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Literature Search Exercise SEBMA F2

This document provides an overview of evidence-based healthcare and literature searching. It discusses the importance of clinical questions, different types of literature including primary and secondary sources, and hierarchies of evidence. Examples are provided to guide novice clinicians on how to practically search literature databases like PubMed and guidelines websites. The document also discusses exercises for practicing evidence-based skills like appraising new studies, calculating numbers needed to treat, and implementing quality improvement initiatives. Healthcare professionals are encouraged to continue self-educating using online resources to incorporate evidence into clinical decision making.

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HealthCare Informatics: The big picture 1
HEALTH CARE LITERACY IS ESSENTIAL TO THE MEDICAL TEAM
Secrets In Literature Searching: Implementing Evidence & Transforming Healthcare Provision Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MemAcadMedEd MSc (UK) MBBS Consultant Physician & Pulmonologist Department of Medical Protocol KAMC, Riyadh Kingdom of Saudi Arabia
Knowledge: Foreground/Background
Ask clinical question novice expert Foreground questions Background question
Types of Literature
Types of Literature  Primary (Original)  Pubmed  Embase  CINAHL  Secondary (Appraised)  Guidelines  Systematic Reviews  Critically appraised Topics CATs
Levels of Evidence: Hierarchy Pyramid
What is Best Evidence? Hierarchy of Levels of Evidence
Sources of Evidence
Types of Resources  Primary (Original)  Pubmed  Embase  CINAHL  Secondary (Appraised)  Guidelines websites: Guideline Clearinhouse  Systematic Review Websites: Cochrane Library  CAT websites: BestBets  Tertiary (Access to both) (meta search engines, databases of databases):  TRIP+ (Translating Research Into Practice)  SumSearch
Exercises for Practice • During the ward round, a medical student inquired about EBM and what it means. • How can you guide him/her if he/she asks you about some literature information?
The Answer • Google it! • YouTube it! • Ask an Expert: – Oxford Center for EBM: http://www.cebm.net/ – KT Clearinghouse: http://ktclearinghouse.ca/
Self-Education & Training in EBM • EBM Resources: – http://guides.mclibrary.duke.edu/c.php?g=158178&p=103 5956 – http://library.medicine.yale.edu/tutorials/subjects/evidenc e-based-practice • CEBM Website: – http://www.youtube.com/user/cebmed, – http://www.cebm.net/index.aspx?o=1965 • YouTube: – http://www.youtube.com/watch?v=odfo9CQGi0c
Exercises for Practice • During the ward round, an R1 inquired about Pubmed and how to use it. • How can you guide him/her on the practicalities of using it?
The Answer • Google it! • YouTube it! • Ask an Expert: – Every Literature Searching Website/Database has its own “How to Use Stuff” – Pubmed: https://www.nlm.nih.gov/bsd/disted/pubmed.html – Cochrane: http://www.cochranelibrary.com/help/how-to- use-cochrane-library.html
Exercises for Practice: Guidelines • Exercise: 1 • “What is the evidence-based management of Appendicitis?" • Exercise: 2 • “What is the evidence-based management of eclampsia?
Looking for EBM information in Guideline Clearinghouse directly from Google
Exercises for Practice: Therapy • Exercise: 1 • "In elderly patients with congestive heart failure, is digoxin effective in reducing the need for re- hospitalization?" • Exercise: 2 • "In a patient with COPD which is more effective in symptom control: LABA or LAMA?
