Transcript EBM Point-of-Care Resources

EBM Point-of-Care Resources
Mercer University School of Medicine Medical Libraries
Patient
Values
EBM
Best Research
Evidence
Clinical
Expertise
What are Point-Of-Care Resources?




Many research studies have looked at the obstacles
doctors face when trying to find evidence to
answer questions that arise during clinical practice.
A 2002 BMJ study by John Ely and others identified
over 50 barriers doctors encountered while
searching for patient care information.
Point-of-Care information tools attempt to address
some of these problems. These clinically-focused
resources emphasize diagnosis and treatment.
BMJ. 2002 Mar 23;324(7339):710. Obstacles to answering doctors'
questions about patient care with evidence: qualitative study. Ely JW,
Osheroff JA, Ebell MH, Chambliss ML,Vinson DC, Stevermer JJ, Pifer EA.
Point-of-Care Choices
There are a lot of different Point-of-Care
Resources available.
 Some are free, some require a yearly
subscription fee.

Point-of-Care Choices




Sometimes an institution will purchase
access to Point-of-Care resources.
For example, Mercer University School of
Medicine has purchased access to:
AccessMedicine; Cochrane Library Full-Text;
ClinicalKey; Dynamed; Essential Evidence
Plus; Facts & Comparisons; and Micromedex
Memorial University Medical Center &
MCCG have purchased access to:
UpToDate and Micromedex
The Georgia Dept. of Public Health has
purchased access for all hospitals in Georgia
to: VisualDX
Point-of-Care Choices

Free resources include: ACP PIER (free
to members and students); TRIP; Google
Scholar; PubMed; PubMed Health;
SUMSearch; eMedicine/Medscape;
National Guideline Clearinghouse; USPST
ePSS Tool; Drug Information Portal;
Drugs@FDA; Archimedes; and Calculate
by QxMD
Point-of-Care Choices
Check with your institution to see if they
provide access to subscribed Point-ofCare Resources.
 If they don’t, or don’t provide access to
the ones you want, information regarding
personal subscriptions is provided on the
EBM Point-of-Care Chart


http://med.mercer.edu/library/capstone.pdf
Resource Types
Deciding to use a Point-of-Care resource
is like deciding to buy grits at the grocery
store.
 It seems easy enough…

Resource Types

But it can get complicated…

You get to the store and there is an entire aisle
devoted to grits.
Resource Types
There are quick grits….
 ….and regular grits
 Yellow grits….
 ….and white grits
 Stone ground grits
 Grits in bags and grits in boxes
 What do you do!!!!

Resource Types
Assess your needs. If you don’t have
much time to make your grits, you may
want to get the quick grits. You may be
sacrificing depth of flavor and texture for
speed.
 If you want the very best grits experience,
you may want to go with a fancy stone
ground variety… with whole milk and
land o lakes butter.

Resource Types
It is the same way with Point-of-Care
resources.
 Assess your needs.

Resource Types

There are different types of Point-of-Care resources
that can be used for various circumstances:
◦ Systematic Reviews (stone ground grits with whole milk
and butter)
◦ Critically Appraised Topics (quick grits)
◦ Unfiltered Resources (regular grits)
◦ Textbook Style Information (big bag of grits)
◦ Guidelines (small box of grits)
◦ Drug Information that enables EBM (cheese in cheese
grits)
◦ Medical Calculators (timer for the grits)

The different types of Point-of-Care resources are
represented in different colors on the EBM Point-ofCare Chart
http://med.mercer.edu/library/capstone.pdf
SYSTEMATIC REVIEWS
The highest level of evidence on the EBM Pyramid of
Evidence is Systematic Reviews
Systematic Reviews
Systematic Reviews are literature reviews
that use rigorous, systematic, and
transparent methods to minimize bias in
the results.
 They provide the decision-maker with the
best available evidence.
 They are like fancy stone ground grits
with whole milk and land o lakes butter.

Systematic Reviews

Cochrane Reviews are systematic reviews
of primary research in human health care
and health policy, and are internationally
recognized as the highest standard in
evidence-based health care.
Systematic Reviews

Each Cochrane systematic review
addresses a clearly formulated question;
for example: Can antibiotics help in
alleviating the symptoms of a sore throat? All
the existing primary research on a topic
that meets certain criteria is searched for
and collated, and then assessed using
stringent guidelines, to establish whether
or not there is conclusive evidence about
a specific treatment.
Systematic Reviews
The Cochrane reviews are updated regularly,
ensuring that treatment decisions can be based
on the most up-to-date and reliable evidence.
 Use Cochrane to find the highest level of
evidence for patient care or health policy.
 The Cochrane abstracts are free, the full-text
requires a subscription.

Systematic Reviews
PubMed Clinical Queries
 Specialized PubMed searches to retrieve
citations identified as systematic reviews,
meta-analyses, reviews of clinical trials,
evidence-based medicine, consensus
development conferences, and guidelines.

Systematic Reviews
Use PubMed’s clinical queries to select
systematic reviews from the MEDLINE
database.
.
 PubMed citations are free.

PubMed Health
Based on systematic reviews of clinical trials
Use these clinical effectiveness reviews to see
what treatments and prevention methods have
been proven to work – and what remains
unknown.
 PubMed Health is free.


