Transcript Finding Reliable Online Medical Information

Finding Reliable Clinical
Information Online
An Introduction
Nancy Clark, M.Ed.
Director of Medical Informatics Education
FSU College of Medicine
http://www.med.fsu.edu/informatics/MedicalReferences.asp
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Major Competency
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Students will
• Demonstrate the ability to acquire new data
and information and to critically appraise its
validity and applicability.
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Objectives of Session
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Students will
• Demonstrate ability to locate quality clinical
information on the web utilizing a variety of
strategies
• Assess the reliability and validity of clinical
information found using search engines on
the web
• Begin to utilize the FSU COM virtual library
resources to locate medical information for
clinical decision support [Old and new]
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Resources
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http://www.med.fsu.edu/informatics/
Medical References
• PowerPoint
• Assessing the Validity of Online Medical
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Information
Decision Support
Using Drug Resources
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Review
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What is the most efficient, unbiased way
to keep up to date?
1. Go to conferences
2. Read 20-30 journal articles a week
3. Look up answers to clinical questions when
they occur in a reliable, current resource
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In the Beginning…
Journals
Text Books
Peer Reviewed
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Pocket Manuals
Drug Info
Note Cards
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“Textbooks don’t smell as their
contents rot, so readers will need to
develop alternative crap detectors to
avoid poisoning their minds and
robbing their patients of current best
care.”
David Sackett, MD
Pioneer of Evidence Based Medicine (EBM)
The half life of medical information
is estimated at 5 years.
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21st Century Medical Information
Journals
Text Books
Pocket Manuals
Drug Info
Note Cards
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Here is the Problem…
Which of these sites are accurate?
Which of these sites are reliable?
Which of these sites are up to date?
Which of these sites are not biased?
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Assessing the Validity of
Information on the Web
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AMA Guidelines for Medical and Health
Information Sites on the Internet
Health on the Net Code of Conduct HON
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Assessing the Validity of
Information on the Web
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Site ownership/domain
• Gov
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CDC
AHRQ
NLM.NIH
DHHS
FDA
States fl.us
• Edu
– Medical Centers
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• Org
– Associations
• AAFP
• ACP
• ACOG
– Disease orgs
• ADA
• ALA
• Com
– Commercial
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Assessing the Validity of
Information on the Web
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Site ownership/domain
Contributors listed, credentials, contact info
Highly referenced, linked to primary literature
• MEDLINE Abstracts/Journal Articles
• Proceedings from scientific meetings
Timeliness: date posted, revised
Viewer access, payment and privacy
Funding and sponsorship
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Wikipedia
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List 5 ways Wikipedia does not fit the
criteria as a reliable site.
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Exercise
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Search Google for treatment of back pain
Rate the first 20 hits
• Sponsor? Advertisements?
• Audience?
• Authors?
• Links?
• Date Revised?
Do advanced search limit to .gov domain and
compare results
Search for prostate cancer screening
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Types of Information Found Free on
the Web
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Information for/by students
Information for/by patients
Information for/by clinicians
Information for/by researchers
Sales pitches, ads
Quacks who want to sell something
Unproven, unsubstantiated nonsense
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Assessing the Validity of
Information on the Web
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Library subscription resource = reliable
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Be Skeptical
You will be taught the principles of
critical review of the literature in your
second year along with Evidence
Based Medicine (EBM)
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What Kind of Question Do I Have?
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Basic science or background question?
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Clinical question?
• What is an olecranon?
• What are the risk factors for hypertension?
• Which is better for diagnosing pneumonia: x-ray,
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CT or MRI?
How should I treat otitis media?
How much does amoxicillin cost?
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Answering a Background Question
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Searching most efficient
Google/Wikipedia (assess the validity)
Use Medical Dictionary
Basic Science Textbooks
• Access Medicine
• Thieme
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Searching with Google
$ubscription
Free
Web Based
Medical Information
Google Search
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Your eBookshelf
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Medical Dictionaries
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Stedman’s is at eMedicine, in PEPID
Dorland’s at Merck
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Exercises for Practice
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Using Stedman’s Medical Dictionary
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Look up:
dyspnea
teratogenic
epistaxis
cyanosis
• eMedicine online
• PEPID online and PDA
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nephrolithiasis
iatrogenic
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Books on the Library Web Page
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When to Use
eBooks versus Quick References
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Background information on topic
• Basic science question instead of disease
specific question
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Detailed information/explanations versus
bottom line
Lots of time versus short on time
Zebras versus common problems
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WebFeat Search
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Searches Library Resources
Pick the type of resources to
search
Groups by resource
Uses resource search engine
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New Website Searches
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Multi-Search =
Webfeat
Changing to
SerialSolutions
360, August 2010
Only eBooks and
Patient Education
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Access Medicine
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Best selection of all basic science books
Combined with good clinical medicine
books
Search productive
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Answering Clinical
Questions
At the Point of Care
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Answering Clinical Questions
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Quickest method: Browse to specific
resource
Requires: knowing the content of
sites/resources
Starting point: Library web page or your
handheld (iPod or cell phone)
Learn to use subscription resources
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Current Library Web Site
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(Sum 2010)
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New Library Webpage
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Access Issues
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IP address verification
Limited simultaneous users
Special URL issues
Bottom Line
• Use links on Library Homepage
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Off Campus Access
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IP authentication
Proxy server – EZProxy
FSU COM ID and password
Use links on library page
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Current Site
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New Site
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Primary Resources of the
Maguire Medical Library
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Differential Diagnosis
Tools
DxPlain
PEPID
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Differential Diagnosis Tools
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Enter symptoms or
chief complaint
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PEPID ***
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eMedicine **
Access Medicine’s
• Get a differential
• Get more info on
disease
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DxPlain *****
• Harvard
• Allows for multiple
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symptoms and lab
results
Drawback: Slow
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• Multiple symptoms
• Lab Results
• Age, gender, duration
• Diagnosaurus* (DDX
tab)
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Exercises for Practice
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Using DxPlain or PEPID
Patient 35 yr old female
Chief complaint – fatigue, duration 2
months
• Other symptoms: throat pain, cold intolerance,
weight gain, bradycardia, and constipation,
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Differential?
