Family Med Orientation July 2009

Western Libraries: Need to Know Family Medicine Residents Robin Featherstone, MLIS Clinical Medicine Librarian University of Western Ontario [email_address]

Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

JASPA Criteria (journal-associated score of personal angst) Reference: Modified from ‘Polythenia gravis: the downside of evidence-based medicine.’ British Medical Jou rnal (1995) 311: 1666-1668. ,[object Object],[object Object],[object Object],[object Object],Can you answer these five simple questions? J Are you ambivalent about renewing journal subscriptions? A Do you feel anger towards particular authors? S Do you use journals to help you sleep ? P Are you surrounded by piles of periodicals ? A Do you feel anxious when another journal article lands on your desk?

“ In 2005, 55 new trials were published every day... To keep up to date on RCTs alone, a GP would have to read more than one study report every half hour, day and night.” Reference: Glasziou, P. Evidence-based Practice Workbook: Bridging the Gap Between Health Care Research and Practice . 2 nd Ed. Oxford: Blackwell Publishing, 2007. Lots of evidence...

Lots of questions... ,[object Object],[object Object],[object Object],[object Object],[object Object],References: Green ML, Ciampi MA and Ellis PJ (2000). Residents’ medical information needs in clinical: are they being met? American Journal of Medicine 109:218-233.

Lots of barriers... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference: Green ML, and Ruff TR (2005). Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Academic Medicine, 80(2): 176-182.

Information Services for Family Medicine Residents ,[object Object],[object Object],[object Object]

Canadian Library of Family Medicine http://www.cfpc.ca/English/cfpc/CLFM/main/

Canadian Library of Family Medicine: Key Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

1. Western Libraries: What we’ve got Journals and databases Books Clinical Tools Learning modules Calculators Drug Identification Tools Images

2. Family Medicine 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 Family Medicine

http://www.lib.uwo.ca/programs/familymedicine/ Use this page to find selected resources for family medicine Electronic Books Point of Care Tools Databases Image and video collections And more...

2. How to search our collections Select “Catalogue” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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: For best results, 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 ,[object Object],[object Object],[object Object],[object Object]

Access Exercise 1 ,[object Object],[object Object]

To Register for RACER (InterLibrary Loan ordering system) ,[object Object]

Access Key Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Information Gathering Techniques

Why not just Google it? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference: Sinha, S., R. Krause, R. Moscati, D. Schwartz, and J. Abbas. "48: Are Internet Searches a Reliable Source for Answers to Residents' Clinical Questions in the Emergency Department?" Annals of Emergency Medicine 52, no. 4, Supplement 1 (10, 2008): S57-S57.

“ Just in case” vs. “Just in time” ,[object Object],[object Object],[object Object],Reference: Glasziou, P. Evidence-based Practice Workbook: Bridging the Gap Between Health Care Research and Practice . 2 nd Ed. Oxford: Blackwell Publishing, 2007.

Best Strategies for gathering “Just in Case” Information ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Best Strategies for gathering “Just in Time” Information ,[object Object],[object Object],[object Object]

Exercise ,[object Object],[object Object]

Good Resources for Background Questions ,[object Object],[object Object]

Using the Evidence to Answer Clinical Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],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 ,[object Object],A patient with atrial fibrillation wishes to discontinue taking warfarin. You consider aspirin as an alternative therapy for reducing the patient’s risk of stroke when a colleague suggests you prescribe both aspirin and clopidogrel

Create an answerable question ,[object Object],Population Patients with atrial fibrillation Intervention Aspirin alone Comparison Aspirin combined with clopidogrel Outcomes Prevention of stroke

Clarify the question type ,[object Object],[object Object]

6 Question Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

Find the Best Evidence ,[object Object],4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006. 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 study 4

Evidence Pyramid Less time More time http://www.mh.org.au/royal_melbourne_hospital/www/353/files/pyramidopt.jpg

Exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],Source Hits PubMed 100 (11 if searching narrow/therapy study category) Cochrane Library 6 Embase 256 Micromedex 2 e-CPS 1 drug monograph

Evidence Pyramid Cochrane Library Micromedex e-CPS PubMed EMBASE

Summary & Key Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

And, finally... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Orientation Evaluation ,[object Object],[object Object],[object Object],[object Object]

Family Med Orientation July 2009

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Family Med Orientation July 2009