The Answer Primary Resources • Pubmed via PICO: http://pubmedhh.nlm.nih.gov/ • Pubmed Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical • Pubmed Search Box & Limits options: http://www.ncbi.nlm.nih.gov/pubmed/?querykey=4%26dbase=pubmed% 26querytype=eSearch%26 Secondary Resources • Point of Care Resources e.g. UpToDate • Cochrane Library • Guidelines Websites: https://www.guideline.gov/ Tertiary Resources • TRIP Database: https://www.tripdatabase.com/ (plus PICO)
PubMed for Handhelds ** (Download iOS App or Android App ) a.PICO search Patient, Intervention, Comparison, Outcome b.askMEDLINE free-text, natural language search c.Consensus Abstracts * d.MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts Disclaimer | Privacy | Feedback | NLM mobile
Select Publication Type from drop-down menu
The answer  Digoxin initiation is associated with lower risk of all-cause readmission after hospitalisation for heart failure. Hernandez AF; DeVore AD Evid Based Med; 2014 Aug; 19(4):153. PubMed ID: 24639395 [No Abstract] [Full Text] [Related]  Drug therapy to reduce early readmission risk in heart failure: ready for prime time? Vaduganathan M; Fonarow GC; Gheorghiade M JACC Heart Fail; 2013 Aug; 1(4):361-4. PubMed ID: 24621940 [TBL]Readmission for heart failure remains a major focus of policymakers, clinicians, and patients. Despite meeting key national performance measures and frequent use of evidence- based therapies, rates of 30-day post-discharge rehospitalization may be as high as 25%. Digoxin and mineralocorticoid antagonists are known to reduce admissions for heart failure, but are significantly underused in current clinical practice despite their proven benefits. • [Abstract] [Full Text] [Related] • TBL= The Bottom Line
Exercises for Practice: Diagnosis • You are seeing a patient with breathlessness. She is seventy year old and has a known history of Asthma and ischemic heart disease. Her BNP is 122 (N up to 30). Does she have LVF or bronchial asthma exacerbation?
The Answer Primary Resources • Pubmed via PICO • Pubmed Clinical Queries • Pubmed Search Box & Limits options Secondary Resources • Point of Care Resources e.g. UpToDate • Cochrane Library • Guidelines Websites Tertiary Resources • TRIP Database
Exercises for Practice: Diagnosis & Risk Assessment  You are seeing a patient with COPD exacerbation. ABG is as follows: PaO2: 44 mmHg, PaCO2: 62mmHg, pH 7.32, Bicarbonate 34 mmol/l. What is her acid-base diagnosis?  You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Is warfarin therapy indicated? What is her risk of bleeding on warfarin?  How to assess for a DVT risk?  How to assess the severity of acute pancreatitis?  Calculate your own ATPIII 10 year risk for heart disease based on your age, gender, cholesterol and smoking status.
The Answer Decision Support Calculators • Point of Care Resources e.g. UpToDate • Medscape
Exercises for Practice • You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Her family brought her to ER and was found to have acute kidney injury. • Where would you find guidance and a tool for implementing an evidence-based approach to her care?
The Answer NICE Pathways: guidance at your fingertips- www.nice.org.uk Society of Hospital Medicine: http://www.hospitalmedicine.org/ AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov/ Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovem ent/ ICSI Institute for Clinical Systems Improvements http://www.icsi.org/index.aspx
Exercises for Practice • Your mentor passed a new article for a new anti- migraine medication. • You have been told to appraise the article and tell the team about this new medication. • How are you going to do it? • How are you going to calculate the number needed to treat?
The Answer • Oxford Centre for EBM: http://www.cebm.net/?o=1023 http://www.gla.ac.uk/departments/generalpracticeprimarycare/ebp/checkli sts/#d.en.19536  Checklist for an article on treatment or prevention  Checklist for an article on qualitative research  Checklist for an article on decision analysis  Checklist for an article on an educational intervention  Checklist for an article on prognosis  Checklist for an article on harm or causation  Checklist for an article on guidelines  Checklist for an article on diagnosis or screening  Checklist for a systematic review  Checklist for economic evaluations
Exercises for Practice • Diagnosis: What is the sensitivity, specificity and LR for procalcitonin in acute infections? • Diagnosis: What is the sensitivity, specificity and LR for BNP in heart failure? • Therapy: Which is more effective beta-blockers or ACEI in Systolic heart failure:
The Answer • LR & NNT Websites – http://ktclearinghouse.ca/cebm/toolbox – http://www.thennt.com/
Exercises for Practice  Following a non-ST segment elevation myocardial infarction, a man was admitted to the hospital and placed on a telemetry monitor. As the monitor was constantly sounding with "low voltage" and "asystole" alerts and the patient was well each time clinicians checked, they silenced the alarms. The patient was found dead 4 hours later.  What will you do?
