I'm All Shook Up … How to Stay I'm All Shook Up … How to Stay Ahead of the Constantly Changing Ahead of the Constantly Changing

Medical Information BusinessMedical Information Business

Scott M. Strayer, MD, MPHScott M. Strayer, MD, MPHAssociate ProfessorAssociate Professor

Department of Family MedicineDepartment of Family MedicineUniversity of Virginia Health University of Virginia Health

SystemSystem

ObjectivesObjectives1. Apply a practical, evidence-based framework for 1. Apply a practical, evidence-based framework for evaluating medical information tools. evaluating medical information tools.

2. Understand how clinicians use point of care technology to 2. Understand how clinicians use point of care technology to “hunt” for evidence-based information that can be applied “hunt” for evidence-based information that can be applied to clinical decision making on a daily basis. to clinical decision making on a daily basis.

3. Understand how clinicians use “foraging” tools to 3. Understand how clinicians use “foraging” tools to systematically sift through new medical information that is systematically sift through new medical information that is valid and relevant to clinical practice. valid and relevant to clinical practice.

4. Evaluate “hunting” and “foraging” tools to determine the 4. Evaluate “hunting” and “foraging” tools to determine the validity and relevance of their information sources.validity and relevance of their information sources.

Scientific discoveries will Scientific discoveries will require technological solutions require technological solutions

that allow physicians to that allow physicians to access the latest findings 24 access the latest findings 24 hours a day, 7 days a week, hours a day, 7 days a week, online and on demand, as online and on demand, as

medical learning becomes a medical learning becomes a nonstop processnonstop processNewt Gingrich, AAFP Assembly, Newt Gingrich, AAFP Assembly,

Sep 28, 2006Sep 28, 2006

Medical Information is Big Business Medical Information is Big Business Now!Now!

New EPS Research Forecasts The Scientific, Technical & Medical (STM) Information Market To Reach Nearly $11 Billion Dollars By 2008

·Publicly-traded STM publishers grew 8.6% in their reported currencies in 2005; aggregate profit margins held steady at 25% ·Thomson posted the strongest increase in profits with a year-over-year gain of 20.5%, outperforming its peers and the market average of 17.7% ·Elsevier achieved the strongest organic growth: 5% and 6% in its Science & Technology and Health Sciences divisions, respectively ·The five largest players (Reed Elsevier, Thomson, Wolters Kluwer, Springer and Wiley) continued to

acquire scale, and now account for over half (52.3%) of total market revenues ·Revenues from digital content distribution may be nearing a tipping point: 60% of STM

First Wave of Acquisitions in First Wave of Acquisitions in Medical Information BusinessMedical Information Business

Wiley publishers now owns InfoRetriever Wiley publishers now owns InfoRetriever and Info Poems, now “Essential Evidence”and Info Poems, now “Essential Evidence”Ebsco publishers owns DynamedEbsco publishers owns Dynamed

Recent Changes

Skyscape acquired by Physicians Skyscape acquired by Physicians Interactive, Inc. (2009)Interactive, Inc. (2009)Wolters Kluwers acquired UpToDate Wolters Kluwers acquired UpToDate (2008)(2008)Large publishers and other businesses Large publishers and other businesses focused on profitability will continue to focused on profitability will continue to acquire evidence based sourcesacquire evidence based sources

How did most physicians How did most physicians find out about that new find out about that new

smoking cessation drug?smoking cessation drug?

Varenicline, an 4 2 Nicotinic Acetylcholine Receptor Partial Agonist, vs Sustained-Release Bupropion and Varenicline, an 4 2 Nicotinic Acetylcholine Receptor Partial Agonist, vs Sustained-Release Bupropion and Placebo for Smoking Cessation Placebo for Smoking Cessation A Randomized Controlled Trial A Randomized Controlled Trial David Gonzales, PhD; Stephen I. Rennard, MD; Mitchell Nides, PhD; Cheryl Oncken, MD; Salomon Azoulay, MD; David Gonzales, PhD; Stephen I. Rennard, MD; Mitchell Nides, PhD; Cheryl Oncken, MD; Salomon Azoulay, MD; Clare B. Billing, MS; Eric J. Watsky, MD; Jason Gong, MD; Kathryn E. Williams, PhD; Karen R. Reeves, MD; for Clare B. Billing, MS; Eric J. Watsky, MD; Jason Gong, MD; Kathryn E. Williams, PhD; Karen R. Reeves, MD; for the Varenicline Phase 3 Study Group the Varenicline Phase 3 Study Group

