Transcript How to find Point-of-Care resources to answer clinical questions

Point-of-Care Resources to Answer
Clinical Questions
Nicole Capdarest-Arest, MA(LIS)
From: Clinical Questions Raised by Clinicians at the Point
of Care: A Systematic Review
JAMA Intern Med. 2014;174(5):710-718.
doi:10.1001/jamainternmed.2014.368
“In 20 studies that provided
sufficient data, the frequency
of questions ranged from 0.16
to 1.85 per patient seen.”
Figure Legend:
Frequency of Clinical Questions per Patient Seen, Percentage of
Questions Pursued, and Percentage Answered
Copyright © 2014 American Medical
Association. All rights reserved.
From: Clinical Questions Raised by Clinicians at the Point of Care: A Systematic Review
JAMA Intern Med. 2014;174(5):710-718. doi:10.1001/jamainternmed.2014.368
“34% of the
questions asked were
about drug
treatment, and 24%
were related to the
potential causes of a
symptom, physical
finding, or diagnostic
test finding.”
Figure Legend:
Clinical Questions Classified According to the Taxonomy of Ely et ala
Copyright © 2014 American Medical
Association. All rights reserved.
From: Clinical Questions Raised by Clinicians at the Point of Care: A Systematic Review
JAMA Intern Med. 2014;174(5):710-718. doi:10.1001/jamainternmed.2014.368
A few of the most common barriers to pursuing clinical
questions:
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•
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•
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Lack of time
Question not urgent
Question not important
Doubt that a useful answer exists
Forgetting question
Referral
Step 1
Photo: Alvaro Millan, https://www.flickr.com/photos/soroll/3804570043/
Step 2
Use your information toolkit to
find answers to clinical
questions
Lane Clinical Search Tool
Mobile
Laptop, desktop, COW
PubMed & PubMed Clinical Queries
PubMed Clinical Queries
PubMed: Efficient Searching
Quick:
• Boolean (AND, OR, NOT)
• Wildcard
(immun*=immune,
immunology, immunize,
etc.)
• Phrase (“immune system”)
• Tags
[ti] =limit to title
[tiab] =limit to title/abstract
Powerful:
• Medical Subject Headings
(MeSH)
Examples:
1. “Arthritis, juvenile”[Mesh]
2. "Health Literacy"[Mesh] AND
"Internship and
Residency"[Mesh]
Example
I want to find articles about the impact of cold temperature on exerciseinduced asthma in children.
Search: ("Asthma, Exercise-Induced"[Mesh]) AND ("Cold Temperature"[Mesh]
OR cold[ti]), use left sidebar to filter to children
Use similar techniques in Google to quickly get to relevant results
Example:
"exercise-induced asthma" AND (cold OR "cold weather") AND
guideline AND (site:.gov OR site:.edu OR site:.org)
Break it down:
Phrase: “exercise-induced asthma” – quotes search as phrase
AND, OR: to combine terms
Parentheses: to group parts of the search, just like in mathematics
Limit: “Site:.____” searches sites that end in .gov, .edu or .org
NOTE: another great limit is “doctype:.____” (e.g., doctype:.ppt)
UpToDate Anywhere/Mobile
Get set up: http://lane.stanford.edu/help/uptodate-mobile.html
DynaMed
…or DynaMed Mobile via Skyscape
Obtain serial number from Lane Library:
http://lane.stanford.edu/search.html?so
urce=all-all&q=dynamed
mobileMicromedex apps
Access Micromedex apps on mobile devices:
• Lane Library home page >> Micromedex >>
select mobileMicromedex from top left of
screen and follow download instructions
– Micromedex Drug Reference
– Micromedex Drug Interactions
– Micromedex IV Compatibility
CDC Vaccine Schedules App
Visually mimics the CDC vaccine schedules for
children, adolescents and adults
• http://www.cdc.gov/vaccines/schedules/hcp/
schedule-app.html
• Schedules, recommendations, catch-ups,
precautions, resources
Pediatric Care Online
• From AAP
• Go to AAP website from on campus so
AAP recognizes you are with Stanford.
Create an individual login with AAP
(many of you might already have this).
• Download the app and use your
personal login to access app content
• Includes antimicrobial therapy guide,
preventative screening, schedules,
news, care updates, condition quickreference
Step 3
Integrate the information found into your personal
knowledge bank, teaching moments, and patient care.
More informed patient care
Find the
information
Teach a learner to identify
& fill a knowledge gap
Fill your own knowledge gap
AND/OR
Stuck? Ask Us
And you can always contact a librarian
for help…
• Connect you or your learners with information you need for
research or clinical questions
• Teach you or your learners how to navigate and search
resources to find literature, images, instruments, curricula,
etc.
• Help with EBM questions and instruction
• Help with lit reviews, systematic reviews
• Teach you how to manage resources (e.g., RefWorks,
EndNote, Zotero, Mendeley)
• Show you ways to keep current with the literature
• Show you how to obtain an article that Lane doesn’t license
• And more... just ask!