• Add lab:
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elevated TSH
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Drug Information
Epocrates Online
PEPID
Harrison’s Practice
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Epocrates Online
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Rx, OTC and Alternative
medicines by brand name,
generic, and by class
Formularies
Drug Interaction tool
Disease reference, pill identifier,
medical calculators, tables
Constantly updated
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Epocrates Drug Interaction
MultiCheck Tool
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Add all the drugs on the patients
medications list (Rx, OTC, Alt) plus drug
considering
Look to see if any interactions
What is the severity of interaction
PEPID CRC Suite
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Rx, OTC and Alternative
medicines by brand name,
generic, and by class
Drug Interaction tool
DDx, Disease reference, Lab
manual, medical calculators,
clerkships, images
Constantly updated
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PEPID Drug Interaction Tool
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Select all drugs on
list
Say Done
Click Interactions
Click specific
interaction to read
details
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Exercises for Practice
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Using Epocrates Online
How should you prescribe acyclovir for
chicken pox in an immunocompromised
patient? (dose)
How much do 9 (50 mg) tablets of
Imitrex cost? (common migraine drug)
Are there any drug interactions between
Lexapro, Lortab, Xanax and Zocor?
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Disease Quick References
DynaMed (Web and PDA)
eMedicine (Web and PDA)
Harrison’s Practice (Web and PDA)
Epocrates Dx
PEPID
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Types of Questions Best Answered by
Disease Quick References
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Description/background
Epidemiology
Diagnosis
Treatment
Ongoing management
Prognosis/outcomes
Prevention
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Bottom
Line
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DynaMed
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Most comprehensive disease reference
Summarizes all the latest research on topic
Very detailed
Well organized
Links out to full text articles if more details
needed
Includes both diseases and symptoms like
chest pain
PDA and Online
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DynaMed
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Organization:
Includes History and
Physical sections (why am I
asking these questions)
Expand or collapse
sections
Use CTRL-F to search
page
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Exercises
Dynamed Exercise
for Practice
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Using Dynamed -- Question: What is the
typical history of present illness for
someone with SARS?
Type in SARS or use alphabetical listing
Explode History
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Use FireFox
eMedicine
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Moderate amount of detail and information
Several monographs on one topic by
different specialties
Google searches it
Now owned by WebMD/Medscape. Suggest
registering.
One of Student’s favorite
iPhone version in Medscape
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eMedicine Monographs
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Subscription eliminates ads found on
free Medscape site
One long page of information
Navigation clunky, inconsistent
CTRL-F
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Exercises for Practice
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Using eMedicine - Question: What is the
functional anatomy when you have a
Rotator Cuff Injury?
Search or browse to Rotator Cuff Injury.
Use Sports Medicine article.
Select Introduction
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Harrison’s Practice
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Internal Medicine focus
Linked to Access
Medicine content
Has drug information from
GoldStandard
Nice navigation on left
side
PDA and Online
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Exercises for Practice
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Using DynaMed, eMedicine, Epocrates and/or
Harrison’s Practice:
• Develop a scenario for CSSC practice
• Complete form provided
• (optional) Pick from diseases top 10 DDx in primary
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care or top 20 diagnoses seen by students
Complete electronically (form on Blackboard)
Change file name to your name (John_Doe.doc)
Upload to Blackboard Assignments Tab on D101 BB
by Friday the 7/23/09, by midnight
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Top 10 Chief Concerns
1.
2.
3.
4.
5.
Cough
Fatigue
Low Back Pain
Fever
Dyspnea
6.
7.
8.
9.
10.
Generalized
Abdominal Pain
Headache
Vertigo
Chest Pain
Edema
Ponka, D., et al. Top Ten Differential Diagnoses in Primary Care. [Web
Resource] U of Ottowa. 2006. Accessed at www.familymedicine.uottawa.ca/
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Top 20
Diseases
Recorded by FSU CoM Students in 3
1. Hypertension
2. Depression
3. Hyperlipidemia
4. Diabetes Type 2
5. Bipolar disorder
6. Anxiety disorder
7. Cold/URI
8. ADHD
9. Otitis media
10. Schizophrenia
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12.
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15.
16.
17.
18.
19.
20.
rd
year Clerkships
Obesity
Gall Bladder disease
GERD
Asthma
Sinusitis
Substance abuse
COPD
Coronary Artery Disease
Peripheral vascular disease
Pneumonia
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iPod/iPhone/iPad Versions
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Clinical Evidence
DynaMed
Epocrates Essentials
Essential Evidence+
Harrison’s Practice
PEPID
Geriatrics at Your
Fingertips
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Free resources
• ePSS USPSTF Tool
• Mobile Merck
•
Medicus
Medscape
PDAs to be distributed in August 25-27
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Review
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Name three things you should look for in a
web site with medical information that would
make you feel more confident about the
content of that website.
What resources are going to be the most
accurate, reliable, and up to date?
Name a library drug reference, a differential
diagnosis resource, and a disease quick
reference
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