JAMA.JAMA. 2006;296:47-55.  2006;296:47-55. Context Context  The 4 2 nicotinic acetylcholine receptors (nAChRs) are linked to the reinforcing effects of nicotine and The 4 2 nicotinic acetylcholine receptors (nAChRs) are linked to the reinforcing effects of nicotine and maintaining smoking behavior. Varenicline, a novel 4 2 nAChR partial agonist, may be beneficial for smoking maintaining smoking behavior. Varenicline, a novel 4 2 nAChR partial agonist, may be beneficial for smoking cessation. cessation. Objective Objective  To assess efficacy and safety of varenicline for smoking cessation compared with sustained-release To assess efficacy and safety of varenicline for smoking cessation compared with sustained-release bupropion (bupropion SR) and placebo. bupropion (bupropion SR) and placebo. Design, Setting, and Participants Design, Setting, and Participants  Randomized, double-blind, parallel-group, placebo- and active-treatment– Randomized, double-blind, parallel-group, placebo- and active-treatment–controlled, phase 3 clinical trial conducted at 19 US centers from June 19, 2003, to April 22, 2005. Participants controlled, phase 3 clinical trial conducted at 19 US centers from June 19, 2003, to April 22, 2005. Participants were 1025 generally healthy smokers ( 10 cigarettes/d) with fewer than 3 months of smoking abstinence in the were 1025 generally healthy smokers ( 10 cigarettes/d) with fewer than 3 months of smoking abstinence in the past year, 18 to 75 years old, recruited via advertising. past year, 18 to 75 years old, recruited via advertising. Intervention Intervention  Participants were randomly assigned in a 1:1:1 ratio to receive brief counseling and varenicline Participants were randomly assigned in a 1:1:1 ratio to receive brief counseling and varenicline titrated to 1 mg twice per day (n = 352), bupropion SR titrated to 150 mg twice per day (n = 329), or placebo titrated to 1 mg twice per day (n = 352), bupropion SR titrated to 150 mg twice per day (n = 329), or placebo (n = 344) orally for 12 weeks, with 40 weeks of nondrug follow-up. (n = 344) orally for 12 weeks, with 40 weeks of nondrug follow-up. Main Outcome Measures Main Outcome Measures  Primary outcome was the exhaled carbon monoxide–confirmed 4-week rate of Primary outcome was the exhaled carbon monoxide–confirmed 4-week rate of continuous abstinence from smoking for weeks 9 through 12. A secondary outcome was the continuous continuous abstinence from smoking for weeks 9 through 12. A secondary outcome was the continuous abstinence rate for weeks 9 through 24 and weeks 9 through 52. abstinence rate for weeks 9 through 24 and weeks 9 through 52. Results Results  For weeks 9 through 12, the 4-week continuous abstinence rates were 44.0% for varenicline vs 17.7% For weeks 9 through 12, the 4-week continuous abstinence rates were 44.0% for varenicline vs 17.7% for placebo (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.70-5.50; for placebo (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.70-5.50; PP<.001) and vs 29.5% for bupropion <.001) and vs 29.5% for bupropion SR (OR, 1.93; 95% CI, 1.40-2.68; SR (OR, 1.93; 95% CI, 1.40-2.68; PP<.001). Bupropion SR was also significantly more efficacious than placebo <.001). Bupropion SR was also significantly more efficacious than placebo (OR, 2.00; 95% CI, 1.38-2.89; (OR, 2.00; 95% CI, 1.38-2.89; PP<.001). For weeks 9 through 52, the continuous abstinence rates were 21.9% for <.001). For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; PP<.001) and vs 16.1% for bupropion SR (OR, 1.46; <.001) and vs 16.1% for bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; 95% CI, 0.99-2.17; PP = .057). Varenicline reduced craving and withdrawal and, for those who smoked while  = .057). Varenicline reduced craving and withdrawal and, for those who smoked while receiving study drug, smoking satisfaction. No sex differences in efficacy for varenicline were observed. receiving study drug, smoking satisfaction. No sex differences in efficacy for varenicline were observed. Varenicline was safe and generally well tolerated, with study drug discontinuation rates similar to those for Varenicline was safe and generally well tolerated, with study drug discontinuation rates similar to those for placebo. The most common adverse events for participants receiving active-drug treatment were nausea (98 placebo. The most common adverse events for participants receiving active-drug treatment were nausea (98 participants receiving varenicline [28.1%]) and insomnia (72 receiving bupropion SR [21.9%]). participants receiving varenicline [28.1%]) and insomnia (72 receiving bupropion SR [21.9%]). Conclusion Conclusion  Varenicline was significantly more efficacious than placebo for smoking cessation at all time points Varenicline was significantly more efficacious than placebo for smoking cessation at all time points and significantly more efficacious than bupropion SR at the end of 12 weeks of drug treatment and at 24 weeks. and significantly more efficacious than bupropion SR at the end of 12 weeks of drug treatment and at 24 weeks.