Exercises for Practice  A man with cirrhosis and abdominal distension was found to have significant ascites. The emergency department providers performed a large volume paracentesis to relieve his symptoms, but, as the 10th liter of fluid was removed, the patient became acutely hypotensive.  What will you do?
The Answer  WebM&M Morbidity & Mortality Rounds:  http://www.webmm.ahrq.gov/
With its PowerPoint presentation
Exercises for Practice  Medication Side-Effect: A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 12.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor? 49
The Answer  Go to pubmed & Use Subheadings
Exercises for Practice  Audit & Quality Assessment: Which Quality Indicators/Audit criteria can you use in COPD care. 52
The Answer  National Quality Measures Clearinghouse http://www.qualitymeasures.ahrq.gov/sea rch/search.aspx?term=copd  NICE Website Audit Tools http://www.nice.org.uk/about/what-we- do/into-practice/audit-and-service- improvement
Exercises for Practice Quality Improvement:  How do I improve my use of antibiotics at my hospital?  Critical lab. reporting?  Reducing length of Stay?  Reducing readmissions?  Reducing PEG-site infections?  Innovations in practice? 54
The Answer  Agency for Healthcare Research & Quality AHRQ: http://www.ahrq.gov/  The National Institute for Health and Care Excellence (NICE): https://www.nice.org.uk/  Innovation Exchange: https://innovations.ahrq.gov/  Pubmed
Exercises for Practice • Your patient; a newly diagnosed diabetic wants to know more about his disease and the medications. • How would you explain to him? • He is worried about weight gain with treatment. How would you approach this?
The Answer • Patient Education Websites • Shared-Decision-making Websites
WebMD: http://www.webmd.com/ PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/ s/diseases_and_conditions/a/ MedlinePlus: http://www.nlm.nih.gov/medlineplus/ NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.as px The NNT: •http://www.medicine.ox.ac.uk/bandolier/ba nd50/b50-8.html •http://www.thennt.com/ •http://www.nntonline.net/visualrx/v3/displa y.aspx King Abdullah Encyclopedia: ‫الملك‬ ‫موسوعة‬ ‫عبدهللا‬‫العربية‬ ‫عبدالعزيز‬ ‫بن‬‫الصحي‬ ‫للمحتوى‬ http://www.kaahe.org/ar/ Point of Care Clinical Resources: Patient Education
Health Care Literacy Around the World
Patient-Centered Shared Decision Making Mayo Clinic: http://shareddecisions.mayoclinic.org/ Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_ Choice.pdf Patient Decision Aids http://decisionaid.ohri.ca/AZlist.html
Shared Decision Making Resources  DHMC Center for Shared Decision Making  http://www.dhmc.org/dept/csdm  Ottawa Health Research Institute  http://decisionaid.ohri.ca/index.html  Healthwise Preferred Care  http://www.healthwise.net/preferredcare  WebMD  http://www.webmd.com/  Foundation for Informed Medical Decision Making  http://www.informedmedicaldecisions.org  Health News Review  http://www.healthnewsreview.org
Exercises for Practice • You have a male 42 yr old present in the ER with a severe headache, nausea, myalgia, malaise, prostration. This just started suddenly a day or so ago. Physical exam reveals generalized macules that are red, fever, skin erythema, generalized papules that are small red, rash on his palms and soles of his feet. He thinks he has had insect bites while camping recently. • What could this be? – http://www.ddderm.blogspot.com/
Looking for Nation-Wide Evidence- based Policies • National Guidelines Clearinghouse: http://www.guideline.gov/ Guideline International Network GIN http://www.g-i-n.net/library • NICE National Institute for Health and Clinical Excellence: www.nice.org.uk, http://pathways.nice.org.uk/ NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder • Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html • Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm Health-Evidence-ca: http://health-evidence.ca/ • MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html • ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx • Health Care Improvement Skills Centre: http://improvementskills.org/
