Developing Foundational Knowledge in Medical Reference for Librarians July 2011

For a review of medicine-related prefixes /suffixes, seehttp :// hlwiki . slais . ubc . ca / index . php / Medical _ vocabulary

See HLWIKI Canada to examine/ study these Top Biomedical Texts 2010, Print & Online

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A group of SLAIS students and I studied the Top Biomedical Texts 2010, Print & Online and came up with a series of questions which you see here in this document. Prior to our practice session on June 10th, I raised the following that needed clarification:

What subject areas or disciplines are included in a discussion of internal medicine? In discussing internal medicine... it seems clear that listing different disciplines within internal medicine is important such as endocrinology, gastroenterology, cardiology, urology, hematology... but we questioned ‘dermatology’ and whether it fits neatly into the overview of internal medicine?.

I e-mailed an internist about this question and got back the following answer: “Dean - [derm] is usually situated within the Department of Medicine so yes. UBC also has a separate dept of dermatological sciences -- but I consider it as a discipline of int medicine” Anita Palepu , MD , MPH

What is internal medicine? A medical specialty dealing with the prevention, diagnosis and Rx of adult diseases. Physicians specializing in internal medicine are called internists and are

especially skilled in management of patients who have multi-system disease processes... patients are often seriously ill or require complex investigations, internists do much of their work

in hospitals ... Allergies / Cardiology/ Vascular medicine / Geriatrics / Gastroenterology / Endocrinology / Hematology / Infectious diseases / Medical oncology / Nephrology /

Pneumology / Rheumatology

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Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

2. What is rheumatology? A sub-specialty of internal medicine and pediatrics devoted to diagnosis and therapy of conditions and diseases affecting joints, muscles, and bones. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints , soft tissues , certain autoimmune diseases , vasculitis and heritable connective tissue disorders -- Kelley ' s textbook of rheumatology

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3. Patient X has problems with vertigo and is seing a specialist. What type of doctor is she most likely to see? Those who specialize in problems of the ear, nose and throat are called ENTs or

Otolaryngologists... If the doctors have additional training in management of dizziness, hearing loss and tumours of the ear they may be called Otologists

Bulleted / tabular / condensed sources:● ACP Medicine (Online via STATRef ! )● ( Griffith ' s ) Five Minute Clinical Consult - preview at Google Books ● Toronto Notes - a comprehensive medical review textbook for MCCQE - UBC Catalogue

Why is Toronto Notes so popular among medical students? TN is a comprehensive medical review revised annually by the University of Toronto medical class under guidance of experts in the Faculty of Medicine. This text started as a compilation of notes written by UofT students who were studying for their medical licensing exams. After 27 years, it has become a reputable study guide used by medical students across Canada and around the world. This transformation could not have happened without the dedication of students who ensure that each edition contains the latest evidence-based information on 29 subspecialties of medicine. This year has been no different: over 100 staff worked tirelessly to complete this edition.

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In addition to building a bank of reference questions for possible pedagogical purposes in LIBR534, let’s review texts when we first meet this Friday - rather than book talks, how about we have a general discussion about each of the sources and share our knowledge?

See the wiki for Top Biomedical Texts 2010, Print & Online

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

What will be your strategy in answering these questions?

F = factualI = instructionalT = technicalC = consultation (more complex, and longer) Or a combination? – Dean

<<<>>> 1. I need two or three texts in psychiatry and dermatology for residents. So, what texts do psychiatry and/or dermatology resident need to know in their respective areas? A few for each would be great.

C = consultation

Domains & NLMC areas: WR Dermatology WM Psychiatry

Relevant subject guides: http :// guides . library . ubc . ca / psychiatry http :// toby . library . ubc . ca / subjects / subjpage 1. cfm ? id =284

Issues: Online equivalents in Access Medicine & STATRef!

Sources: Kaplan & Sadock ' s Pocket Handbook of Clinical Psychiatry Fitzpatrick ' s dermatology in general medicine & Fitzpatrick ' s online DSM - IV - TR (Online via STATRef ! )

Answer: The DSM and Kaplan/Sadock are key for psychiatry; Fitzpatrick in dermatology

2. Can you find a good Canadian textbook for nurses. Which one will you select? C = consultation

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Domains & NLMC areas: WY Nursing

Relevant subject guide: Nursing

Issues: Canadian content is critical in many aspects of health care

Sources:

Canadian fundamentals of nursing

Answer: The recent Potter title is a classic.

<<<>>>3. A 2nd yr. medical student needs a clearly written overview of areas of internal medicine. What’s the most logical source for them and why?

