Enjoy UpToDate (UTD) at UMHS
UpToDate (UTD) for Evidence-based Clinical Decision Support is now provided to UMHS students and faculty! Check out the access link on the Anne Ross Library Home page and further information on the UMHS LMS - Library Services section.
"When you care for patients, the stakes are high and every decision counts.You need the best evidence and clinical guidance at your fingertips to answer even the most complex questions with confidence.
Healthcare professionals turn to UpToDate as the one trusted reference for answers even when the evidence isn’t clear. When you face a challenging clinical question or need to confirm your approach, you can turn to UpToDate for trusted answers based on the latest evidence and best practice.
Registration provides the following benefits:
Easy remote access to UpToDate(outside of the UMHS network)
Convenient continuing education credits (CME/CE/CPD)earned researching clinical questions using UpToDate onsite, remotely, and on mobile.
CME Real-time reflection: Look for the blue checkmark in the top navigation of the topic review to complete your CME reflection in real-time.
Electronically submit UpToDate CME credits for MOC points for these boards:
American boards of Internal Medicine, Anesthesiology, Ophthalmology, Otolaryngology (head and neck surgery), Pathology,Pediatrics, and Surgery."
Labels: Anne Ross Library, clinical decision support, CME, evidence-based medicine, evidence-based practice, mobile medicine, new library resources, UMHS, UpToDate, UTD
The Cochrane Collaboration has relaunched their new and improved blog called
Evidently Cochrane! After blogging about over 200 Cochrane reviews during the last eighteen months, the blog has proven very popular gaining a wide and growing audience. I think you will agree that the engaging and colorful format draws you in, in a manner similar to
Pintrest!
But what are Cochrane reviews?
"Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are
published online in The Cochrane Library."
Here are UMHS in St. Kitts we have access to The Cochrane Library through the
Pan American Health Organization (PAHO) and the
Cochrane Virtual Health Library (VHL).
Learn more about
Evidently Cochrane: Sharing Health Evidence You Can Trust by clicking on the embedded link and enjoy the blog!
Learn more about Cochrane and systematic reviews by trying out these
learning modules which illustrate real life dementia research examples.
Labels: blogs, Cochrane Collaboration, Cochrane Library, Cochrane Systematic Reviews, evidence-based medicine, medical blog, systematic reviews
The
BMC Cases Database is a freely-accessible and up-to-date data base of over 11,000 medical case reports from publishers such as Springer, BMJ and
PubMed Central.
Bio-Med Central has aggregated these case reports together into one searchable database to facilitating comparison and provide clinicians, researchers, regulators and patients a simple resource to explore content, and identify emerging trends. An advanced search and alerts feature is also provided.
Labels: BioMed Central, case reports, case studies, databases, evidence-based medicine, medical cases
The first in a new video series from the
Health Council of Canada will answer this question for you and help you to understand
Clinical Practice Guidelines (CPG's); how they are used, how they are disseminated and implemented, and what impact they can have. This video series was developed by the professionals who design, disseminate, and use CPG's in Canada.
"CPGs are evidence-based recommendations that help health care professionals make better clinical decisions. When designed and used properly, CPGs can play an important role in the Canadian health care system."
Understanding Clinical Practice Guidelines: A Video Series Primer
Video 1: What are CPGs?
Video 2: Challenges for CPGs.
Video 3: Integration of CPGs at the system level.
Video 4: Opportunities and future considerations for CPGs. Labels: clinical decision making, clinical medicine, clinical practice guidelines, CPG's, evidence-based medicine, evidence-based practice, Health Council of Canada, medical diagnosis
Facing the Challenge of Teaching Evidence-Based Medicine to Medical Students
I would encourage you all to read this article!
George P., Reis S., Nothnagle M., (2012). Using a Learning Coach to Teach Residents Evidence-based Medicine.
Family Medicine, 44(5), 351-355. http://www.stfm.org/fmhub/fm2012/May/Paul351.pdf
This study demonstrates how important the acquisition of
‘information mastery skills’ are to physician success in practicing evidence-based medicine! It shows what one university medical school did to try to improve these skills in their students, targeting their second year family medicine residents. [Alpert Medical School, Brown University, Family Medicine Residency Program and the Department of Family Medicine, Memorial Hospital of Rhode Island]
The article quotes the current ACGME accreditation competency:
“The ACGME requires that residents demonstrate competency in information mastery or the ability to 'locate, appraise, and assimilate evidence from scientific studies'.“
Reiterated in the
ACGMEs Next Accreditation System (NAS) ‘General Milestones’
*:
(adopting July 2013)
Level 2: (residents) “Formulates a searchable question from a clinical question (e.g., using PICO format).”