Looking for Nation-Wide Evidence- based Policies National Guidelines Clearinghouse: http://www.guideline.gov/ Guideline International Network GIN http://www.g-i-n.net/library NICE National Institute for Health and Clinical Excellence: www.nice.org.uk, http://pathways.nice.org.uk/ NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm Health-Evidence-ca: http://health-evidence.ca/ MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx Health Care Improvement Skills Centre: http://improvementskills.org/
http://pubmedhh.nlm.nih.gov/nlm/ PubMed for Handhelds (PubMed4Hh): Download to your device from Play Store • MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts • PICO search Patient, Intervention, Comparison, Outcome • askMEDLINE free-text, natural language search S
SOFTWARE PUBLISHERS • Apps for Healthcare Professionals Collection Apple's App Store has put together a collection to make it easier for healthcare professionals to find apps for their mobile devices. It includes six categories: reference apps, educational apps, EMR & patient monitoring apps, imaging apps, point of care apps, and personal care apps (which is actually aimed for consumers.) See the link above for a review by iMedicalApps. • Medical Wizards Software for medical professionals by medical professionals. Not free. • QxMD Authored by clinician experts, QxMD’s authoritative free and inexpensive mobile apps are relied upon by physicians, nurses and other health care professionals. • Skyscape - 25% discount - Skyscape offers medical references for mobile devices. - Available for Windows Mobile, Palm, iPhone, BlackBerry, Android. - In collaboration with the University of Calgary Libraries, Skyscape now offers a 25% discount on the purchase of Skyscape resources for mobile devices. • Unbound Medicine Unbound Medicine offers medical references for purchase for mobile devices.
72 • Discussions • Questions
73 • Thank you!

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Literature Search Exercise SEBMA F2

  • 1.
  • 2.
    HEALTH CARE LITERACYIS ESSENTIAL TO THE MEDICAL TEAM
  • 3.
    Secrets In LiteratureSearching: Implementing Evidence & Transforming Healthcare Provision Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MemAcadMedEd MSc (UK) MBBS Consultant Physician & Pulmonologist Department of Medical Protocol KAMC, Riyadh Kingdom of Saudi Arabia
  • 4.
  • 5.
    Ask clinical question noviceexpert Foreground questions Background question
  • 6.
  • 7.
    Types of Literature Primary (Original)  Pubmed  Embase  CINAHL  Secondary (Appraised)  Guidelines  Systematic Reviews  Critically appraised Topics CATs
  • 8.
    Levels of Evidence:Hierarchy Pyramid
  • 9.
    What is BestEvidence? Hierarchy of Levels of Evidence
  • 10.
  • 11.
    Types of Resources Primary (Original)  Pubmed  Embase  CINAHL  Secondary (Appraised)  Guidelines websites: Guideline Clearinhouse  Systematic Review Websites: Cochrane Library  CAT websites: BestBets  Tertiary (Access to both) (meta search engines, databases of databases):  TRIP+ (Translating Research Into Practice)  SumSearch
  • 12.
    Exercises for Practice •During the ward round, a medical student inquired about EBM and what it means. • How can you guide him/her if he/she asks you about some literature information?
  • 13.
    The Answer • Googleit! • YouTube it! • Ask an Expert: – Oxford Center for EBM: http://www.cebm.net/ – KT Clearinghouse: http://ktclearinghouse.ca/
  • 14.
    Self-Education & Trainingin EBM • EBM Resources: – http://guides.mclibrary.duke.edu/c.php?g=158178&p=103 5956 – http://library.medicine.yale.edu/tutorials/subjects/evidenc e-based-practice • CEBM Website: – http://www.youtube.com/user/cebmed, – http://www.cebm.net/index.aspx?o=1965 • YouTube: – http://www.youtube.com/watch?v=odfo9CQGi0c
  • 15.
    Exercises for Practice •During the ward round, an R1 inquired about Pubmed and how to use it. • How can you guide him/her on the practicalities of using it?
  • 16.