Critically Appraised Topics

Expert/s search the primary literature and
select information to be presented in a
resource as a topic.

What you are seeing
is information that
has been chosen by
the expert/s, not all
of the literature
available.
Critically Appraised Topics

For example, there are a lot of point-ofcare resources available. What you are
seeing in this presentation is what
Carolyn and Carolann have selected for
you to see, not everything that is
available.
Critically Appraised Topics

Information on a topic
is usually divided up
into sections such as
General Information,
Causes and Risk
Factors, History and
Physical, Diagnosis,
Treatment, Prognosis,
Prevention and
Screening, Guidelines,
and Patient
Information.
Critically Appraised Topics



Recommendations for patient care are
provided.
Sometimes references to the primary
literature are provided.
Sometimes EBM levels of evidence are
provided.
Critically Appraised Topics
These are like quick grits.
 Use these resources to find quick
answers to clinical questions for patient
care.
 Remember: these resources provide
selected information, chosen by expert/s.
 You may be sacrificing depth of flavor and
texture for speed.

Critically Appraised Topics

Databases include: ACP PIER; Clinical
Evidence; ClinicalKey (FirstConsult);
Dynamed; Essential Evidence Plus; PEPID;
TRIP; UpToDate;VisualDX.
Unfiltered Resources

This is where the experts who do the
critically appraised topics in resources like
UpToDate, Dynamed, PEPID, ACP PIER,
etc. get their information.
Unfiltered Resources

The experts select their information from
these unfiltered resources that help you
search for primary literature such as RCTS,
Systematic Reviews, Case Reports etc.
Unfiltered Resources
These resources are like regular grits. You
may find more depth of flavor, but it may
not be quick.
 Use these unfiltered resources to find
more in depth information that is not
provided in resources such as Dynamed
or UpToDate.

Unfiltered Resources

Use unfiltered resources
when you have questions
about the information
provided by an expert and
want to see the primary
literature for yourself.

Also, use unfiltered resources to find
information that is so new that it may not
have been synthesized into a database yet.
Unfiltered Resources

The physician is sitting down with liquid
refreshment because it may take some
time to search through unfiltered
resources.
Unfiltered Resources

Unfiltered Resources include: ClinicalKey
(articles); Google Scholar; PubMed;
SUMSearch.
Textbook Style Information
Resources that provide access to online
textbooks or information that is presented in a
textbook format.
 Use these for in depth background/overview
information.
 These are like a big bag of grits. There is often a
lot of information (ie Boron!)

Textbook Style Information

Resources include: AccessMedicine;
ClinicalKey (eBooks); eMedicine/Medscape
Guidelines
Guidelines are statements by which to
determine a course of action.
 They are best used to help make decisions
about appropriate health care for specific
clinical circumstances.
 They are like a small box of grits (called polenta
on the box). They have focused information.

Guidelines

Guidelines are included in resources such as
ClinicalKey, Dynamed, and Essential Evidence Plus.

Guideline specific
resources include:
National Guideline
Clearinghouse and U.S.
Preventive Services Task
Force (USPSTF) ePSS
Tool
Guidelines

You can use the
Guideline
and/or Practice
Guideline filter
in PubMed to
limit your
PubMed results
to just
guidelines.
Drug Information
Quality drug knowledge resources,
optimally integrated into clinical workflow,
enable EBM
 They are like the cheese in cheese grits.
They can enhance and transform the grits
experience.

Drug Information

To facilitate EBM,
drug databases must
be accurate and
reliable;
comprehensive;
timely, and updated
frequently.
Drug Information

Use these resources to find information
about a drug, side effects, drug
interactions, warnings, dosage, patient
information and more.
Drug Information

Resources include: Drug Information
Portal; Drugs@FDA; Epocrates; Facts &
Comparisons; and Micromedex.
Medical Calculators
Medical Calculators
help you to evaluate
situations and through
them reach informed
decisions.
 They are like a timer
for your grits. They
help you to evaluate
the cooking of your
grits.

Medical Calculators
Calculators can be used to determine risk
scores, likelihood of disease, and
diagnostic tests.
 Use them to determine a patient’s body
mass index, predicted peak flow,
gestational age or other clinical
parameters.
 Use the Critical Appraisal of the Evidence
Stats Calculator to calculate statistics in
articles to evaluate them.

Medical Calculators

Resources include: Archimedes; Calculate
by QxMD; Critical Appraisal of the
Evidence Stats Calculator; Essential
Evidence Plus; and Mediequations
Suggested Possible Starter Kit for a
Mobile Device







PubMed (there are a number of PubMed apps; a
popular one for iPad is PubMed Clip; $2.99)
Dynamed ($149.95 for residents) or Essential
Evidence Plus ($85.00) or PEPID Primary Care
(Family Medicine; $264.95) or ACP PIER (Internal
Medicine; $109.00 for residents)
U.S. Preventive Services Task Force (USPSTF) ePSS
Tool (free)
Medscape (free)
Epocrates Essentials ($159.99)
Calculate by QxMD (free)
These choices are our own suggestions and are not endorsed by Mercer
University School of Medicine. Opinions will vary a lot.