Level 3: (residents) “Applies a set of critical appraisal criteria to different types of research, including synopses of original research findings, systemic reviews and meta-analyses, and clinical-practice guidelines.” “Critically evaluates information from others.”
Level 4: (graduating resident) “Demonstrates a clinical practice that incorporates principles and basic practices of evidence-based practice and information mastery.”
Overall, I agree with the approaches taken by the developers of the course, the
one-on-one coaching model coupled with being a
structured component of the curriculum, and would encourage the adoption of a similar type of program at UMHS. Post intervention assessment of the resident’s EBM knowledge showed a notable increase of
31.8% , along with improved attitudes toward EBM and its increased use in the clinical setting. However there is still room for improvement as the average score on the posttest was still only 58%!
A few areas I suggest warrant further consideration or emphasis when undertaking such a program :
- stressing the quality and value of subscription clinical point-of-care databases, full-text journal databases, and other library resources.
- the integral involvement of the medical librarians in the program (course development, delivery, and evaluation).
- incorporating the ‘6S’ model ** for accessing pre-appraised evidence and providing directional steps to the search process.
- augmenting the course with training in current methods for staying up-to-date while navigating the flood of medical information, such as RSS alerting.
- recognizing that information resources are dynamic and will continue to challenge the information searcher’s flexibility and adaptability. Thus, it is important that the program emphasize teaching the concepts of information searching rather than focusing on the idiosyncrasies of any individual resource, or promoting dependency on any one database.
- working toward seamless integration of relevant evidence-based clinical information into the individual patient’s electronic medical record (a CDSS or Computerized Decision Support System).
Evidence-based practice isn’t just about finding
an answer to your clinical question, it is finding the
current best answer based on the peer-reviewed medical evidence, for the care of your particular patient.
I invite your comments ….
Ann Celestine,
Library Director
http://lib.umhs-sk.net/
*Nasca, T. J., Brigham, T., Philibert, I., & Flynn, T. C. (2012).
The Next GME Accreditation System — Rationale and Benefits. New England Journal Of Medicine, 366(11), 1051-1056. doi:10.1056/NEJMsr1200117.
**DiCenso, A., Bayley, L., & Haynes, R. (2009).
Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12(4), 99-101. doi:10.1136/ebn.12.4.99-b
Labels: evidence-based medicine, evidence-based practice, information literacy, medical education, medical information search, medical student competencies, medical students
Did you know that
DynaMed has recorded
nine "Practice-Changing Updates" already this morning? Yesterday, DynaMed posted
21 updates!
Never before has the saying
"If you stand still you will be left behind" been more true than in the world of 21st century medicine.
How can you keep pace and truely provide current, best, evidence-based practice? One method is to take advantage of DynaMed's
"Recent Updates" page (notice the second link on left in the top navigation bar), which provides a view of the most recent articles added to DynaMed summaries.
◦DynaMed is updated daily through a 7-step evidence-based method for systematic literature surveillance so clinicians can find the best available evidence at the point of care. DynaMed topics provide synthesized summaries integrating new evidence with existing evidence to directly answer most clinical questions in a single source.
Check out DynaMed's new interface while you are there.If you need more help accessing DynaMed come and see us in the Library for your EBSCO login and/or your mobile access code.
Labels: DynaMed, evidence-based medicine, evidence-based practice, staying current
Have you been looking to join a journal club? Do you want to do more for your journal club but are restrained by time? I invite you to consider what the
Cochrane Journal Club offers to members:
"The Cochrane Journal Club is a free, monthly publication that introduces a recent Cochrane review, together with relevant background information, a podcast explaining the key points of the review, discussion questions to help you to explore the review methods and findings in more detail, and downloadable PowerPoint slides containing key figures and tables. You can even contact the review authors with your questions."
The
latest issue #21 discusses
"Selenium for preventing cancer". Labels: cancer prevention, Cochrane Collaboration, Cochrane Journal Club, Cochrane Systematic Reviews, evidence-based medicine, evidence-based practice, journal clubs, selenium, systematic reviews
What is Evidence-Based Practice (EBP)?
Evidence-based practice is "the integration of best research evidence
with clinical experience
and patient values and circumstances."
EBP is like a three legged tripod. Just as a tripod needs all three legs to stand, EBP needs all three components to really succeed!
