ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
Finding Medical Information
1. Clicker Test – Do you think patients
should be able to view doctors’ notes?
1. Definitely, yes
2. Absolutely no
3. Maybe… it depends
Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, Feldman HJ, Mejilla R, Ngo L, Ralston JD, Ross SE,
Trivedi N, Vodicka E, Leveille SG. Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study
and a Look Ahead. Ann Intern Med. 2012 Oct 2;157(7):461-70. doi: 10.7326/0003-4819-157-7-201210020-
00002. PubMed PMID: 23027317.
http://www.ncbi.nlm.nih.gov/pubmed/23027317
2. Finding Medical Information
Basis of Medicine, Unit 2, October 2012
Robin Featherstone, MLIS
Liaison Librarian (Medicine)
robin.featherstone@mcgill.ca
3. Where would you go first to find
information about asthma therapies?
1. Cochrane Database of Systematic Reviews
2. Expert opinion
3. Facebook
4. Google
5. Google Scholar
6. PubMed
7. MedlinePlus
8. Textbooks (i.e., Harrison’s)
9. UpToDate
10. Other
4. In 1995, where would you go first to find
information about asthma therapies?
1. Cochrane Database of Systematic Reviews
2. Expert opinion
3. Facebook
4. Google
5. Google Scholar
6. PubMed
7. MedlinePlus
8. Textbooks (i.e., Harrison’s)
9. UpToDate
10. Other
5. Objectives
By the end of this lecture, you will be
able to:
1.Differentiate between filtered and
unfiltered information
2.Describe the difference between
background and foreground questions
3.Begin to identify the best sources to
answer medical questions
6. Less time
Less work
Less evidence
Filtered
Filtered
Unfiltered
Unfiltered
Expert Opinion
More time
More work
More evidence
7. What are the
bronchodilatory effects
of combined inhaled
budesonide/formoterol
and
budesonide/salbutamol
in acute asthma?
Foreground
questions
What are the signs of an
asthma attack?
Background
questions
What is the pathology of
asthma?
Novice Expert
8. A 25 year-old female has been recently diagnosed with
classical Hodgkin’s lymphoma (nodular sclerosing subtype).
Staging reveals that she is a stage IIA with a 4.5 cm nodal
mass in her neck and mediastinal nodes. Her hematologist
recommends combined modality therapy
(chemotherapy/radiation therapy). The patient has done
some reading about therapy and is worried about the long
term effects of radiation especially the risk of breast cancer.
Background Foreground
9. What is the pathophysiology of
Hodgkin’s lymphoma?
Background Foreground
10. For a 25 year old female with stage IIA
Hodgkin’s lymphoma, is combined
modality therapy superior to
chemotherapy alone?
Background Foreground
11. A 35 year-old patients presents to the ER with a right leg swelling
x 3 days. The patient recently returned from a business trip in
Malasia and therefore you suspect a deep vein thrombosis (DVT).
It is the weekend and so the patient receives a CT angiogram that
does not reveal any pulmonary embolism and the venous portion
of the study does not reveal any above or below knee clots. That
said, you are still convinced that the patient may have a lower
limb DVT and so you ask for a lower limb doppler which requires
the radiologist to come into the hospital in the middle of the
night to perform the study. The radiologist is reluctant to come as
the venous phase of the CT angiogram was negative.
Background Foreground
13. Which of the following is more sensitive
for detecting lower limb DVTs (both above
and below knees): venous dopplers or CT
angiograms?
Background Foreground
15. Answers Background questions
Audience Everyone
Compare to WebMD
Contents Filtered information
Cost Free
URL http://www.nlm.nih.gov/
medlineplus/
16. HARRISON’S PRINCIPLES OF INTERNAL
MEDICINE (AKA Harrison’s Online)
Answers Background questions
Audience Novice and expert
Compare to Goldman’s Cecil Medicine
Contents Filtered information
Cost Institutional subscription
URL http://bit.ly/harrisonsonline
17. Answers Background and foreground
questions
Audience Novice and expert
Compare to Harrison’s or DynaMed
Contents Filtered & unfiltered information
Cost Institutional subscription
URL http://bit.ly/uptodatemcgill
18. Answers Foreground questions
Audience Experts
Compare to MetaLib
Contents Unfiltered information
Cost Free
URL http://scholar.google.ca/
19. Answers Foreground questions
Audience Experts
Compare to EMBASE
Contents Unfiltered information
Cost Free
URL http://www.ncbi.nlm.nih.gov/pubm
ed
20. Answers Foreground questions
Audience Experts
Compare to DARE
Contents Filtered information
Cost Institutional subscription
URL http://bit.ly/cochranemcgill
21. Which tool contains the answer to the
question: What is the treatment for
Hodgkin’s disease?