For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; PP<.001) and vs 16.1% for <.001) and vs 16.1% for bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; PP = .057). = .057).

0.99 1.46

Difference could be this minimal(1% decrease)

Difference could be this high(117% increase)

95% C.I.

Since the 95% CI crosses 1.0, the difference is not significant

1.0

For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline For weeks 9 through 52, the continuous abstinence rates were 21.9% for varenicline vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; vs 8.4% for placebo (OR, 3.09; 95% CI, 1.95-4.91; PP<.001) and vs 16.1% for <.001) and vs 16.1% for bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; bupropion SR (OR, 1.46; 95% CI, 0.99-2.17; PP = .057). = .057).

2.17

How Well Do We Distribute How Well Do We Distribute New InformationNew Information??

Left to our own devicesLeft to our own devices 1987: Of 28 Landmark trials, only 2 had 1987: Of 28 Landmark trials, only 2 had

an immediate (1-2 year) effect on clinical an immediate (1-2 year) effect on clinical practice practice Fineberg HV. Clinical evaluation: how does it Fineberg HV. Clinical evaluation: how does it influence medical practice? Bull Cancer 1987;74:333-46.influence medical practice? Bull Cancer 1987;74:333-46.

1992: Thrombolytic therapy for acute MI: 1992: Thrombolytic therapy for acute MI: 13 years after proof of benefit before 13 years after proof of benefit before review articles suggest it for routine usereview articles suggest it for routine useAntman EM, et al. A comparison of results of meta-analyses Antman EM, et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA experts. Treatments for myocardial infarction. JAMA 1992;268:240-8.1992;268:240-8.

How Well Do We Distribute How Well Do We Distribute New InformationNew Information? ?

1996: Little effect of publication of the ISIS-2 1996: Little effect of publication of the ISIS-2 (Aspirin works post-MI) and diltiazem post-(Aspirin works post-MI) and diltiazem post-infarction trial (diltiazem doesn’t work).---ASA infarction trial (diltiazem doesn’t work).---ASA and Diltiazem use---no change after trialand Diltiazem use---no change after trialCol NF, et al. The impact of clinical trials on the use of medications for Col NF, et al. The impact of clinical trials on the use of medications for acute myocardial infarction. Arch Int Med 1996; 156: 54 - 60.acute myocardial infarction. Arch Int Med 1996; 156: 54 - 60.

Majumdar 2003:Majumdar 2003: HOPEHOPE study – study – in ramipril prescribing by 5% per month in ramipril prescribing by 5% per month

without advertising, 12% without advertising, 12% per month per month withwith advertising advertising over the next 2 yearsover the next 2 yearsMajumdar SR, et al. Synergy between publication and promotion: Comparing Majumdar SR, et al. Synergy between publication and promotion: Comparing adoption of new evidence in Canada and the United States. Am J Med adoption of new evidence in Canada and the United States. Am J Med 2003;115:467-72.2003;115:467-72.