Thank you
Janet Wale from
CCNet for sharing this in the Cochrane Collaboration
'Consumer Digest' Vol.556(1), Feb 14, 2010.
From: Straus S, Richardson SR, Glasziou P, Haynes BR. Evidence-Based Medicine. How to practice and teach EBM. 3rd ed. Elsevier Churchill Livingstone. 2005.
Labels: Cochrane Collaboration, consumer health, evidence-based medicine, evidence-based practice
Has the Evidence Based Medicine (EBM) movement "driven the study of health care policy-making into a conceptual cul-de-sac"?The goal of EBM has always been to find and implement the best medical research evidence to ensure best patient outcomes. In effect 'bridge the know-do gap'. A smooth unimpeded path for new research knowledge to be translated to patient care and beyond to health care policy, has been the default expectation.
Should this be, or does this have to be a 'cul-de-sac' situation? This has been a growing argument in some circles (no pun intended), and one put forward by an
interdisciplinary research group based out of the UK. Studying the science and nature of evidence with a wide-angle lense, this group takes policy studies in general and health care policy-making in particular, beyond simple 'decision science'.
"...we have argued that it is time to problematize the notion of 'evidence' in the heath care policy-making process and to legitimize rather than devalue the place of practical judgement."
Login to the EBSCO database for the full text of this interesting article from the
Journal of Health Services Research & Policy (UK) .
Citation: Russell, J., Greenhalgh, T., Byrne, E., & McDonnell, J. (2008). Recognizing rhetoric in health care policy analysis. (pp. 40-46). doi:10.1258/jhsrp.2007.006029.
This all brings to my mind the infamous word's of Inspector Clouseau,
"Facts Hercule, nothing matters but the facts..." Labels: evidence science, evidence-based medicine, health care policy, health policy, policy-making
Check out this new evidence-based digital resource from JAMA and McGraw Hill. JAMAevidence, designed for medical students, residents, educators, and clinicians, provides the fundamental learning tools required for understanding and applying the medical literature and making clinical diagnoses.
JAMAevidence provides full-text access to both the second edition of
The User's Guides to the Medical Literature and the newly published
The Rational Clinical Examination. On
JAMAevidence, these etitles are combined with teaching tools, media, and interactive features to convey the best practices of evidence-based medicine – including the careful assessment and interpretation of medical research.
Labels: clinical medicine, diagosis of disease, EBM, evidence-based medicine, JAMA, JAMAevidence
A new web resource has been launched called
"Evidence-based Tuberculosis Diagnosis" by
Stop TB Partnership's New Diagnostic Working Group, in collaboration with
WHO, TDR, FIND, GLI, PHAC, and other partners.
As new tests and technologies are constantly entering the market and aggressively promoted, decisions about their use must be evidence-based. The aim of this website is to provide the most comprehensive single source of evidence syntheses, policies, guidelines and research agendas on TB diagnosis. It provides access to systematic reviews, reports, monographs and training modules, as well as slide presentations on TB diagnostics. The website is free to utilize, so anyone can view and download the information.
Dr Madhukar Pai,
Stop TB Partnership's New Diagnostic Working GroupLabels: diagosis of disease, EBM, evidence-based medicine, TB, Tuberculosis
The findings of a landmark randomized controlled trial which demonstrates the value and impact of the medical librarian has just been published!
"
BACKGROUND: The "Just-in-time Information" (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction...
CONCLUSIONS: In this study, providing timely information to clinical questions had a highly positive impact on decision-making and a high approval rating from participants. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Such services may reduce costs through decreasing the need for referrals, further tests, and other courses of action."
McGowan J, Hogg W, Campbell C, Rowan M. Just-in-time information improved decision-making in primary care: a randomized controlled trial. PLoS ONE. 2008;3(11):e3785. Epub 2008 Nov 21.PMID: 19023446 [open source]. Labels: clinical care, evaluation, evidence-based medicine, health care costs, hospital librarian, hospital library, hospital services, impact of librarian, medical librarian, RCT
"
PEARLS are succinct summaries of
Cochrane Systematic Reviews for primary care practitioners – developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the
New Zealand Guidelines Group.
PEARLS provide guidance on whether a treatment is effective or ineffective. PEARLS are prepared as an educational resource and do not replace clinician judgment in the management of individual cases."
Labels: case studies, Cochrane Systematic Reviews, evidence-based medicine, New Zealand Guidelines Group, PEARLS, primary care
