Advanced Information Mastery Deborah R. Erlich, MD MMedEd Assistant Professor, Tufts University School of Medicine Assistant Clerkship Director, Family Medicine

Aims Review Information Mastery Concepts Practice: apply concepts to real clinical questions Try some new resources

Objectives Name 5 different EBM sources and identify when each is most useful Perform an effective search… fast! Categorize quality of an answer using the Usefulness Equation

What makes a “good” question? For a specific population Compares Intervention to Comparator Outcome of interest is patient-oriented (can ask about intervention, prognosis or diagnosis)

What makes a “good” answer? Patient-oriented Valid – Systematic review – Meta-analysis – Single study (RCT) – Guidelines – Expert opinion Relevant Reliable Supported by Level of Evidence

What makes a “good” resource? Work – Long? Painful? – Expensive? – Inaccessible? Relevance – Answers your question Validity Transparency – Grade/level of evidence Relevance x Validity Usefulness = _____________ Work Relevance x Validity Usefulness = _____________ Work

Question #1 Need L. Fobia is a 62 year old male with osteoarthritis of the knee. Another doctor recommended a steroid injection but Mr. Fobia is terrified of needles and is only willing to undergo the procedure if it will really help him. What is your advice?

Question #2 Wedd Mibed is a 7 year old boy with nocturnal enuresis. His mother heard from her neighbor that an antidepressant called imipramine might cure the problem. She also saw an ad online for a bed alarm and a dry bed training program and wants to know which treatment is best for Wedd’s problem. What does the evidence say?

Question #3 Mary Mee is a 28 year old female with a bump on her hand. She is hoping for an engagement ring soon so she desperately wants this gone! What’s the most effective way to get rid of it?

A few more… Mr. O. Beece is a 48 year old male with blood pressure 149/88, HR 80, and weight 205 pounds. He wants to know if he should be checked for diabetes.

Tina Bopper is a 17 year old female who had all of her early childhood vaccines on time. She also had the Menactra vaccine 4 years ago and the Tdap vaccine 6 years ago. She asks if she needs any shots today.

Mr. N. Gola is a 38 year old planning to travel to Africa. He wants to know if he needs any vaccines before his trip.

Background Treatments for common conditions Systematic review Free / no TUSK access Immunizations Travel Screening / preventive care Medications Esoterica / rare conditions / specific paper UpToDate BMJ Clinical Evidence Cochrane (gold standard) Dynamed (more recently updated, easier?) TRIP database Shots app (STFM) / CDC.gov CDC.gov USPSTF Epocrates (no LOE or NNT) Micromedex Medline

Thanks Allen Shaughnessy PharmD MMedEd Kristen Goodell MD Molly Cohen-Osher MD