Post on 21-Jan-2016
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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 May be evidence-based Print book chapters typically out-of-date/ Textbooks vs spiral manuals (overview/educate vs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other published and unpublished sources Does not contain the full text of the article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.