable course of the disease over time4. Therapy: selection of effective treatments which meet

you patient’s values.5. Cost-effectiveness: is one intervention more cost-

effective than another?6. Quality of life: what will be the quality of life of the

patient? 3

3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

Find the Best Evidence

• Studies which best answer each question type

Type of Question Type of Evidence

Aetiology Case-control or cohort study

Diagnosis Diagnostic validation study

Prognosis Inception cohort study

Therapy Randomized controlled trial

Cost-effectiveness Economic evaluation

Quality of life Qualitative study4

4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

Evidence Pyramid

Less time

More time

http://www.mh.org.au/royal_melbourne_hospital/www/353/files/pyramidopt.jpg

Formulating your search

• State the search question• Isolate and prioritize the main concepts• Search each concept separately• Use controlled vocabulary if available (MeSH,

EMTree) and keywords• Combine search sets to get final results, if

necessary• Apply limits (language, age group)

Exercise

Search the following resources to answer the question: In cataract surgery patients, does topical anaesthetic alone reduce pain perception when compared to topical anaesthetic supplemented by intracameral lidocaine?

1. Cochrane Library2. TRIP Database3. PubMed4. EMBASE

Conclusions

• Number of results

Source Hits

Cochrane Library 1

TRIP Database 8

PubMed 418 (13 using clinical queries)

Embase 600 (188 if using clinical queries)

Google 3,420 (444 if using Google Scholar)

Evidence Pyramid

Cochrane Library

TRIP Database

PubMed

EMBASE

Google

Summary & Key Points

• “Off campus access” • Browse by Program pages• The Library Catalogue• Electronic textbooks for background questions• Constructing a search using PICO for clinical

questions• Identify the study type which will best answer your

question• Save time by searching summaries first

And, finally...• Who to call for help:

– Research Help: General or access type questions• Phone: 519 661 3168• Email, Chat: http://www.lib.uwo.ca/taylor/researchhelp.shtml

– Subject Librarian (Robin): Specific searching questions• Phone: 519 661 2111 ext: 86383• Email: rfeathe@uwo.ca• Chat:

http://www.lib.uwo.ca/programs/anesthesiaandperioperativemedicine/

– Hospital Librarians (Brad Dishan at St. Joe’s): for on-site support• Phone: 519 646 6000 ext: 65727• Email: Brad.Dishan@sjhc.london.on.ca

Questions?