C = consultation (though it’s possible that the health librarian will show the sources only, and then allow the medical student to review them independently)

Domains & NLMC areas: Internal Medicine WB 115

Relevant subject guide: Medicine

Issues: There are some excellent reference texts on our list that will do the trick Important to explain the benefits and characteristics of each resource so that the patron

knows what each text includes; inform them that these texts are available online

Sources: ACP Medicine (Online via STATRef ! )

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Toronto Notes - a comprehensive medical review textbook - UBC Catalogue Harrison ' s Principles of internal medicine ( Online via Access medicine ) Merck Manual of Diagnosis and Therapy - or online UBC . Merck Manuals available here . Manual of Intensive Care Medicine ( Irwin & Rippe ' s )

Answer: see pages 25-30 in the Appendices of this overview

http :// www . deptmedicine . utoronto . ca / Assets / DeptMed + Digital + Assets /10- 11+ Year +3+ Orange + Book _ Sep +1. pdf

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4. What is the area behind the knee called? Colloquially, it’s the knee pit. F = factual

Domains & NLMC areas: QS Human Anatomy

Issues:For speed, you may want to establish Latin equivalents for the ‘knee’ first.

Sources: Melloni ' s illustrated medical dictionary Netter ' s Atlas of the Human Anatomy

Answer: popliteal fossa

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5. Detailed drawing and history of the popliteal fossa for the anatomy block. What source is best for this type of information need?

Domains & NLMC areas: QS Human Anatomy

Relevant subject guide: Anatomy

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Issues: It seems prudent to have a mix of print and online sources for comparison.

Sources: Netter ' s Atlas of the Human Body

Answer: popliteal fossa - http :// www . bartleby . com /107/158. html

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6. I need three different drawings of the 5th cranial nerve or trigeminal nerve.

C = consultation

Domains & NLMC areas: QS Human Anatomy Central Nervous System - Cranial nerves: WL 330

Relevant subject guide: Anatomy

Issues: It seems prudent to have a mix of print and online sources for comparison Would also be useful to give the patron a large range of drawings so that they could

decide on what they feel would be most appropriate

Sources: Netter ' s Atlas of the Human Body Melloni ' s illustrated medical dictionary

Answer: Free Dictionary http :// medical - dictionary . thefreedictionary . com /_/ viewer . aspx ? path = MosbyMD & name = trigeminal _ nerve . jpg

7. What’s a Gamberdiscus?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

F = factual

Spelling error, try Gambierdiscus toxicus

Domains & NLMC areas: LC or NLM? Biology: LC – Subclass QH QR Microbiology

Relevant subject guide: Medicine

Issues: This is a biology question and typically what we get at Woodward Library.

Sources: NCBI Taxonomy Browser Mashup - iSpecies Gambierdiscus toxicus Adachi & Fukuyo - Encyclopedia of Life

Answer: Encyclopedia of Life “...an armoured, marine, benthic dinoflagellate species. It is anterio-posteriorly compressed with epitheca and hypotheca?s very similar in size. The theca is very thick covered with numerous deep and dense pores. This species is autotrophic creating energy via several golden-brown chloroplasts. The crescent-shaped nucleus is oriented ventrally (Adachi & Fukuyo, 1979). “

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8. What is Li-Fraumeni syndrome and the type of patient most likely to develop it?

C = consultation

Domains & NLMC areas: Genetics, Medical QZ 50 MeSH: Eponyms -- Dictionary

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Issues: This is an eponym question and can involve a variety of sources.

Sources: Genetics Home Reference - http://ghr.nlm.nih.gov/condition/li-fraumeni-syndrome Mendelian inheritance in man - Online version here Whonamedit . com - Li - Fraumeni syndrome Dictionary of medical syndromes ( Magalini ) & print: Dictionary of medical syndromes /

Answer: WhoNamedIt “...rare familial syndrome characterized by the occurrence of sarcomas, breast cancer, brain tumours, leukaemia, and adrenocortical tumours in children and young adults.” & Genetics Home Reference “Li-Fraumeni syndrome is a rare disorder that greatly increases the risk of developing several types of cancer, particularly in children and young adults.” “The CHEK2 and TP53 genes are associated with Li-Fraumeni syndrome.”

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9. CHEK2 - what types of diseases are carriers susceptible to? F = factual

Domains & NLMC areas: Genetics, Medical QZ 50

Relevant subject guide: Medicine

Issues: Simpler patient oriented information: CHEK 2

Sources: Mendelian inheritance in man - Online version here Genetics Home Reference - http://ghr.nlm.nih.gov/gene/CHEK2

Answer:

CHEK2 has been implicated in the development of several cancers, and syndromes

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Mutations in this gene have been linked with Li-Fraumeni syndrome, a highly penetrant familial

cancer phenotype usually associated with inherited mutations in TP53. Also, mutations in this gene are thought to confer a predisposition to sarcomas, breast cancer, and brain tumors

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10. Is there an official name /recognized disorder for those who are somnambulists? Have clinical studies been done? When was it first described as a psychiatric disorder?

