Information Needs:

An Evidence-Based Medicine Module

Information plays an essential role when we are trying to make sense of a problem and to validate a decision. During Major Clinical Year, and in subsequent professional practice, your information needs are going to vary. You may need to refresh your memory about a medical condition in order to better understand a patient. You may need to see if what you learned in school and prior practice is still considered the best standard of care. Or, maybe you need to find information to prepare a 20-minute presentation on a cutting-edge topic.

 

Understanding information needs, and knowing how information is organized and situated within the sources, are two essential characteristics of effective and efficient information practice in a clinical environment.  This module will provide you with a model to make the best possible match between your future information needs and information sources. This model directly puts into practice the principles of Evidence-Based Medicine. For more information about EBM, please visit JAMA Evidence.

 

In this module, we will be exploring potential information needs you could encounter for a patient admitted with Chronic Kidney Disease.  While this should be a familiar condition to you, something you learned about in the classroom, different situational contexts will direct you to explore different sources. As you move through each situation, think about your own information needs, and how you might use the suggested resources to help you find the right information.

I HAVE A PATIENT

What do I know about their condition and what is known in the literature?

Outline:

Review a condition to make decisions about patient care informed by the knowledge available in the literature.

Learn how to assess your knowledge of a condition and know when to search the literature.

Apply your knowledge and make connections to your current clinical situation.

Sources to Consult:

Access Medicine – A collection of online textbooks, illustrations, assessments and more. Use Access Medicine if you have no prior knowledge of a medical condition.

DynaMed Plus and Up-To-Date – Are databases of topic reviews and summary information put together by clinical experts. Use these sources when you have some prior knowledge of your patient’s medical condition, but need to do a quick review.

DIAGNOSIS

What do you need to know for situations when you have to diagnose a patient with an unknown condition?

Outline:

Review your patient’s symptoms.

Consider possible diagnoses from what you learned from the patient and the available information you found in the literature.

Apply your knowledge and provide your best diagnosis to your patient.

Sources to Consult:

Rational Clinical Examination – The RCE series are careful systematic efforts to assess the accuracy of items from the patient’s medical history and the clinical examination.

PubMed: MGH Case Reports – Search the PubMed database for Massachusetts General Hospital Case Reports to see examples of patient diagnoses and the thought process behind them.

 

TREATMENT

What are the current treatment options and how do I choose the best one for my patient?

Outline:

Review current treatment options for your patient’s condition.

Evaluate which treatment option is most appropriate.

Apply your knowledge and create a treatment plan for your patient.

Sources to Consult:

 

DynaMed Plus and Up-To-Date – Are databases of topic reviews and summary information put together by clinical experts. Use these sources to find treatment information for your patient’s medical condition.

Cochrane Library – A database of systematic and other types of reviews created by experts in their respective fields. Use this source to review evidence-based literature on treatment options for your patient.

PubMed – A biomedical database that can be used to search for systematic reviews and evidence-based literature. Use this source to review evidence-based literature on treatment information.

ADVERSE EVENTS

What are the adverse events associated with a course of treatment? Is the symptom my patient is experiencing a known adverse event?

Outline:

Review the known adverse events for a treatment.

Determine if the symptom your patient is experiencing is a known adverse event for their course of treatment.

Apply your knowledge and choose or change your patient’s course of treatment.

Sources to Consult:

Micromedex – A drug database with information about drug interactions, adverse events and more.

Lexicomp (Up-To-Date) – A subset of the Up-To-Date database specific to drug information such as drug interactions and adverse events.

Access Medicine – A collection of online textbooks, illustrations, assessments and more. Use Access Medicine to review information about the adverse events associated with your patient’s treatment.

PROGNOSIS

What do I need to know to advise the patient about their prognosis and the natural history of their condition?

Outline:

Review your patient’s condition.

Determine the important aspects in the literature to be considered for a prognosis and natural history.

Apply your knowledge to create a prognosis and natural history for your patient.

Sources to Consult:

Access Medicine – A collection of online textbooks, illustrations, assessments and more. Use Access Medicine to find information about a medical condition to review for your patient’s prognosis.

PubMed – A biomedical database that can be used to search for systematic reviews and evidence-based literature. Use this source to find evidence-based material to help form your patient’s prognosis.

DynaMed Plus – A database of topic reviews and summary information put together by clinical experts. Use DynaMed Plus to review important information about the medical decision to help inform your prognosis.

APPLICATIONS

In the previous sections, you used Evidence-Based Medicine in the clinical setting. For the remaining two sections, we will consider another application of EBM principles. How can EBM be used for presentations and scholarly projects? Explore the modules below to learn more.

PRESENTATION

My preceptor asked me to give a 10 minute presentation on a disease: where do I start?

Outline:

Review general knowledge of disease processes from the basic pathophysiology to a more advanced knowledge of prognoses and treatments.

Determine what information will be important to include in your presentation.

Create a presentation based on your knowledge and the information found from searching the appropriate resources.

Sources to Consult:

Access Medicine – A collection of online textbooks, illustrations, assessments and more. Use Access Medicine if you have no prior knowledge of a medical condition.

Cochrane Library – A database of systematic and other types of reviews created by experts in their respective fields.

PubMed – A biomedical database that can be used to search for systematic reviews and evidence-based literature.

National Guideline Clearinghouse – A database of evidence-based clinical guidelines provided by the US Department of Health and Human Services.

 

SCHOLARLY PROJECT

I want to conduct a research project: where do I start?

Outline:

Review general knowledge of disease processes from the basic pathophysiology to a more advanced knowledge of prognoses and treatments.

Determine if your research question needs refinement based on the literature.

Create a research project based on your knowledge and the information found from searching the appropriate resources for your specific topic.

Sources to Consult:

Access Medicine – A collection of online textbooks, illustrations, assessments and more. Use Access Medicine if you have no prior knowledge of a medical condition.

Cochrane Library – A database of systematic and other types of reviews created by experts in their respective fields.

PubMed – A biomedical database that can be used for systematic reviews and evidence-based literature.