Students will



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Students will

  • Students will

    • Demonstrate the ability to acquire new data and information and to critically appraise its validity and applicability.


Students will

  • Students will

    • Demonstrate ability to locate quality clinical information on the web utilizing a variety of strategies
    • Assess the reliability and validity of clinical information found using search engines on the web
    • Begin to utilize the FSU COM virtual library resources to locate medical information for clinical decision support [Old and new]


http://www.med.fsu.edu/informatics/

  • http://www.med.fsu.edu/informatics/

  • Medical References

    • PowerPoint
    • Assessing the Validity of Online Medical Information
    • Decision Support
    • Using Drug Resources


What is the most efficient, unbiased way to keep up to date?

  • What is the most efficient, unbiased way to keep up to date?

    • Go to conferences
    • Read 20-30 journal articles a week
    • Look up answers to clinical questions when they occur in a reliable, current resource










AMA Guidelines for Medical and Health Information Sites on the Internet

  • AMA Guidelines for Medical and Health Information Sites on the Internet

  • Health on the Net Code of Conduct HON



Site ownership/domain

  • Site ownership/domain



Site ownership/domain

  • Site ownership/domain

  • Contributors listed, credentials, contact info

  • Highly referenced, linked to primary literature

    • MEDLINE Abstracts/Journal Articles
    • Proceedings from scientific meetings
  • Timeliness: date posted, revised

  • Viewer access, payment and privacy

  • Funding and sponsorship



List 5 ways Wikipedia does not fit the criteria as a reliable site.

  • List 5 ways Wikipedia does not fit the criteria as a reliable site.



Search Google for treatment of back pain

  • Search Google for treatment of back pain

  • Rate the first 20 hits

    • Sponsor? Advertisements?
    • Audience?
    • Authors?
    • Links?
    • Date Revised?
  • Do advanced search limit to .gov domain and compare results

  • Search for prostate cancer screening



Information for/by students

  • Information for/by students

  • Information for/by patients

  • Information for/by clinicians

  • Information for/by researchers

  • Sales pitches, ads

  • Quacks who want to sell something

  • Unproven, unsubstantiated nonsense



Library subscription resource = reliable

  • Library subscription resource = reliable





Basic science or background question?

  • Basic science or background question?

    • What is an olecranon?
  • Clinical question?

    • What are the risk factors for hypertension?
    • Which is better for diagnosing pneumonia: x-ray, CT or MRI?
    • How should I treat otitis media?
    • How much does amoxicillin cost?


Searching most efficient

  • Searching most efficient

  • Google/Wikipedia (assess the validity)

  • Use Medical Dictionary

  • Basic Science Textbooks

    • Access Medicine
    • Thieme






Stedman’s is at eMedicine, in PEPID

  • Stedman’s is at eMedicine, in PEPID

  • Dorland’s at Merck



Using Stedman’s Medical Dictionary

  • Using Stedman’s Medical Dictionary

  • Look up:

  • dyspnea nephrolithiasis

  • teratogenic iatrogenic

  • epistaxis

  • cyanosis





Background information on topic

  • Background information on topic

    • Basic science question instead of disease specific question
  • Detailed information/explanations versus bottom line

  • Lots of time versus short on time

  • Zebras versus common problems



Searches Library Resources

  • Searches Library Resources

  • Pick the type of resources to search

  • Groups by resource

  • Uses resource search engine



Multi-Search = Webfeat

  • Multi-Search = Webfeat

  • Changing to SerialSolutions 360, August 2010

  • Only eBooks and Patient Education



Best selection of all basic science books





Quickest method: Browse to specific resource

  • Quickest method: Browse to specific resource

  • Requires: knowing the content of sites/resources

  • Starting point: Library web page or your handheld (iPod or cell phone)

  • Learn to use subscription resources







IP address verification

  • IP address verification

  • Limited simultaneous users

  • Special URL issues

  • Bottom Line

    • Use links on Library Homepage


IP authentication

  • IP authentication

  • Proxy server – EZProxy

  • FSU COM ID and password

  • Use links on library page











Enter symptoms or chief complaint

  • Enter symptoms or chief complaint

    • Get a differential
    • Get more info on disease
  • DxPlain *****



Using DxPlain or PEPID

  • Using DxPlain or PEPID

  • Patient 35 yr old female

  • Chief complaint – fatigue, duration 2 months

    • Other symptoms: throat pain, cold intolerance, weight gain, bradycardia, and constipation,
  • Differential?

