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Finding Reliable Clinical Information Online

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Finding Reliable Clinical Information Online An Introduction Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine – PowerPoint PPT presentation

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Title: Finding Reliable Clinical Information Online


1
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/MedicalReferenc
es.asp
2
Major Competency
  • Students will
  • Demonstrate the ability to acquire new data and
    information and to critically appraise its
    validity and applicability.

3
Objectives of Session
  • 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

4
Resources
  • http//www.med.fsu.edu/informatics/
  • Medical References
  • PowerPoint
  • Assessing the Validity of Online Medical
    Information
  • Decision Support
  • Using Drug Resources

5
Review
  • What is the most efficient, unbiased way to keep
    up to date?
  • Go to conferences
  • Read 20-30 journal articles a week
  • Look up answers to clinical questions when they
    occur in a reliable, current resource

6
In the Beginning
Journals
Pocket Manuals
Drug Info
Text Books
Note Cards
Peer Reviewed
7
Textbooks dont 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.
8
21st Century Medical Information
Journals
Pocket Manuals
Drug Info
Text Books
Note Cards
9
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?
10
Assessing the Validity of Information on the Web
  • AMA Guidelines for Medical and Health Information
    Sites on the Internet
  • Health on the Net Code of Conduct HON

11
Assessing the Validity of Information on the Web
  • Site ownership/domain
  • Gov
  • CDC
  • AHRQ
  • NLM.NIH
  • DHHS
  • FDA
  • States fl.us
  • Edu
  • Medical Centers
  • Org
  • Associations
  • AAFP
  • ACP
  • ACOG
  • Disease orgs
  • ADA
  • ALA
  • Com
  • Commercial

12
Assessing the Validity of Information on the Web
  • 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

13
Wikipedia
  • List 5 ways Wikipedia does not fit the criteria
    as a reliable site.

14
Exercise
  • 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

15
Types of Information Found Free on the Web
  • 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

16
Assessing the Validity of Information on the Web
  • Library subscription resource reliable

17
Be Skeptical
  • You will be taught the principles of critical
    review of the literature in your second year
    along with Evidence Based Medicine (EBM)

18
What Kind of Question Do I Have?
  • Basic science or background question?
  • What is an olecranon?
  • Clinical question?
  • What are the risk factors for hypertension?
  • Which is better for diagnosing pneumonia x-ray,
    CT or MRI?
  • How should I treat otitis media?
  • How much does amoxicillin cost?

19
Answering a Background Question
  • Searching most efficient
  • Google/Wikipedia (assess the validity)
  • Use Medical Dictionary
  • Basic Science Textbooks
  • Access Medicine
  • Thieme

20
Searching with Google
ubscription
Web Based Medical Information
Free
Google Search
21
Your eBookshelf
22
Medical Dictionaries
  • Stedmans is at eMedicine, in PEPID
  • Dorlands at Merck

23
Exercises for Practice
  • Using Stedmans Medical Dictionary
  • eMedicine online
  • PEPID online and PDA
  • Look up
  • dyspnea nephrolithiasis
  • teratogenic iatrogenic
  • epistaxis
  • cyanosis

24
Books on the Library Web Page
25
When to Use eBooks versus Quick References
  • Background information on topic
  • Basic science question instead of disease
    specific question
  • Detailed information/explanations versus bottom
    line
  • Lots of time versus short on time
  • Zebras versus common problems

26
WebFeat Search
  • Searches Library Resources
  • Pick the type of resources to search
  • Groups by resource
  • Uses resource search engine

27
New Website Searches
  • Multi-Search Webfeat
  • Changing to SerialSolutions 360, August 2010
  • Only eBooks and Patient Education

28
Access Medicine
  • Best selection of all basic science books
  • Combined with good clinical medicine books
  • Search productive

29
Answering Clinical Questions
  • At the Point of Care

30
Answering Clinical Questions
  • 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

31
Current Library Web Site (Sum 2010)
32
New Library Webpage
33
Access Issues
  • IP address verification
  • Limited simultaneous users
  • Special URL issues
  • Bottom Line
  • Use links on Library Homepage

