1. Information Mastery Information management Determine usefulness Understand sources (jungle) Make decisions with your patient

2. Usefulness Usefulness of medical information = Relevance x Validity Work

3. Relevance Three major criteria to determine relevance of an article: –How common? –Patient-oriented outcomes? –Change practice if valid?

4. POEs and DOEs POE: Patient-oriented evidence –mortality, morbidity, symptoms, quality of life, cost –final outcome - matter to patients DOE: Disease-oriented evidence –“intermediate” outcome - matter to researchers –pathophysiology, pharmacology, etiology –premature to change practice

5. POEMs Patient-Oriented Evidence that Matters –Improve patient-oriented outcomes –Would change your practice

6. DOEs vs. POEMs POEM Gemfibrozil lowers cholesterol Gemfibrozil lowers CV morbidity/mortality Gemfibrozil lowers overall mortality Intensive insulin tx can keep FBS <140 mg% Intensive insulin therapy can decrease micro- vascular complications Intensive insulin therapy can decrease mortality and improve QOL DOEDOE

7. Validity: Therapeutics Some kinds of evidence are better than others... A. Randomized controlled trials (RCTs) and meta-analyses of RCTs B. Observational studies: case-control, cohort, cross-sectional C. Case series, case report, uncontrolled trial, personal experience and observation

8. Validity: Diagnosis A high quality diagnostic study has… –a broad spectrum of disease (mild to severe) in a large cohort of patients (not case-control) –a high quality gold standard –independence: the gold standard and test in question are applied to every patient (or random sample) –blinding: the people doing the gold standard don’t know the results of the test being studied, and vice versa

9. Reducing Work Smarter literature searching Let someone else do the heavy lifting –searching the literature –regularly reviewing journals –critical appraisal –summarizing evidence

10. Reducing Work Primary sources –Medline (PubMED, Grateful Med) –Databases

11. Reducing Work Secondary sources (POEM-based) –Journal of Family Practice POEMs –Evidence-Based Practice newsletter Secondary sources (other) –Cochrane Database –Best Evidence –ACP Journal Club / Evidence-Based Medicine

12. Feeling Good About Not Knowing Everything: Information Mastery Prioritize efforts to identify, validate, and apply common POEMs Responsibility : less to read, but more important to find and evaluate Consider work factor with rare POEMs Ignore and avoid rare DOEs

13. Searching the medical literature: PubMED Medline: primary bibliographic database of the National Library of Medicine Covers: Medicine, nursing, dentistry, veterinary medicine, health care system and preclinical sciences Contains over 10 million citations from over 4,000 journals

14. What can PubMED do? Specify basic or advanced search Allows access to MeSH terms (medical subject headings) used to index articles Narrow search strategies: –Clinical queries (therapy, diagnosis, etiology and prognosis) Numerous hot buttons which link to help pages

15. What can PubMED do? Advanced search mode: –AND combines MeSH terms to retrieve only articles that contain all terms (narrows search) –OR combines MeSH terms to retrieve articles containing any or all terms (expands search)

16. What can PubMED do? Places limits –Limits search to main point of interest (“MeSH Major Topic) –Other limiting strategies: “human”, age groups, english –Specify types of designs: clinical trial, case reports, cross-sectional

17. What can PubMED do? Can order slides through “Lonesome Doc” Can download citations to your computer (as text file (*.txt))

18. References Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: Feeling good about not knowing everthing. J Fam Pract 1994; 38 (5):505-513. Shaughnessy AF, Slawson DC, Bennett JH. Becoming a medical information master: A guidebook to the medical information jungle. J Fam Pract 1994; 39 (5):489-499.