Domains & NLMC areas: Psychiatry - WM

Relevant subject guides: http :// guides . library . ubc . ca / psychiatry

Issues: Don’t forget medical/historical aspect; start with books such as The parasomnias and

other sleep - related movement disorders

Sources: DSM - IV - TR (Online via STATRef ! ) PubMedHealth - http :// www . ncbi . nlm . nih . gov / pubmedhealth / PMH 0001811/ PubMed - MeSH look up for “sleep walking” - you will find “somnabulism.” Can then use

the MeSH term and limit to clinical trials Current Medical Diagnosis and Treatment

Answer: A somnambulist is someone who walks in his sleep. See 307.46 Sleepwalking Disorde r Dissociative disorder - parasomnia - sleepwalking

11. Does every health or medical professional group have a code of ethics?

F = factual

Domains & NLMC areas:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Medical ethics W 50

Issues: Many medical associations have their own codes of ethics; see CHLA - ABSC Code

of Ethics While many associations do have their own code – there are some out there that

don’t – important to consider

Sources: Codes of ethics : ethics codes , standards and guidelines for professionals working in a

health care setting in Canada Answer: The obvious answer is no but most do.

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12. What is the active ingredient in poison ivy that causes rashes? Is it a poison? or a toxin?

F = factual

Domains & NLMC areas: Plant poisoning QV 607 , WD 501

Issues: The active ingredient must be found and possible treatments Need to look potentially in different places to find if it is a poison or toxin

Sources: Dreisbach ' s Handbook of Poisoning - preview at Google Books Casarett & Doull’s Toxicology: The basic Science of Poisons

Answer:

Urushiol – a mix of catechols, an allergen Urushiol; Frank: “It’s a toxin, although I learned that from finding the definition of

“poison” and “toxin” not from the sources…” See Toxicodendron Poisoning http://emedicine.medscape.com/article/817671-overview

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

From NMCD: “Poison ivy is a severe skin irritant that stimulates the immune system.

Contact sensitivity is due to the urushiols, which bind to skin proteins, sensitizing the individual. Once sensitized, re-exposure leads to allergic reactions.”

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13. A nuclear physicist asks you to find an updated list of radioactive isotopes. He’s interested in those used therapeutically. Domains & NLMC areas:

● Nuclear Physics QC 796.C6● See also special topics under Radioisotopes

Issues: Canada produces its own medical isotopes but since 2010 when Chalk River ceased to

function, there has been much discussion about where we will get our supply Producing medical isotopes using X - rays

Sources: Merck Index - Merck site CRC Handbook of Chemistry & Physics - online access

Answer:

See Radioactive Isotopes <<<>>>

14. What did Dr. R. Schreiber bill the BC Medical Services Plan in ‘08? What about Stikine’s Health Centre? F = factual

Domains & NLMC areas: N/A

Issues: Information is in the public domain.

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources:● Financial statement - Medical Services Commission ( MSC ) of BC

Answer:

● Schreiber, Richard A. ...................... $203,070.07● For Stikine Health Centre, check 2010.. $25,190.36

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15. I’m a post-doc PhD in psychology. I’m treating someone with chronic pain and would like a technical-physiological description of pain blockade.

Domains & NLMC areas: Analgesia WO 200 & Pain WL 704

Issues: See also International Association for the Study of Pain ( IASP )

Sources: ● Chapter 18. Opioids , Analgesia , and Pain Management Goodman & Gilman's The

Pharmacological Basis of Therapeutics, 12● Miller ' s Anesthesia (Online version via MD Consult ) see Peripheral Nerve Blockade ● Sabiston Textbook of Surgery, 18th ed - Analgesia , Sedation , and Neuromuscular

Blockade ● CHAPTER 48 - Principles of Pain Management

Answer: Above texts outline mechanisms associated with anesthesia, analgesia, pain blockade.

16. What is cat’s claw typically used for? Domains & NLMC areas:

● Complementary medicine WB 880-962

Issues:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Does it have other popular names? What is its plant name? Does the patron want some other information on this topic – or just what it is used for?

Sources:● Natural Medicines comprehensive database ● Online version via UBC Library - CAT ' S CLAW

Answer: Acccording to NMCD: “Orally, cat's claw is used for diverticulitis, peptic ulcers, colitis,

gastritis, hemorrhoids, parasites, Alzheimer's disease, and leaky bowel syndrome. Cat's claw is also used orally for viral infections including herpes zoster, herpes simplex, and human immunodeficiency virus (HIV). It is used orally for chronic fatigue syndrome (CFS), wound healing, arthritis, asthma, allergic rhinitis, cancer (especially urinary tract), glioblastoma, gonorrhea, dysentery, birth control, bone pain, "cleansing" the kidneys. “

From NMCD - cat’s claw also known as: Griffe Du Chat, Life-Giving Vine of Peru, Samento, Uña De Gato; Plant names: “Two species of cat's claw are of primary interest for medicinal use: Uncaria tomentosa and Uncaria guianensis. Uncaria tomentosa is most commonly used in the US, and Uncaria guianensis is typically used in Europe.”