34
Off Campus Access
  • IP authentication
  • Proxy server EZProxy
  • FSU COM ID and password
  • Use links on library page

35
Current Site - New Site
36
Primary Resources of the Maguire Medical Library
37
(No Transcript)
38
Differential Diagnosis Tools
DDx
  • DxPlain
  • PEPID

39
Differential Diagnosis Tools
  • Enter symptoms or chief complaint
  • Get a differential
  • Get more info on disease
  • DxPlain
  • Harvard
  • Allows for multiple symptoms and lab results
  • Drawback Slow
  • PEPID
  • Multiple symptoms
  • Lab Results
  • Age, gender, duration
  • eMedicine
  • Access Medicines
  • Diagnosaurus (DDX tab)

40
Exercises for Practice
  • 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,
  • Differential?
  • Add lab elevated TSH

41
Drug Information
Rx
  • Epocrates Online
  • PEPID
  • Harrisons Practice

42
Epocrates Online
  • 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

43
Epocrates Drug Interaction MultiCheck Tool
  • 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

44
PEPID CRC Suite
  • 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

45
PEPID Drug Interaction Tool
  • Select all drugs on list
  • Say Done
  • Click Interactions
  • Click specific interaction to read details

46
Exercises for Practice
  • 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?

47
Disease Quick References
  • DynaMed (Web and PDA)
  • eMedicine (Web and PDA)
  • Harrisons Practice (Web and PDA)
  • Epocrates Dx
  • PEPID

48
Types of Questions Best Answered by Disease Quick
References
  • Description/background
  • Epidemiology
  • Diagnosis
  • Treatment
  • Ongoing management
  • Prognosis/outcomes
  • Prevention

Bottom Line
49
DynaMed
  • 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
50
DynaMed
  • Organization
  • Includes History and Physical sections (why am I
    asking these questions)
  • Expand or collapse sections
  • Use CTRL-F to search page

51
Dynamed Exercise
Exercises for Practice
  • Using Dynamed -- Question What is the typical
    history of present illness for someone with SARS?
  • Type in SARS or use alphabetical listing
  • Explode History

52
eMedicine
Use FireFox
  • 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 Students favorite
  • iPhone version in Medscape

53
eMedicine Monographs
  • Subscription eliminates ads found on free
    Medscape site
  • One long page of information
  • Navigation clunky, inconsistent

CTRL-F
54
Exercises for Practice
  • 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

55
Harrisons Practice
  • Internal Medicine focus
  • Linked to Access Medicine content
  • Has drug information from GoldStandard
  • Nice navigation on left side

PDA and Online
56
Exercises for Practice
  • Using DynaMed, eMedicine, Epocrates and/or
    Harrisons Practice
  • Develop a scenario for CSSC practice
  • Complete form provided
  • (optional) Pick from diseases top 10 DDx in
    primary 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

57
Top 10 Chief Concerns
  1. Cough
  2. Fatigue
  3. Low Back Pain
  4. Fever
  5. Dyspnea
  • 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/

58
Top 20 Diseases
Recorded by FSU CoM Students in 3rd year
Clerkships
1. Hypertension 11. Obesity
2. Depression 12. Gall Bladder disease
3. Hyperlipidemia 13. GERD
4. Diabetes Type 2 14. Asthma
5. Bipolar disorder 15. Sinusitis
6. Anxiety disorder 16. Substance abuse
7. Cold/URI 17. COPD
8. ADHD 18. Coronary Artery Disease
9. Otitis media 19. Peripheral vascular disease
10. Schizophrenia 20. Pneumonia
59
iPod/iPhone/iPad Versions
  • Clinical Evidence
  • DynaMed
  • Epocrates Essentials
  • Essential Evidence
  • Harrisons Practice
  • PEPID
  • Geriatrics at Your Fingertips
  • Free resources
  • ePSS USPSTF Tool
  • Mobile Merck Medicus
  • Medscape

PDAs to be distributed in August 25-27
60
Review
  • 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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