    • Add lab: elevated TSH




Rx, OTC and Alternative medicines by brand name, generic, and by class

  • Rx, OTC and Alternative medicines by brand name, generic, and by class

  • Formularies

  • Drug Interaction tool

  • Disease reference, pill identifier, medical calculators, tables

  • Constantly updated



Add all the drugs on the patients medications list (Rx, OTC, Alt) plus drug considering

  • Add all the drugs on the patients medications list (Rx, OTC, Alt) plus drug considering

  • Look to see if any interactions

  • What is the severity of interaction



Rx, OTC and Alternative medicines by brand name, generic, and by class

  • Rx, OTC and Alternative medicines by brand name, generic, and by class

  • Drug Interaction tool

  • DDx, Disease reference, Lab manual, medical calculators, clerkships, images

  • Constantly updated



Select all drugs on list

  • Select all drugs on list

  • Say Done

  • Click Interactions

  • Click specific interaction to read details



Using Epocrates Online

  • Using Epocrates Online

  • How should you prescribe acyclovir for chicken pox in an immunocompromised patient? (dose)

  • How much do 9 (50 mg) tablets of Imitrex cost? (common migraine drug)

  • Are there any drug interactions between Lexapro, Lortab, Xanax and Zocor?





Description/background

  • Description/background

  • Epidemiology

  • Diagnosis

  • Treatment

  • Ongoing management

  • Prognosis/outcomes

  • Prevention



Most comprehensive disease reference

  • Most comprehensive disease reference

  • Summarizes all the latest research on topic

  • Very detailed

  • Well organized

  • Links out to full text articles if more details needed

  • Includes both diseases and symptoms like chest pain



Organization:

  • Organization:

  • Includes History and Physical sections (why am I asking these questions)

  • Expand or collapse sections

  • Use CTRL-F to search page



Using Dynamed -- Question: What is the typical history of present illness for someone with SARS?

  • Using Dynamed -- Question: What is the typical history of present illness for someone with SARS?

  • Type in SARS or use alphabetical listing

  • Explode History



Moderate amount of detail and information

  • Moderate amount of detail and information

  • Several monographs on one topic by different specialties

  • Google searches it

  • Now owned by WebMD/Medscape. Suggest registering.

  • One of Student’s favorite

  • iPhone version in Medscape



Subscription eliminates ads found on free Medscape site

  • Subscription eliminates ads found on free Medscape site

  • One long page of information

  • Navigation clunky, inconsistent



Using eMedicine - Question: What is the functional anatomy when you have a Rotator Cuff Injury?

  • Using eMedicine - Question: What is the functional anatomy when you have a Rotator Cuff Injury?

  • Search or browse to Rotator Cuff Injury. Use Sports Medicine article.

  • Select Introduction



Internal Medicine focus

  • Internal Medicine focus

  • Linked to Access Medicine content

  • Has drug information from GoldStandard

  • Nice navigation on left side



Using DynaMed, eMedicine, Epocrates and/or Harrison’s Practice:

  • Using DynaMed, eMedicine, Epocrates and/or Harrison’s Practice:

    • Develop a scenario for CSSC practice
    • Complete form provided
    • (optional) Pick from diseases top 10 DDx in primary care or top 20 diagnoses seen by students
    • Complete electronically (form on Blackboard)
    • Change file name to your name (John_Doe.doc)
    • Upload to Blackboard Assignments Tab on D101 BB by Friday the 7/23/09, by midnight


Cough

  • Cough

  • Fatigue

  • Low Back Pain

  • Fever

  • Dyspnea





Clinical Evidence

  • Clinical Evidence

  • DynaMed

  • Epocrates Essentials

  • Essential Evidence+

  • Harrison’s Practice

    • PEPID
    • Geriatrics at Your Fingertips


Name three things you should look for in a web site with medical information that would make you feel more confident about the content of that website.

  • Name three things you should look for in a web site with medical information that would make you feel more confident about the content of that website.

  • What resources are going to be the most accurate, reliable, and up to date?

  • Name a library drug reference, a differential diagnosis resource, and a disease quick reference



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