<<<>>> 17. What’s the best-selling natural medicine in North America targeting pain symptoms? F = factual

Domains & NLMC areas:

Relevant subject guide: Complementary & Alternative Medicine

Sources:● Natural Medicines comprehensive database Online version - Pain section of NMCD

Answer:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

“best selling natural medicines include those that target pain related to osteoarthritis,

such as glucosamine or chondroitin. Osteo Bi-Flex, which contains glucosamine HCl, chondroitin, and other ingredients had sales of over $65 million in 2006.”

Procaine (most effective) - Natural Medicines comprehensive database Osteo Bi-Flex, sold most in 2006 in Natural Medicines comprehensive database (Online

version via UBC Library )

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18. I’ve been reading about chicken-borne viruses and need information on AMV (avian myeloblastosis virus); acronym v = virus. I’m not sure if it’s an influenza type or not. F = factualC = Consultation

Domains & NLMC areas: Virology QW 160

Issues: Human Influenza WC 515

Sources:● Manual of Clinical Microbiology

Answer:

It is a retrovirus and not an influenza type virus

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19. What’s the name of the oldest medical writing? What script is used in it? In pre- and Post-Gutenberg eras, name a few of the oldest medical books. F = factual

Domains & NLMC areas: History, Ancient - Of medicine (General) WZ 51

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Relevant subject guide: History of Medicine

Sources:● Garrison Morton medical bibliography - review on PubMed Central ● http :// en . wikipedia . org / wiki / Edwin _ Smith _ Papyrus ● Ancient Egyptian scripts Hieratic script “priestly writing” was developed at the same

time as the hieroglyphic script and used in parallel with it...Edwin Smith or Kahoun Papyrus (1950 B.C) in hieratic handwriting (w some hieroglyphic) ... http :// t . co /0 ez 1 dDR

Answer:Edwin Smith and Kahoun Papyri are in hieratic handwriting (w some hieroglyphs)

20. Why is Galen important in medical history? Which contribution seems unusual today?

F = factual

Domains & NLMC areas: History, Ancient - Of medicine (General) WZ 51

Relevant subject guide: History of Medicine

Sources: Garrison Morton medical bibliography - review on PubMed Central

Answer: Birth of Galen . Greek physician to gladiators and Roman emperors; proponent of

bloodletting based on four humours; used into the 19th century but of course soon thereafter abandoned.

21. Who was responsible for eradicating Devonshire colic in the 18th c? How did he eradicate it?

F = factual

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Domains & NLMC areas:

History, 18th Century - Of medicine (General) WZ 56

Relevant subject guide: History of Medicine

Issues: Some clues here http :// en . wikipedia . org / wiki / Devon _ colic

Sources:● Garrison Morton medical bibliography - review on PubMed Central ● Wikipedia then OvidSP (- + Search terms used: baker, George, george baker, history,

18th century, lead poisoning)●

Answer: Sir George Baker , 1722 – 15 June 1809 said that "Devonshire colic", a painful and

occasionally fatal condition, was caused by lead poisoning from drinking cider. When lead was removed from the cider manufacturing process the colic problem disappeared

<<<>>> 22. Canadian families work longer to generate income for housing, groceries, education and debts. The growth in hours comes at the expense of time with family, friends and community. Is this true? Domains & NLMC areas:

Sources:■ Profiling Canada ' s families III - Vanier Institute of the Family and 2010 update

Answer: Yes the trend is for more working hours at the expense of time with family. Frank: No: “With few exceptions, at least until 1998, Canadians had more time left over at the end of the day than they used to.” Did you check 2010? Dean

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

23. I’m interested in reading a basic overview of nursing informatics. What do you recommend? Domains & NLMC areas:

Nursing Informatics WY 26.5

Relevant subject guide: Health Informatics Nursing

Issues: A Canadian perspective might be useful; a book or textbook would be appropriate,

something recent. Review articles tend to be too specific

Sources:● Canadian fundamentals of nursing ● CNIA Canadian Nursing Informatics Association ● Nursing informatics : where technology and caring meet / Marion J. Ball ... [et al.] ● Nursing informatics and the foundation of knowledge / McGonigle, Mastrian.

Answer:

A good overview of the topic might combine perspectives and sources.

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24. Can you find the global temperature trends from 1850-2010?

