QCOM Library ResourcesRick Wallace, Nakia Woodward, Katie Wolf

EBM is the Basis of Library Resources

• EBM is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." [Sackett D, BMJ Jan 13 1996;312:71-73]

Why important• Unanswered questions • Studies of information-seeking habits of physicians have shown that, when asked, physicians

reported that their practice generated about 2 questions for every 3 patients. It has also been reported that only about 30% of physicians' information needs are met during the patient visit. Reasons for not pursuing answers to questions included office textbook collections too old, lack of knowledge of appropriate resources, and lack of time to find the needed information. [Covell DG, Ann Intern Med. 1985 Oct;103(4):596-9]

• When observed, investigators found that physicians actually had about 5 questions for each patient. 52% of these questions could be answered by the medical record or hospital information system. Information resources such as textbooks or MEDLINE could have answered another 25% of these questions. [Osheroff JA, Ann Intern Med. 1991 Apr 1;114(7):576-81]

• However, studies have also shown that when clinicians have access to information, it changes their patient care management decisions. In 1998, David Sackett, using an “evidence cart” on rounds, reported that of 71 information searches to answer clinical questions, 37 (52%) confirmed the management decision, but 18 (25%) lead to a new therapy or diagnostic test and 16 (23%) corrected a previous plan. [Sackett, D, 1998 Oct 21;280(15):1336-8]

• Crowley et al reported similar results. The CAR study reported on 520 clinical questions for which residents sought answers in the medical literature. In 53% of the cases the literature confirmed the management decision, but in 47% of these cases the literature changed the resident’s orders for medication, diagnostic test, or prognostic information given to the patient. [Crowley S, Acad Med. March 2003 78(3):270-4]

Database Pyramid

Best Type of Study

5 steps

Step 1- Start with the Patient- Assess

• Start with the patient -- a clinical problem /question arises out of the care of the patient

Step 2- Ask

• Construct a relevant, answerable question derived from the case

PICO• Background questions:

– What’s the latest on treating otitis media?• Foreground questions:

– (P) patient and/or problem– (I) intervention– (C) comparison intervention (if relevant)– (O) clinical outcomes.

More on PICO• Formulating the clinical question is done to

focus the information need and to facilitate searching the literature. So when you define your PICO think about it in terms of searching the literature. You want to end up with a question that makes sense and can be effectively searched.

More on PICO

• You might not need to use all the terms in the PICO for the search strategy, but they can help you decide which specific articles are most appropriate for your case.

Step 3- Acquire

• Select the appropriate resources and conduct a search

• (much more later)

Ideal Resource• What is the ideal resource? • Located in the clinical setting • Easy to use • Fast, reliable connection • Comprehensive /Full Text • Allows the separation of ‘junk” from “gold”

(quality of the search interface) • Provides or reviews the primary data

Step 4- Critical Appraisal

• Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

Therapy Appraisal• Key issues for evaluating therapy studies: • FRISBE

– Follow-up (80% or better) – Randomization and concealed allocation – Intention to Treat – Same at Baseline (established at the start of the trial)– Blinding (the more blinding the better)– Equal Treatment

Step 5- Application

• Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice

Evaluate Performance with Patient• Did I ask the right question? • Were the necessary EBM resources readily available? • Did I know how to access and use them? • Was I able to obtain full text information? • Did I find a useful answer? • Did I actually use the findings in your clinical practice? • What could I have done better?

Specific Resources

• PubMed

Major MeSH

Sub-heading

This will send term to search box

Secondary-DynaMed

Secondary- Essential Evidence

Secondary- UpToDate

Secondary- Cochrane

Books- StatRef

Books- R2

GUIDELINES FOR WOMEN'S HEALTH CARE

Books- MD Consult

Books, etc.- Clinical Key

First Consult- Clinical Key

Clinical Key- videos

Books- Access Medicine

Books- Access Medicine

Conclusion• We will work one on one with you at any time• We will load clinical databases on your

smartphone• We check out laptops, projectors, Nooks, mp3

players, iPads• We stay open 24/7

Contact

• Rick Wallace, wallacer@etsu.edu• Nakia Woodward, woodwardn@etsu.edu• Katie Wolf