How Well Do We Distribute How Well Do We Distribute New InformationNew Information??

Bottom Line:Bottom Line: Change occurs quicklyChange occurs quickly

When supported by lots of publicity or When supported by lots of publicity or pharmaceutical company marketing pharmaceutical company marketing (like any consumer product)(like any consumer product)

Change is much slowerChange is much slowerWhen left up to publications or word of When left up to publications or word of mouth for dissemination of informationmouth for dissemination of information

Two Tools Needed to Master Two Tools Needed to Master Information- BMJ 1999Information- BMJ 1999

A method of being A method of being alertedalerted to new information (a to new information (a “foraging” or “push” tool)“foraging” or “push” tool)A tool for A tool for findingfinding the information again when you the information again when you need it. (a “hunting” or “pull” tool)need it. (a “hunting” or “pull” tool)Without both:Without both: You don’t know that new info. is availableYou don’t know that new info. is available You can’t find it when you doYou can’t find it when you doClinical example- Anticholinergics for COPDClinical example- Anticholinergics for COPD

Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools for lifelong learning? British Medical Journal 1999 (13 Nov): for lifelong learning? British Medical Journal 1999 (13 Nov): www.bmj.com. . (http://bmj.com/cgi/reprint/319/7220/1280.pdf)(http://bmj.com/cgi/reprint/319/7220/1280.pdf)

Information Mastery in a Information Mastery in a NutshellNutshell

Clinically useful information can be defined by:Clinically useful information can be defined by:

Usefulness = Usefulness = Relevance x ValidityRelevance x Validity WorkWork

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Everything. Information Master:Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13.The Journal of Family Practice 1994;38:505-13.

Highly Controlled ResearchRandomized Controlled TrialsSystematic Reviews

Physiologic ResearchPreliminary Clinical ResearchCase reportsObservational studies

Uncontrolled Observations&

Conjecture

Effect on Patient-Oriented OutcomesSymptomsFunctioningQuality of LifeLifespan

Effect on Disease MarkersDiabetesArthritisPeptic Ulcer

Effect on Risk Factors for DiseaseImprovement in markers (blood pressure, cholesterol)

Valid Patient-OrientedEvidence

Validity of Evidence

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Strayer’s Corollary: Information Strayer’s Corollary: Information Mastery and ComputersMastery and Computers

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13.Everything. The Journal of Family Practice 1994;38:505-13.Can be reduced by

computers

Usefulness = Relevance x Validity Work

Not always assessed by software

Clinicians demand “just-in-time” Clinicians demand “just-in-time” resourcesresources

48 randomly selected generalist physicians in 48 randomly selected generalist physicians in ambulatory careambulatory careAsked 1062 questions but only answered 585 Asked 1062 questions but only answered 585 (55%)(55%)Obstacles:Obstacles: Doubt that answer exists (11%)Doubt that answer exists (11%) Selected source doesn’t have answer (26%)Selected source doesn’t have answer (26%) Requested comprehensive sources that answer Requested comprehensive sources that answer

questions likely to occur in clinical practice with questions likely to occur in clinical practice with emphasis on treatment and bottom-line adviceemphasis on treatment and bottom-line advice

Help locating information quickly with lists, bolded Help locating information quickly with lists, bolded sub-headings, algorithms….avoid lengthy textsub-headings, algorithms….avoid lengthy text

Ely et al J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.

Quality Hunting and Foraging Quality Hunting and Foraging Systems---A New DefinitionSystems---A New Definition

1. How is the information filtered?1. How is the information filtered? Patient- vs disease- oriented?Patient- vs disease- oriented? Specialty-specific?Specialty-specific? Comprehensive? Which journals?Comprehensive? Which journals? Does it matter (change my practice?) or is it Does it matter (change my practice?) or is it

simply news?simply news?

2. Is the information valid?2. Is the information valid? must have levels of evidence labelsmust have levels of evidence labels Beware “Trojan Horse”!Beware “Trojan Horse”!