F = factual

Domains & NLMC areas: Global Warming, General QC 981.8.G56; Medical aspects WB 700

Issues: Evidence of temperatures over time may differ; check several sources Is this information related to another project they are working on? Or is it just for

informational purposes

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources:● CRC Handbook of Chemistry & Physics - online access ● See Global Temperature Trend, 1856-2009● NOAA Paleoclimatology Global Warming:

http://www.ncdc.noaa.gov/paleo/globalwarming/instrumental.html

25. I’m looking for drug to drug interactions for Accutane - a patient needs sources that provide risks involved when taking other drugs.

F = factual

Domains & NLMC areas: Drug Interactions QV 38

Relevant subject guide: Pharmacy / Pharmaceutical Sciences

Issues: May be important to get Canadian perspectives Does physician need materials to synthesize for the patient?

Sources:● Compendium of Pharmaceuticals and Specialties ( CPS ) online e - Therapeutics ● Goodman and Gilman ' s manual of pharmacology and therapeutics

Answer: The eCPS provides information about contraindications and interactions. eCPS is also an excellent resource for consumer information.

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26. I need some information on panic - particularly its association with family members and genetic influences. How do these aspects influence panic? What resources can I use to find out about this?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Domains & NLMC areas:

For panic, see WM 172 For genetic influences, see QZ 40-109 Pathogenesis . Etiology

Sources:● Mendelian inheritance in man - Online version here

Answer: The chapter in OMIM is clear about the genetic influences of panic. BOVINE CARTILAGE (possibly effective)

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27. I need a natural remedy to cure poison ivy - can I look up what remedies are effective?

Domains & NLMC areas: Homeopathy WB 880-962

Relevant subject guide: Complementary & Alternative Medicine

Sources:● Natural Medicines comprehensive database (Online version via UBC Library )● Product effectivness checker from the NM database

Answer: Vitamin C to prevent infection and rapid spread of the rash; reduces swelling. Calcium and Beta-

carotene boost immune response and speed healing; Zinc to repair skin tissue; Calamine lotion to speed healing

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28. I’m completing a project on vaccines given to children by pediatricians. I need to outline each and discuss in depth - where can I find this information? Domains & NLMC areas:

Pediatric, vaccines e.g. Measles-Mumps-Rubella Vaccine WC 580

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Issues: Canadian vaccination schedules may be needed Consensus statements by pediatricians Is it for a patient? VCH Patient Resources Catalogue Search

Sources:● Rudolph ' s Pediatrics Online via STATRef ! ● Nelson textbook of pediatrics ● Oski ' s pediatrics ● American Academy of Pediatrics - Immunization Schedule ● Canadian Pediatric Society - Infectious Diseases and Immunization ● CPS - Immunization; immunization schedules by age/patient groups● government source/ Canadian context/ practical/ lots of references

● Alternative would be something like: Fields' virology

● Canadian Immunization Guide , 7 ed , 2006 ● Adult vaccines - UpToDate

Answer:● When building this question, I thought the patron might want an overview of vaccines

provided to children while gaining an understanding of what each vaccine was for; how administered; what consists of; etc.

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29. I’m giving a presentation on patient safety in surgery - are there resources I can use to provide diagrams/graphs so that I can use them in my slides? C = consultation

Domains & NLMC areas: Surgery - WO

Issues: Will presentation be given in-house, or is it a conference/classroom presentation?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources:

● Chapter 12. Patient Safety Schwartz's Principles of Surgery● Multimedia Learning Objects - Medicine

Answer: Check copyright issues; show physician how to find images in Creative Commons

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30. I need information on local anesthetics - I am looking for how anesthetics affect the central nervous system. Is there a book I can take out that will provide this? F = factual

Domains & NLMC areas: Nervous system, anesthesia QV 110 Local anesthetics Surgery - WO

Issues: Is the information for a physician? [Yes. Resident] What kind of diagrams are they looking for? Statistical? Graphical? What type of

information do they want to present in this form?

Sources:● Miller ' s Anesthesia (Online version via MD Consult ) (includes pediatric anesthesia)● MD Consult – Patient Education – Anesthesia: consumer-friendly fact sheet explains

local anesthesia, including a “How it works” section

Answer: Approach from an anesthetic point of view – are they looking for information on a

specific type of patient – ex. pediatrics/geriatrics?

<<<>>>

31. Good visual guide to understand spinal cord and various discs - what can I use?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

F = factual

Domains & NLMC areas: Human Anatomy - QS

Issues: Patron would like to do a drawing.

Sources: Netter ' s Atlas of the Human Body Grey’s Atlas of Anatomy as first resource, more general, systems organization, hard 10-

20 pages of various diagrams and images relating to the spinal cord and discs Grey’s Anatomy is much more complete, more pictures of real anatomy vs. diagrams

32. Ready reference guide for Rx of gastrointestinal disorders – what do you recommend? F = factual

Domains & NLMC areas: WI - Digestive system

Issues: Audience? Format?