    The Answer • Googleit! • YouTube it! • Ask an Expert: – Every Literature Searching Website/Database has its own “How to Use Stuff” – Pubmed: https://www.nlm.nih.gov/bsd/disted/pubmed.html – Cochrane: http://www.cochranelibrary.com/help/how-to- use-cochrane-library.html
  • 18.
    Exercises for Practice:Guidelines • Exercise: 1 • “What is the evidence-based management of Appendicitis?" • Exercise: 2 • “What is the evidence-based management of eclampsia?
  • 19.
    Looking for EBMinformation in Guideline Clearinghouse directly from Google
  • 23.
    Exercises for Practice:Therapy • Exercise: 1 • "In elderly patients with congestive heart failure, is digoxin effective in reducing the need for re- hospitalization?" • Exercise: 2 • "In a patient with COPD which is more effective in symptom control: LABA or LAMA?
  • 24.
    The Answer Primary Resources •Pubmed via PICO: http://pubmedhh.nlm.nih.gov/ • Pubmed Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical • Pubmed Search Box & Limits options: http://www.ncbi.nlm.nih.gov/pubmed/?querykey=4%26dbase=pubmed% 26querytype=eSearch%26 Secondary Resources • Point of Care Resources e.g. UpToDate • Cochrane Library • Guidelines Websites: https://www.guideline.gov/ Tertiary Resources • TRIP Database: https://www.tripdatabase.com/ (plus PICO)
  • 25.
    PubMed for Handhelds** (Download iOS App or Android App ) a.PICO search Patient, Intervention, Comparison, Outcome b.askMEDLINE free-text, natural language search c.Consensus Abstracts * d.MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts Disclaimer | Privacy | Feedback | NLM mobile
  • 27.
    Select Publication Typefrom drop-down menu
  • 28.
    The answer  Digoxininitiation is associated with lower risk of all-cause readmission after hospitalisation for heart failure. Hernandez AF; DeVore AD Evid Based Med; 2014 Aug; 19(4):153. PubMed ID: 24639395 [No Abstract] [Full Text] [Related]  Drug therapy to reduce early readmission risk in heart failure: ready for prime time? Vaduganathan M; Fonarow GC; Gheorghiade M JACC Heart Fail; 2013 Aug; 1(4):361-4. PubMed ID: 24621940 [TBL]Readmission for heart failure remains a major focus of policymakers, clinicians, and patients. Despite meeting key national performance measures and frequent use of evidence- based therapies, rates of 30-day post-discharge rehospitalization may be as high as 25%. Digoxin and mineralocorticoid antagonists are known to reduce admissions for heart failure, but are significantly underused in current clinical practice despite their proven benefits. • [Abstract] [Full Text] [Related] • TBL= The Bottom Line
  • 29.
    Exercises for Practice:Diagnosis • You are seeing a patient with breathlessness. She is seventy year old and has a known history of Asthma and ischemic heart disease. Her BNP is 122 (N up to 30). Does she have LVF or bronchial asthma exacerbation?
  • 30.
    The Answer Primary Resources •Pubmed via PICO • Pubmed Clinical Queries • Pubmed Search Box & Limits options Secondary Resources • Point of Care Resources e.g. UpToDate • Cochrane Library • Guidelines Websites Tertiary Resources • TRIP Database
  • 31.
    Exercises for Practice:Diagnosis & Risk Assessment  You are seeing a patient with COPD exacerbation. ABG is as follows: PaO2: 44 mmHg, PaCO2: 62mmHg, pH 7.32, Bicarbonate 34 mmol/l. What is her acid-base diagnosis?  You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Is warfarin therapy indicated? What is her risk of bleeding on warfarin?  How to assess for a DVT risk?  How to assess the severity of acute pancreatitis?  Calculate your own ATPIII 10 year risk for heart disease based on your age, gender, cholesterol and smoking status.
  • 32.
    The Answer Decision SupportCalculators • Point of Care Resources e.g. UpToDate • Medscape
  • 33.
    Exercises for Practice •You are seeing a patient with atrial fibrillation. She is seventy year old and has a known history of ischemic heart disease. Her family brought her to ER and was found to have acute kidney injury. • Where would you find guidance and a tool for implementing an evidence-based approach to her care?
