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• 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