Sources: Current Medical Diagnosis and Treatment Goodman and Gilman's manual of pharmacology and therapeutics ( Griffith ' s ) Five Minute Clinical Consult - preview at Google Books Merck Manual of Diagnosis and Therapy Gastrointestinal Disorders ACP Medicine

Answer:This answer may change depending on the audience (who asked the question) and the format needed (electronic, print, handbook, etc).

<<<>>>

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

33. I’m a cardiology resident doing research into anaesthesia in patients with existing cardiovascular diseases. Detailed background and make it comprehensive. Domains & NLMC areas:

WG Cardiovascular System WO 200-460 WG 460 Special cardiac problems in anesthesia, dentistry, surgery (e.g., Choice of anesthetic)

Issues: Question may need to be approached from one of cardiology, anesthesia or surgery.

Sources: Hurst ' s the Heart : Manual of Cardiology - via AccessMedicine see Hurst ' s The Heart , 12 e Miller: Miller's Anesthesia, 7th ed. via MD Consult) – Chapter 33: Risk of anesthesia. In online

index: “Cardiovasular disease – anesthesia-related risk in – pg. 985) Subchapter: Diseases Involving the Cardiovascular System

Hypertension Ischemic Heart Disease Valvular Heart Disease Cardiac Conduction Disturbances: Cardiac Arrhythmias

Answer:Consult texts.

<<<>>>

34. Looking for statistics on new HIV/AIDS cases in British Columbia (broken down by year). F = factual

Domains & NLMC areas: Statistics and surveys WA 900

Issues: Disease outbreaks and statistics in Canada PHAC: Centre for Chronic Disease Prevention and Control see HIV / AIDS In BC: BC Centre for Disease Control

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources:

PHAC and the BC CDC websites Statistics in health Public Health Agency of Canada: Home > Infectious Diseases > HIV/AIDS > Reports and

Publications > Surveillance Report to December 31, 2009 > Section I http://www.phac-aspc.gc.ca/aids-sida/publication/survreport/2009/dec/3-eng.php#table6b

Answer: StatsCan and PHAC are important sources as is BCCDC.

<<<>>> 35. I’m a medical student wanting to learn the differential diagnosis for common cold (rhinoviruses), influenza (orthomyxoviridae), and mono (Mononucleosis) Domains & NLMC areas:

Orthomyxoviridae QW 168.5. O 7 Rhinovirus QW 168.5. P 4 Infectious mononucleosis WC 522

Issues: See also First Consult ; includes differential diagnoses

Sources: Diagnosaurus on Access Medicine - Influenza Fields ' Virology - preview Vol. 1 at Google Books Sherris Medical Microbiology - Influenza Viruses & Orthomyxoviruses

Answer:Diagnosaurus has an excellent differential diagnostic guide for viruses.

<<<>>> 36. A resident is looking for information on “black tongue” a fungal infection that a patient has just presented with. F = factual

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Domains & NLMC areas: Candiasis, Oral WC 470

Issues: Infectious agents

Sources: Fitzpatrick ' s dermatology in general medicine & Fitzpatrick ' s online see Black Hairy

Tongue Fields ' Virology - preview Vol. 1 at Google Books Merck Manual of Diagnosis and Therapy

Answer: “Black, hairy tongue is a temporary, harmless (benign), painless oral condition that gives your tongue a dark, furry appearance. The look of black tongue results from bacteria in the mouth.”http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=Black+hairy+tongue

<<<>>> 37. Medical student looking for the “diagnostic criteria” for generalized anxiety disorder. Needs differential diagnosis from authoritative and respected source. F = factual

Domains & NLMC areas: Anxiety Disorders WM 172

Relevant subject guide: Psychiatry

Issues: The new edition of DSM is coming out soon.

Sources: DSM - IV - TR (Online via STATRef ! )

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Harrison's Online - Generalized Anxiety Disorder See First Consult also; it too has a section on differential diagnoses

Answer: Diagnostic criteria laid out clearly in DSM but close alternatives in several tools.

<<<>>> 38. A BMB patron looking for local diabetes support groups, services & resources

F = factual

Domains & NLMC areas: Diabetes in NLMC: WK 810-850

Issues: Canadian Diabetes Association - Regional Offices

Sources: The Red Book

Answer:

Online Red Book is excellent; local Diabetes groups can also be located through the CBA.

<<<>>>

39. A doctor comes in looking for a quick clinical review on headaches in adult patients. Domains & NLMC areas:

Headache WL 342

Relevant subject guide: Neurology Diabetes

Issues:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

It may be necessary to use clinical guidelines from expert groups such as:

● American Academy of Neurology ( AAN ) Practice Guidelines ● US Headache Consortium Guidelines

Sources: Chapter 18. Opioids , Analgesia , and Pain Management Goodman & Gilman's The

Pharmacological Basis of Therapeutics, 12 Harrison’s Chapter 15 - Headache ACP Medicine Headache Adams & Victor’s Principles of Neurology - Headache and Other Craniofacial Pains

Answer:

This is the kind of question where you can go to consensus statements at the AAN or via a standard textbook, perhaps both.