  • 34.
    The Answer NICE Pathways:guidance at your fingertips- www.nice.org.uk Society of Hospital Medicine: http://www.hospitalmedicine.org/ AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov/ Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovem ent/ ICSI Institute for Clinical Systems Improvements http://www.icsi.org/index.aspx
  • 37.
    Exercises for Practice •Your mentor passed a new article for a new anti- migraine medication. • You have been told to appraise the article and tell the team about this new medication. • How are you going to do it? • How are you going to calculate the number needed to treat?
  • 38.
    The Answer • OxfordCentre for EBM: http://www.cebm.net/?o=1023 http://www.gla.ac.uk/departments/generalpracticeprimarycare/ebp/checkli sts/#d.en.19536  Checklist for an article on treatment or prevention  Checklist for an article on qualitative research  Checklist for an article on decision analysis  Checklist for an article on an educational intervention  Checklist for an article on prognosis  Checklist for an article on harm or causation  Checklist for an article on guidelines  Checklist for an article on diagnosis or screening  Checklist for a systematic review  Checklist for economic evaluations
  • 39.
    Exercises for Practice •Diagnosis: What is the sensitivity, specificity and LR for procalcitonin in acute infections? • Diagnosis: What is the sensitivity, specificity and LR for BNP in heart failure? • Therapy: Which is more effective beta-blockers or ACEI in Systolic heart failure:
  • 40.
    The Answer • LR& NNT Websites – http://ktclearinghouse.ca/cebm/toolbox – http://www.thennt.com/
  • 44.
    Exercises for Practice Following a non-ST segment elevation myocardial infarction, a man was admitted to the hospital and placed on a telemetry monitor. As the monitor was constantly sounding with "low voltage" and "asystole" alerts and the patient was well each time clinicians checked, they silenced the alarms. The patient was found dead 4 hours later.  What will you do?
  • 45.
    Exercises for Practice A man with cirrhosis and abdominal distension was found to have significant ascites. The emergency department providers performed a large volume paracentesis to relieve his symptoms, but, as the 10th liter of fluid was removed, the patient became acutely hypotensive.  What will you do?
  • 46.
    The Answer  WebM&MMorbidity & Mortality Rounds:  http://www.webmm.ahrq.gov/
  • 48.
  • 49.
    Exercises for Practice Medication Side-Effect: A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 12.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor? 49
  • 50.
    The Answer  Goto pubmed & Use Subheadings
  • 52.
    Exercises for Practice Audit & Quality Assessment: Which Quality Indicators/Audit criteria can you use in COPD care. 52
  • 53.
    The Answer  NationalQuality Measures Clearinghouse http://www.qualitymeasures.ahrq.gov/sea rch/search.aspx?term=copd  NICE Website Audit Tools http://www.nice.org.uk/about/what-we- do/into-practice/audit-and-service- improvement
  • 54.
    Exercises for Practice QualityImprovement:  How do I improve my use of antibiotics at my hospital?  Critical lab. reporting?  Reducing length of Stay?  Reducing readmissions?  Reducing PEG-site infections?  Innovations in practice? 54
  • 55.
    The Answer  Agencyfor Healthcare Research & Quality AHRQ: http://www.ahrq.gov/  The National Institute for Health and Care Excellence (NICE): https://www.nice.org.uk/  Innovation Exchange: https://innovations.ahrq.gov/  Pubmed
  • 60.
    Exercises for Practice •Your patient; a newly diagnosed diabetic wants to know more about his disease and the medications. • How would you explain to him? • He is worried about weight gain with treatment. How would you approach this?
  • 61.
    The Answer • PatientEducation Websites • Shared-Decision-making Websites
  • 62.