Quality Hunting and Foraging Quality Hunting and Foraging Foraging SystemsForaging Systems

3. How well is information summarized?3. How well is information summarized? 2000 - 3000 words 2000 - 3000 words accuratelyaccurately in 200 words in 200 words

4. Is the information placed into context?4. Is the information placed into context? Much more than abstractsMuch more than abstracts ““Translational Validity”Translational Validity”

Hunting ToolsHunting ToolsHuntingHunting First Consult—www.firstconsult.comFirst Consult—www.firstconsult.com Essential EvidenceEssential Evidence Up To Date---www.uptodateonline.comUp To Date---www.uptodateonline.com DynaMed---www.dynamicmedical.com/DynaMed---www.dynamicmedical.com/ Medscape---www.medscape.comMedscape---www.medscape.com Database of Abstracts of Reviews of Effectiveness Database of Abstracts of Reviews of Effectiveness

DARE---http://agatha.york.ac.uk/darehp.htmDARE---http://agatha.york.ac.uk/darehp.htm Translating Research Into Practice (TRIP)--- Translating Research Into Practice (TRIP)---

www.tripdatabase.comwww.tripdatabase.com

Foraging ToolsForaging ToolsSystematically identified tools between May-Systematically identified tools between May-August 2007August 2007Searched Internet for all medical content sites Searched Internet for all medical content sites (e.g. Medscape, WebMD, etc.)(e.g. Medscape, WebMD, etc.)Searched well-known evidence-based Searched well-known evidence-based databases (e.g. Cochrane, TRIP, DARE)databases (e.g. Cochrane, TRIP, DARE)Monitored List-serves for Health IT and PDA Monitored List-serves for Health IT and PDA tools (e.g. Palm-Med, Wireless Medical tools (e.g. Palm-Med, Wireless Medical Applications, STFM EBM)Applications, STFM EBM)Consulted with experts and practicing physiciansConsulted with experts and practicing physiciansSent invitations to list-serves for suggestionsSent invitations to list-serves for suggestions

tool Abbrev. URL

American College of Physicians Journal Club AC www.acpjc.org

American Family Physician Tips AF www.aafp.org

BMJ Clinical Evidence CE http://clinicalevidence.bmj.com/ceweb/index.jsp

Cochrane for Clinicians CC http://www.aafp.org/afp/20070501/cochrane.html

Doctor’s Guide DG www.docguide.com

Dynamed Weekly Update DM http://www.ebsconewsletter.com/dmweeklyupdate/index000242960.cfm?x=b11,0,w

Epocrates DocAlerts EP www.epocrates.com

Essential Evidence Plus (formerly InfoPoems) EE http://infopoems.com

FPIN Clinical Inquiries FP http://www.aafp.org/afp/20070101/fpin.html

Global Family Doctor Daily Alerts GF www.globalfamilydoctor.com

Journal Abstracts Delivered Electronically (JADE)

JD www.biodigital.org/jade

Journal Watch JW www.jwatch.org

MD Linx Network LX www.mdlinx.com

Medscape Best Evidence (also BMJ Updates and McMaster Plus)

ME www.medscape.com

PeerView Institute PV www.peerview-institute.org

Physician’s First Watch PW http://firstwatch.jwatch.org/misc/about.dtl?q=etoc

Skyscape ARTbeat SA www.skyscape.com/Estore/ProductDetail.aspx?ProductID=924

Treatment Guidelines TG www.medicalletter.org

Hunting and Foraging SystemHunting and Foraging SystemRisksRisks

““Spyware”: Spyware”: May be tracking your usageMay be tracking your usage““Trojan Horse”: Trojan Horse”: who’s paying when it’s free?who’s paying when it’s free?Abstracts only: Abstracts only: Journal Watch, Journal Rack, Journal Watch, Journal Rack, Tips from other JournalsTips from other Journals, , ClinicalClinical UpdatesUpdates, , etc. etc. No relevance/ validity filterNo relevance/ validity filterYou can have information “free” and you can You can have information “free” and you can have it “uncensored”, but you can’t have it both have it “uncensored”, but you can’t have it both ways. No Free Lunch!ways. No Free Lunch!

Not All Information Tools Not All Information Tools are Created Equal!are Created Equal!