<<<>>>

40. A physician is looking for an overview of Hunter Syndrome including early childhood symptoms. Domains & NLMC areas:

Metabolic diseases WD 200

Relevant subject guide: Pediatrics

Issues: eMedicine - Genetics of Mucopolysaccharidosis Type II

Sources: Mucopolysaccharidoses Harrison's Online > Chapter 355. Lysosomal Storage Diseases Rudolph ' s Pediatrics Online via STATRef ! Nelson textbook of pediatrics & Oski ' s pediatrics Mendelian inheritance in man - Online version here

http :// www . ncbi . nlm . nih . gov / omim /309900

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

In the early 1900s, Gertrud Hurler and Charles Hunter described patients with MPS,

whose diseases now bear their names; subsequent MPSs are assigned numbers and eponyms associated with the origin of their report. MPS II was described by Hunter in 1917. The X-linked disorder results from deficiency of iduronate sulfatase & accumulation of heparan and dermatan sulfate (polysaccharides)

Whonamedit . com - Li - Fraumeni syndrome Dictionary of medical syndromes ( Magalini ) & print: Dictionary of medical syndromes /

Answer:

Hunter syndrome, or mucopolysaccharidosis type II (MPS II), belongs to a group of inherited metabolic disorders caused by a deficiency of lysosomal enzymes required for degradation of mucopolysaccharides or glycosaminoglycans (GAGs)

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41. An international medical graduate is looking for a current textbook on liver surgery.

C = consultation

Domains & NLMC areas: Liver - General Surgery WI 770

Relevant subject guide: Surgery

Sources: Schwartz ' s Manual of Surgery - online via AccessMedicine MD Consult What is new in liver surgery? - Hackerstedt K - Scand J Surg - JAN-2011; 100(1): 5-7 Surgical Clinics of North America 90, 4 (August, 2010) – an entire issue on liver surgery

Answer:In the absence of a specific monograph, you can always go to a general text and point out the specific section.

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Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

42. A medical student is doing a research report on Tuberculosis and needs to find infection control guidelines and rates of incidence in Canada.

Domains & NLMC areas: Tuberculosis, Pulmonary WF 300-360

Issues: Canadian tuberculosis standards 6 th edition - 2007

Sources:● ACP Medicine (Online via STATRef ! ) under “Hospital-Based Prevention”● CCDR - Tuberculosis Prevention and Control Surveillance Reports ● Sherris Medical Microbiology, 5e - Mycobacterium Tuberculosis ● Harrison's Online see Tuberculosis

Answer:There may be a range of sources and evidence. Show some examples to the student.

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43. A nurse is looking for up-to-date guidelines on patient confidentiality.

Domains & NLMC areas: Patient confidentiality

Issues:Local information? Vancouver General Hospital Patient & Family Handbook

Sources:● Canadian fundamentals of nursing ● Codes of ethics : ethics codes , standards and guidelines for professionals working in a

health care setting in Canada

Answer: There are provincial and national guidelines – as well as those within the nursing profession.

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

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44. A physician is asking for a comprehensive list of X-linked recessive disorders with a clinical synopsis to aid in diagnosis. Domains & NLMC areas:

Genetic disorders--Dictionaries Genetics, Medical - QZ 50

Relevant subject guide: Medical genetics

Issues: Type and format of resource may be important.

Sources: Mendelian inheritance in man - Online version here Birth defects encyclopedia Emery and Rimoin's principles and practice of medical genetics Emery's elements of medical genetics Foundations of Classical Genetics

Answer: Several sources are able to provide the needed information.

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45. A nurse needs current information on palliative care in a Canadian context. Domains & NLMC areas:

Nursing WY 152.3

Relevant subject guide: Nursing

Issues:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Try nursing or palliative care approach.

Sources:● Palliative nursing - Competencies; Bibliography; CHPCN ( C ) ● Canadian Hospice Palliative Care Association ( CHPCA ) ● Canadian fundamentals of nursing ● BC Ministry of Health – Guidelines for palliative care

http://www.bcguidelines.ca/submenu_palliative.html

Answer: There will be monographs in the WYs, and chapters in textbooks such as the Potter.

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46. An international medical grad needs list of specialist physicians practicing in oncology in BC. F = factual

Domains & NLMC areas: Physicians -- Canada -- Directories

Issues: Some directory information online

Sources:● Canadian Medical Directory

47. A medical student needs dosage information and side effects for opioids used in pain management.

F = factual

Domains & NLMC areas: Pain WL 704

Relevant subject guide:

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

● Anaesthesia

Sources:

● Goodman and Gilman ' s manual of pharmacology and therapeutics see Chapter 18. Opioids , Analgesia , and Pain Management

● e-CPS has dosing information, search for “opioids” is unspecific but monograph contains info for specific drugs as well as links to complete information sheet

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48. A nursing student needs general information on the management of kidney stones.

