Need to Know: Western Libraries

Internal Medicine Residents

Agenda

• How to access the evidence • How to search the evidence

1. Western Libraries: What we’ve got Journals

and databases

Books

Clinical Tools

Learning modules

Calculators

Drug Identification Tools

Images

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

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

- Select Browse by Program

- Select Medicine and Dentistry

- Select a specialty

http://www.lib.uwo.ca/programs/generalmedicine/Use this page to find selected resources for general medicine

Electronic Books

Point of Care Tools

Databases

Image and video collections

2. How to search our collections

Select “Catalogue”

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

...including:

• Journals• Books• Databases• Point of Care Tools

http://alpha.lib.uwo.ca

You can even search for electronic full-text journals.

Select “Journal Title”

Then enter the name of the journal

And select “Go”

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

Exercise

• How would you get a hold of this article?

1: 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.

Searching

Exercise 1

• Answer the following background question using the library website:

What conditions are in the differential diagnosis for atrial fibrillation?

(hint: check AHA Clinical Cardiac Consult)

Clinical 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 atrial fibrillation wishes to discontinue taking warfarin. You consider aspirin as an alternative therapy for reducing the patient’s risk of stroke when a colleague suggests you prescribe both aspirin and clopidogrel

Create an answerable question

In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?

Population Patients with atrial fibrillation

Intervention Aspirin alone

Comparison Aspirin combined with clopidogrel

Outcomes Prevention of stroke

Clarify the question type

In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?

What kind of question is this?

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 Pyramid

Less time

More time

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

Formulating your search

• State the search question• Isolate the main concepts (keywords)• Search each concept separately• Use controlled vocabulary if available (MeSH)• Combine search sets to get final results• Apply limits (language, age group)

Exercise

• In groups, search the following resources to answer the question: In patients with atrial fibrillation is aspirin alone more effective than aspirin combined with clopidogrel in preventing stroke?

1. Cochrane Library2. Micromedex3. PubMed4. EMBASE5. e-CPS

Conclusions

• Number of results

Source Hits

PubMed 100 (11 if searching narrow/therapy study category)

Cochrane Library 6

Embase 256

Micromedex 2

e-CPS 1 drug monograph

Evidence Pyramid

Cochrane Library

Micromedexe-CPS

PubMed

EMBASE

Summary & Key Points

• “Off campus access” • Browse by Program pages• The Library Catalogue• Clinical Questions• Constructing a search• Levels of Evidence

And, finally...• Who to call for help:

– Research Help: General or access type questions• Service Desk• Phone: 519 661 3168• Email, Chat: http://www.lib.uwo.ca/taylor/researchhelp.shtml

– Subject Librarian (Robin): Specific searching questions• Phone: 519 661 2111 ext: 86383• Email: rfeathe@uwo.ca• Chat: http://www.lib.uwo.ca/programs/generalmedicine/

Questions?