Information Rx: Western Libraries’ Prescription for Accessing Clinical

Evidence

SWOMEN/Family Medicine Teaching Retreat

Robin Featherstone, BA, MLISClinical Medicine Librarian University of Western Ontariorfeathe@uwo.ca

Disclosure

I received fellowship funding from the National Library of Medicine (who produces PubMed)

Agenda• Library services• Accessing Western Libraries’ collections• Using Western’s collections to answer

background questions• Using Western’s collections to answer clinical

questions

Library Services

1. Canadian Library of Family Medicine

2. Hospital Libraries

3. Leddy Library

4. Western Libraries

Western Libraries: What we’ve got Journals

and databases

Books

Clinical Tools

Learning modules

Calculators

Drug Identification Tools

Images

Medicine Information: How to access- Go to: http://www.lib.uwo.ca/

-Log in to Off-Campus Access with your UWO username and password (same as your UWO email account)

jsmith27sdK?8N*5

- Select Browse by Program

- Select Medicine and Dentistry

- Select Clinical Outreach

http://www.lib.uwo.ca/programs/clinicaloutreach/Use this page to find selected medical resources

Electronic Books

Point of Care & EBM Tools

Databases

Image and video collections

And more...

How to search our collectionsSelect “Catalogue”

Search the Catalogue to find anything Western Libraries owns or subscribes to

...including:

• Journals• Books• Databases• Point of Care Tools

Catalogue Searching

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

• When searching for articles in databases, use the button to link to full-text

Tip: To see the buttons in PubMed • Use the PubMed links from the library website• Change the display in PubMed to Abstract or AbstractPlus

Using the button

Select the “Go” button to link to full text

Access Exercise 1

• How would you get a hold of this article?

Weber M. Achieving blood pressure goals: should angiotensin II receptor blockers become first-line treatment in hypertension? J Hypertens. 2009 Jul;27 Suppl 5:S9-14.

Access Exercise 2

• How would you get a hold of this article?

Olsson SB, Orndahl G, Erneström S, Eskilsson J, Persson S, Grennert ML, Johansson BW. Spontaneous reversion from long-lasting atrial fibrillation to sinus rhythm. Acta Med

Scand. 1980;207(1-2):5-20. PubMed PMID: 7368973.

Access Key Points

• Off-Campus Access – Remember to log in• Browse by Program > Clinical Outreach• Search the catalogue to find anything UWO

owns or subscribes to• Use Getit@Western button to access full-text• Select “Request Item” from the catalogue to

request ARCC and RDL items for Desktop Delivery

Answering questions using Western’s collections

Background Questions

What are the general preventative measures for otitis externa?

What are the mechanisms of Gabapentin?

What conditions are in the differential diagnosis for atrial fibrillation?

What are current guidelines for use of carotid endarterectomy?

Resources for Background Questions

Textbooks• Library Catalogue (can limit to electronic)• Books@Ovid (623 clinical textbooks)• Harrison’s Online (AccessMedicine)• STAT!Ref (27 clinical textbooks)

Clinical/Foreground Questions

Using the Evidence to Answer Clinical Questions

Identify your problem

Define a structured question

Find the best evidence

How valid is the evidence?

What are the results?

How should I apply the results to patient care?1

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

Using the PICO model, formulate an answerable question

A patient with chronic asthma and a BMI of 36 asks if the low-calorie diet that you’ve recommended may also help with her asthma.

Create an answerable question

In patients with asthma, does a low-calorie diet help to decrease symptoms?

Population Patients with asthma

Intervention Low-calorie diet

Comparison

Outcomes Decreased symptoms

6 Question Types

1. Aetiology: the causes of the disease and their modes of operation

2. Diagnosis: signs, symptoms or tests for diagnosing a disorder

3. Prognosis: the probable course of the disease over time4. Therapy: selection of effective treatments which meet

you patient’s values.5. Cost-effectiveness: is one intervention more cost-

effective than another?6. Quality of life: what will be the quality of life of the

patient? 3

3 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

Find the Best Evidence

• Studies which best answer each question type

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 study4

4 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.

Evidence PyramidLess timeLess work

Less evidence

More timeMore work

More evidence

http://www.mh.org.au/royal_melbourne_hospital/www/353/files/pyramidopt.jpg

Exercise

Search the following resources to answer the question: In patients with asthma, does a low-calorie diet help to alleviate symptoms associated with the condition?

1. Cochrane Library2. Essential Evidence Plus3. PubMed4. SCOPUS

Conclusions

• Number of results

Source Hits

Cochrane Library 7

Essential Evidence Plus 23

PubMed 949 (75 if using Clinical Queries)

SCOPUS 2010

Evidence Pyramid

Cochrane Library

EMBASE

PubMed

SCOPUS

Summary & Key Points• Library Services• Access

– Log in to off-campus access– Browse by Program > Clinical Medicine– Search the Catalogue (use the Advanced search)– Access full text by using the Get it @ Western button

• Searching– Use textbooks to answer background questions– Use PICO to formulate answerable clinical questions– Save time by searching filtered information sources first

QUESTIONS?