1. Google Scholar
2. Harrison’s Online
3. MedlinePlus
4. PubMed
5. UpToDate
6. 1 OR 4
7. 2 OR 3 OR 5
22. What kind of information does
EMBASE contain?
1. Filtered
2. Unfiltered
3. Don’t know
23. What kind of question is this: Is written or video
educational interventions more effective at increasing
vaccination intention rates in young adults?
1. Background
2. Foreground
3. Don’t know
25. Less time
Less work
Less evidence
Filtered
Filtered
Unfiltered
Unfiltered
Expert Opinion
More time
More work
More evidence
26. Labs
Groups A, D & G Groups B, E & H Groups C, F & I
Mon Oct 22 Tues Oct 23 Weds Oct 24
12:35 pm – 2:25 pm 12:35 pm – 2:25 pm 9:35 am – 11:25 am
Cybertheque, Redpath Redpath e-classroom, Rm 409, McIntyre (2nd
Library Basement Rm 23 floor, Life Sciences
Library)
Assignment
Take home searching exercises
Due: 5 pm on Tues, Oct 30
Submit to the Dean’s Office, 6th floor of McIntyre
27. Questions
Robin Featherstone, MLIS
Liaison Librarian (Medicine)
robin.featherstone@mcgill.ca
Hinweis der Redaktion
First of three lectures on medical information Unit 2 – General overview of medical information tools and PubMed searching labs Unit 8 – Pharmacology Resources & RefWorks training
Cochrane: first available on the web in 1996 Facebook: known then as “The Facebook” – launched in 2004 Google: Larry Page and Sergey Brin had only just met at Stanford. They begin collaborating on their search engine, then known as “ BackRub ” in 1996 Google Scholar: released in Beta in 2004 MedlinePlus: consumer website launched in 1998 PubMed: while the index called Medline has been around since the 1970s , PubMed (the searchable web interface) was first released in 1996 UpToDate: Bud Rose’s single-author nephrology textbook went online in the early 1990s. Arguably the first modern medical textbook: Principles and Practice of Medicine – 1892 Key point: There are at least 7 new revolutionary tools for finding medical information invented within the last 18 years. Many of the attending staff at the MUHC and clinical faculty at McGill have been practicing medicine for 20 years at least.
This is a highly simplified diagram of the medical literature. We’ll learn a lot more about the “levels of evidence” for medical information in January of 2014, right before you start clerkship. But, for an overview, it’s important to recognize the difference between filtered and unfiltered information. If a piece of information is “filtered,” that means an expert has collected many individual studies or opinions and created a summary. If a piece of information is unfiltered, it is either one single study or one person’s opinion. Information tools can be distinguished by the amount and the quality of unfiltered or filtered information they contain.
Another useful way we can distinguish information is by the kind of questions that it answers. Medical questions can be either background question or foreground questions Background questions tend to be broad and we ask them to learn more about the fundamental aspects of a disease or topic. Background questions are commonly asked on MCCQEs. The answers to background questions may not be widely known, but they are considered common knowledge. For example… What are the signs of an asthma attack? Foreground questions tend to be narrow or specific, and we ask them to learn more about a particular case. The kinds of questions which will arise during patient encounters will most likely be foreground. For example… What are the bronchodilatory effects of combined budesonide formoterol and budesonide salbutamol in acute asthma? During the first two years of medical school, you’ll be asking mostly background questions. As you move into the clinical environment, you’ll start asking more and more foreground questions.
Clinical scenarios, like this hematology case study will contain both kinds of questions. Sometimes you may have to answer a combination of background and foreground questions. Or you may have to answer a background question before you can address a foreground question.
So, in this case, there is the background question: What is the pathophysiology of Hodgkin’s lymphoma?
And then the foreground question related to treatment: Is combined modality therapy superior to chemotherapy alone? Or another foreground question could be: do the risks of developing breast cancer outweigh the benefits of combined modality therapy? There can be many questions in a single scenario
Before we talk about the information tools which best answer each type of question, can you please read this scenario. With your neighbour, discuss the case and write down one foreground and one background question.
Key point: Information sources for answering background questions tend to all be filtered. When answering foreground questions, you will find use a mix of unfiltered and filtered tools. Obviously, start with filtered tools and then look at individual studies. It all depends on how specific your question is.
Which resource will answer this question? Answer: 7 – 1 OR 3 OR 5 Why? These are all filtered sources for answering background questions
Remember: EMBASE is a database of individual articles, like PubMed. Answer 2 – it contains individual studies, which are unfiltered
After the poll: ask the class > Where would you look to answer this question? Answer: 2 – Foreground question – best answered with an individual study – these are answered in tools like PubMed
Key point: Information sources for answering background questions tend to all be filtered. When answering foreground questions, you will find use a mix of unfiltered and filtered tools. Obviously, start with filtered tools and then look at individual studies. It all depends on how specific your question is.