Quality of Drug Foraging and Quality of Drug Foraging and Hunting ToolsHunting Tools

Strayer, SM, Slawson, DC, Shaugnessy, AM, Disseminating Drug PrescribingInformation: The COX-2 Inhibitor Withdrawals. JAMIA 2006. 13:396-398.

A Few Foraging Tools…A Few Foraging Tools…

Beware of the Trojan Beware of the Trojan HorseHorse

Will Skyscape Become a new Trojan Horse Information

Source?

A Few Hunting Tools…A Few Hunting Tools…

Rating Hunting and Rating Hunting and Foraging ToolsForaging Tools

Rating Hunting and Foraging ToolsRating Hunting and Foraging ToolsHunting Tool Evaluation WorksheetHunting Tool Evaluation WorksheetForaging Tool Evaluation WorksheetForaging Tool Evaluation Worksheet

BMJ Updates

Hunting and Foraging ToolsHunting and Foraging ToolsForagingForaging

InfoPoems---www.infopoems.comInfoPoems---www.infopoems.com Peer View Institute---Peer View Institute---

www.peerview-institute.org/www.peerview-institute.org/ Journal Alerts---Journal Alerts---

www.globalfamilydoctor.com/dailywww.globalfamilydoctor.com/dailyalerts/main.htmalerts/main.htm

Medscape Best EvidenceMedscape Best Evidence(http://hiru.mcmaster.ca/MORE/(http://hiru.mcmaster.ca/MORE/HowRatingsAreUsed.htm)HowRatingsAreUsed.htm)

MDLinxMDLinx BMJ Updates BMJ Updates

(http://bmjupdates.mcmaster.ca)(http://bmjupdates.mcmaster.ca) First Watch (www.jwatch.org)First Watch (www.jwatch.org) Cochrane PEARLSCochrane PEARLS

HuntingHunting First Consult—First Consult—

www.firstconsult.comwww.firstconsult.com InfoPoemsInfoPoems Up To Date---Up To Date---

www.uptodateonline.comwww.uptodateonline.com DynaMed---DynaMed---

www.dynamicmedical.com/www.dynamicmedical.com/ Medscape---Medscape---

www.medscape.comwww.medscape.com Database of Abstracts of Database of Abstracts of

Reviews of Effectiveness Reviews of Effectiveness DARE---http://agatha.york.ac.DARE---http://agatha.york.ac.uk/darehp.htmuk/darehp.htm

Translating Research Into Translating Research Into Practice (TRIP)--- Practice (TRIP)--- www.tripdatabase.comwww.tripdatabase.com

Foraging Tools ResultsForaging Tools Results

Only seven tools had specific criteria for Only seven tools had specific criteria for both relevance and validityboth relevance and validity American College of Physicians Journal ClubAmerican College of Physicians Journal Club BMJ Clinical EvidenceBMJ Clinical Evidence Cochrane for CliniciansCochrane for Clinicians DynaMedDynaMed Essential Evidence (formerly InfoRetriever)Essential Evidence (formerly InfoRetriever) FPIN Clinical InquiriesFPIN Clinical Inquiries Treatment Guidelines (Medical Letter)Treatment Guidelines (Medical Letter)

SummarizeSummarize

Evidence-based clinical decision making Evidence-based clinical decision making requires a coordinated “hunting” and requires a coordinated “hunting” and “foraging” tool.“foraging” tool.Use the principles of Information Mastery Use the principles of Information Mastery to evaluate your information tools.to evaluate your information tools.Not all information tools are created Not all information tools are created alike---evaluate using worksheets.alike---evaluate using worksheets.

Contact InformationContact Information

E-mail: sstrayer@virginia.eduE-mail: sstrayer@virginia.eduInformation Mastery Course: Information Mastery Course: http://www.healthsystem.virginia.edu/interhttp://www.healthsystem.virginia.edu/internet/familymed/information_mastery/net/familymed/information_mastery/information_mastery_course.cfminformation_mastery_course.cfmCenter for Information Mastery: Center for Information Mastery: http://www.healthsystem.virginia.edu/interhttp://www.healthsystem.virginia.edu/internet/familymed/information_mastery/net/familymed/information_mastery/info_mastery.cfminfo_mastery.cfm