C = consultation

Domains & NLMC areas: Nephrology nursing WY 164

Relevant subject guide: Nursing Urology

Issues: Is it for a patient? VCH Patient Resources Catalogue Search

Sources: ● Canadian fundamentals of nursing ● Smith ' s general urology - and Ch. 16 online via Renal & Ureteral Stones

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49. An ICU nursing student needs to brush up on arterial line placement for an exam. Domains & NLMC areas:

Catheters, Indwelling, see names of various types of catheterization; Form number 26 in any NLM schedule where applicable

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Relevant subject guide: Nursing

Sources: Canadian fundamentals of nursing Manual of Intensive Care Medicine ( Irwin & Rippe ' s ) See Chapter 3, page 15, (5th ed.)

“Arterial Line Placement and Care”

50. I need a resource that will tell me the specific techniques used when performing a nephrectomy with images. What can you provide for me?

C = consultation

Domains & NLMC areas: ● Nephrectomy WJ 368

Relevant subject guide: Urology

Sources: Schwartz ' s Manual of Surgery - online via AccessMedicine Smith ' s general urology - online via AccessMedicine Nephrectomy Smith's General Urology

51. I would like a comprehensive resource to tell me what reproductive disorders are associated with obesity. Other pathologic consequences of obesity would be useful also.

Domains & NLMC areas: Obesity WD 210-212

Issues: Copyright? Creative commons? Important to understand all angles. Patron wants reproductive disorder AND pathologic

consequences. Is there ONE resource or would two suffice? Do they want to treat? Who is the patron?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources: Obesity Harrison's Online > Chapter 7. Medical Disorders during Pregnancy

52. A medical student is looking for information on complications/disorders involving amnionic fluid volume during pregnancy.

Domains & NLMC areas: Obstetrics - WQ

Sources: Williams Obstetrics (specifically Chapter 21: Disorders of Amniotic Fluid Volume)

53. I work at a hospital’s walk-in clinic. A patient lost the case for her pills and has forgotten what is what. There is one that neither my colleague nor I recognize – how can I identify it?

Domains & NLMC areas: Pharmacology - QV 1-55 Reference Works. General Works

Issues: Does doctor have pills with him/her; did they write down description of its appearance?

Sources: Compendium of Pharmaceuticals and Specialties (CPS or e - CPS ) - plug in the

characteristics of the pill to the product identification tool in e-CPS

54. I am doing some research on the spread of the HINI virus in Canada during 2009. Where could I find some government documentation on it and any alerts that were made?

Domains & NLMC areas: Communicable Diseases WC General works WC 100

Issues: Are they looking for how government reports were disseminated by popular press, or

just the alerts themselves?

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

Sources: Canada Communicable Disease Report (CCDR) - search 2009 Disease Report. Look up

H1N1 under “Infectious Diseases“ The Library Page 35 4/12/2023for information.

55. I am an ultimate Frisbee player – I would like to find out more about the structure/ mechanics of the hand and wrist.

Domains & NLMC areas: WE 830 (Wrist) QS Human Anatomy

Issues: What is the patron’s background? Are they looking for illustrations or text as well?

Sources: Netter’s Atlas of the Human Body Melloni ’ s Illustrated Dictionary may also be helpful

56. I am looking for some consumer health information on isotretinoin (drug).

Domains & NLMC areas: Pharmacology - QV 1-55 Reference Works. General Works WB 120 not WA590

Issues: What is the brand name (name patient is familiar with)? Are they looking for resources

they can point their patient to, or resources to print out for their patient? What type of specific information are they looking for? Consumer health information on

side effects? Dosing? Benefits? All of the above?

Sources: Compendium of Pharmaceuticals and Specialties (CPS or e - CPS ) - under drug

monographs, look up isotretinoin. Select the brand name (Accutance Roche) to display the monograph. Once the page has reloaded, you can access consumer information by clicking the link at the top (below “About”) called “Information for the Patient”.

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011

57. I have a patient who is interested in natural medicines for Alzheimer’s Disease (particularly antioxidants). Where can I find out more?

Domains & NLMC areas: Complementary medicine WB 880-962

Issues: Is the doctor looking for consumer information, or information that they can read, digest

and then translate for their patient?

Sources: Natural Medicines Comprehensive Database – do a search for Alzheimer’s Disease; look

for it under Clinical Management Series. A list of natural remedies is available, with links to information on each remedy (include four natural antioxidant remedies).

Giustini, Barron, Read, Sayre, Westbrook – Summer 2011