Session 2: Finding Medical Information in a Clinical Context

Leilani St. Anna, MLIS, AHIP

Information Management Librarian, Health Sciences Library

healthlinks.washington.edu/hsl/liaisons/stanna

October 22, 2008

Information Pyramid

Types of information sources Primary Literature

Original research/journal articles

Review articles Summarize information on topic May be evidence-based

Types of information sources (cont.)

Systematic reviews Literature review which tries to identify, appraise,

select and synthesis all high quality research evidence relevant to that question.

Use explicit methods to identify, select, and critically evaluate relevant research.

Meta-Analyses Systematic review that uses quantitative methods to

synthesize/summary the results (Evidence-Based Medicine, 3rd edition, 2005)

Types of information sources (cont.)

Guidelines Systematically developed statements using varying

standards. Cost may be considered as well as health outcomes.

May be evidence-based.

Book chapters Summary of information on topic. May be evidence-based Print book chapters typically out-of-date/ Textbooks vs spiral manuals (overview/educate vs

quick reference)

Patients & Health Information Coming to you with information from a wide

variety of sources Point out reliable, reputable sources

Cochrane Librarywww3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME

The Cochrane Collaboration: international not-for-profit organization, providing up-to-date information about the effects of health care

Cochrane Database of Systematic Reviews (Clinical Reviews) 'Gold Standard' for high-quality systematic reviews Includes full-text Abstracts available in PubMed, other sources

Cochrane Library (cont.) Database of Abstracts of Reviews of Effects (Other

Reviews) Selection of quality assessed reviews for topics where there is

no Cochrane review Brief critical appraisals of previously published reviews of the

effects of health care Structured abstracts, not full-text

Clinical Trials Citations from databases (notably MEDLINE and EMBASE), and

other published and unpublished sources Does not contain the full text of the article

Cochrane Library (cont.) Systematic reviews; RCTs, Case cohorts, control studies

Advantages Clinical Reviews: Very high quality systematic reviews DARE/Clinical Trials: Identify evidence-based articles

from PubMed plus other databases

Disadvantages Limited number of Cochrane-produced systematic

reviews Very specific questions Answer often more research needed

BMJ Clinical Evidencewww.clinicalevidence.com/

Compendium of evidence on the effects of clinical interventions.

Summarizes the current state of knowledge, including knowns and unknowns, based on thorough search.

Categorizes interventions as beneficial, likely beneficial, no known benefit, harmful ...

BMJ Clinical Evidence Evidence summaries Advantages

Decision-support tool for clinical settings

Disadvantages Limited number of topics covered Limited for diagnosis

PubMedwww.ncbi.nlm.nih.gov/sites/entrez/query.fcgi?myncbishare=uwonline

Service of the U.S. National Library of Medicine Includes over 18 million citations from MEDLINE

and other life science journals for biomedical articles back to the late 1940s

Includes links to full text articles and other related resources. MedlinePlus, consumer health source (link in blue

column on left) UW access for more full-text links Abstracts supplied by authors/journals

PubMed:Tools for Evidence-Based Retrieval Clinical Queries: etiology, diagnosis, therapy,

prognosis, clinical prediction guides Systematic Reviews

Limits: publication types

PubMed Systematic reviews & meta-analyses; RCTs, case cohorts, control

studies; Case Reports, Case Series, Other Articles, Practice Guidelines, etc.

Advantages: Huge database of biomedical literature Advanced searching available Lots of links to full-text Available at no-charge anywhere

Disadvantages: No separate evaluation of quality of research May be too slow for clinical use

Google Scholarscholar.google.com/

Beta product Searches specifically for scholarly literature such as

peer-reviewed papers, theses, technical reports, preprints and abstracts

Find articles from academic publishers, professional societies, universities, etc. as well as scholarly articles available on the web

A "Cited by" link identifies other papers that have cited the original one listed

Now links to full text articles the UW subscribes to (Select UW Libraries from the Scholar Preferences link. Enter Washington in the search box, select UW from the list, and save preferences)

Google Scholar Evidence-based literature; journal articles; books,etc

Advantages Huge and easy of use Search full-text within articles

Disadvantages Access to full text only available with subscription Fielded searching not available

See Google vs PubMed searching http://healthlinks.washington.edu/howto/googlechart.html

Updating inconsistent

National Guideline Clearinghousewww.guideline.gov

Initiative of the Agency for Healthcare Research and Quality (AHRQ)

Available at no charge Updated weekly with new and changed

guidelines. Database of clinical practice guidelines and

related documents. Voluntary participation.

National Guideline Clearinghouse Advantages

Largest guidelines database Side-by-side comparison of guidelines available

Disadvantages Level of evidence dependent on producer

UpToDatewww.uptodateonline.com/

Concise comprehensive reviews of clinical topics in multiple specialties

New generation of electronic textbooks

UpToDate Clinical Reference Text

Advantages Scope: many topics covered Ease-of-use

Disadvantages Not always current Evidence-base not always explicit or consistent

across all topics [library pt of view] – cost; individual $495/yr

MD Consulthome.mdconsult.com/groups/uwash8783.html

Electronic ‘bookshelf’ Includes textbooks in major specialties; drug

information; patient ed materials; limited journals; practice guidelines

MD Consult Clinical Reference text

Advantages Continuously updated collection Single search interface

Disadvantages Not all evidence-based materials [library pt of view] – cost; individual ~$350/yr

TRIP Databasewww.tripdatabase.com

TRIP: Turning Research Into Practice Meta-search engine from UK Searches over 70 sites of evidence-based

information Includes links to peer-reviewed journals and

other publications

TRIP Database Meta-search engine

Advantages Search multiple sources at one time

Disadvantages May have more UK focus than desired Not all links to full-text

Information Pyramid

Types of Databases

Primary research database (articles) PubMed, PsycINFO, Cochrane Clinical Trials

Database Secondary research databases (synthesis)

Cochrane Library, Clinical Evidence, UpToDate Tertiary resources (meta search engines,

databases of databases) TRIP

See http://healthlinks.washington.edu/ebp/ebptools.html

healthlinks.washington.edu/care_provider

Role of Librarians Experts on finding & organizing information and

using resources Locate/license reliable, reputable sources Produce finding tools (eg HealthLinks)

15 minute rule: if you don’t find something quickly, ask us

Additional Resources … Care Provider Toolkit

healthlinks.washington.edu/care_provider Evidence-Based Practice Tools Summary

healthlinks.washington.edu/ebp/ebptools.html Evidence-Based Practice

healthlinks.washington.edu/ebp Finding Medical Information Resources

healthlinks.washington.edu/hsl/liaisons/stanna/midm.html Contact your library liaison:

Leilani St.Anna: lstanna@u.washington.edu | 206.543.926 Lisa Oberg: lisanne@u.washington.edu | 206.543.7474

QUESTIONS?

Small Group Session 3:Monday, 10/27, 2:00-2:50 In preparation for the 10/27 small group session students look for

answers to the PICOSS topic assigned to them in the 10/22 small group session in 3 of the resources listed below: Cochrane Clinical Evidence PubMed or Google Scholar UpToDate or MD Consult National Guideline Clearinghouse TRIP

Students report what they have found in resources and any questions they have on what they have found.  Group discusses findings for the 2 topics identified in the 10/22 small group session.

Small Group Session 3 (cont.)

: Small group leaders give examples of clinical situations where they

had to search for information & how they approached the search & what they found

Librarians, students, and small group leaders together in parallel find different types of documents from different medical information resource(s) that may address the clinical question.

Remember to bring your laptops.