    WebMD: http://www.webmd.com/ PubMed Health:http://www.ncbi.nlm.nih.gov/pubmedhealth/ s/diseases_and_conditions/a/ MedlinePlus: http://www.nlm.nih.gov/medlineplus/ NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.as px The NNT: •http://www.medicine.ox.ac.uk/bandolier/ba nd50/b50-8.html •http://www.thennt.com/ •http://www.nntonline.net/visualrx/v3/displa y.aspx King Abdullah Encyclopedia: ‫الملك‬ ‫موسوعة‬ ‫عبدهللا‬‫العربية‬ ‫عبدالعزيز‬ ‫بن‬‫الصحي‬ ‫للمحتوى‬ http://www.kaahe.org/ar/ Point of Care Clinical Resources: Patient Education
  • 63.
    Health Care LiteracyAround the World
  • 65.
    Patient-Centered Shared Decision Making MayoClinic: http://shareddecisions.mayoclinic.org/ Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_ Choice.pdf Patient Decision Aids http://decisionaid.ohri.ca/AZlist.html
  • 66.
    Shared Decision MakingResources  DHMC Center for Shared Decision Making  http://www.dhmc.org/dept/csdm  Ottawa Health Research Institute  http://decisionaid.ohri.ca/index.html  Healthwise Preferred Care  http://www.healthwise.net/preferredcare  WebMD  http://www.webmd.com/  Foundation for Informed Medical Decision Making  http://www.informedmedicaldecisions.org  Health News Review  http://www.healthnewsreview.org
  • 67.
    Exercises for Practice •You have a male 42 yr old present in the ER with a severe headache, nausea, myalgia, malaise, prostration. This just started suddenly a day or so ago. Physical exam reveals generalized macules that are red, fever, skin erythema, generalized papules that are small red, rash on his palms and soles of his feet. He thinks he has had insect bites while camping recently. • What could this be? – http://www.ddderm.blogspot.com/
  • 68.
    Looking for Nation-WideEvidence- based Policies • National Guidelines Clearinghouse: http://www.guideline.gov/ Guideline International Network GIN http://www.g-i-n.net/library • NICE National Institute for Health and Clinical Excellence: www.nice.org.uk, http://pathways.nice.org.uk/ NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder • Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html • Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm Health-Evidence-ca: http://health-evidence.ca/ • MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html • ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx • Health Care Improvement Skills Centre: http://improvementskills.org/
  • 69.
    Looking for Nation-WideEvidence- based Policies National Guidelines Clearinghouse: http://www.guideline.gov/ Guideline International Network GIN http://www.g-i-n.net/library NICE National Institute for Health and Clinical Excellence: www.nice.org.uk, http://pathways.nice.org.uk/ NHS Evidence: https://www.evidence.nhs.uk/search?q=guidelines%20finder Guide to Community Preventive Services: http://www.thecommunityguide.org/index.html Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/cps3dix.htm Health-Evidence-ca: http://health-evidence.ca/ MMWR Reports and Recommendations: http://www.cdc.gov/mmwr/mmwr_rr.html ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx Health Care Improvement Skills Centre: http://improvementskills.org/
  • 70.
    http://pubmedhh.nlm.nih.gov/nlm/ PubMed for Handhelds(PubMed4Hh): Download to your device from Play Store • MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts • PICO search Patient, Intervention, Comparison, Outcome • askMEDLINE free-text, natural language search S
  • 71.
    SOFTWARE PUBLISHERS • Appsfor Healthcare Professionals Collection Apple's App Store has put together a collection to make it easier for healthcare professionals to find apps for their mobile devices. It includes six categories: reference apps, educational apps, EMR & patient monitoring apps, imaging apps, point of care apps, and personal care apps (which is actually aimed for consumers.) See the link above for a review by iMedicalApps. • Medical Wizards Software for medical professionals by medical professionals. Not free. • QxMD Authored by clinician experts, QxMD’s authoritative free and inexpensive mobile apps are relied upon by physicians, nurses and other health care professionals. • Skyscape - 25% discount - Skyscape offers medical references for mobile devices. - Available for Windows Mobile, Palm, iPhone, BlackBerry, Android. - In collaboration with the University of Calgary Libraries, Skyscape now offers a 25% discount on the purchase of Skyscape resources for mobile devices. • Unbound Medicine Unbound Medicine offers medical references for purchase for mobile devices.
  • 72.
  • 73.