Selecting a Resource

In the previous module, we learned how to construct a well-built clinical question. Using that question, we will move on to the finding the best available evidence in a point-of-care database. These clinical decision support tools provide evidence-based answers to specific clinical questions quickly enough for real-time clinical scenarios.

For our patient, the clinical question is: In an elderly patient with an ischemic stroke, without dysphagia or trouble eating, does adding oral protein energy supplements to the usual hospital diet decrease the risk of death or serious disability over a period of several months? It is a therapy question and the best evidence would be a randomized controlled clinical trial.

 

Clinical Question ------->	Clinical Scenario ------->	Search Strategy
Patient Population	ischemic stroke, without dysphagia, elderly	stroke
Intervention	oral protein energy supplements
Comparison (if any)	none, placebo
Outcome	primary: reduce mortality; secondary: reduce serious disability risk over time
Type of Question	therapy	scroll to treatment or therapy section
Type of Study	RCT

Constructing a well-built clinical question can lead directly to a well-built search strategy. Note that you may not use all the pieces or parameters of the well-built clinical question in your search strategy. However, as you review the point-of-care database search results for applicability to your patient you will want to consider all of the parameters.

The Resource

3. Select a point-of-care database and conduct a search.

The practice of Evidence-based Medicine advocates that clinicians search the published literature to find answers to their clinical questions. There are literally millions of published reports, journal articles, correspondence and studies available to clinicians. Choosing the best resource to search is an important decision. Large databases such as MEDLINE, PubMed, and EMBASE give you an index to citations to the primary literature, but then you must locate the fulltext of the reports and conduct your own assessment of the original research. Secondary resources such as the Cochrane Library, ACP Journal Club, POEMS, Clinical Inquiries, and Clinical Evidence, provide you with an assessment of the original study.

The best resources in the clinical setting are the point-of-care databases which provide pre-assessed answers to specific clinical questions in the practical time frame needed by a practicing physician.

Point-of-Care Databases

• DynaMed -  an evidence-based, clinical decision support tool containing more than 2000 up-to-date clinical topic summaries with information on etiology, directed history and physical findings, differential diagnoses and diagnostic testing, prognosis, treatment, prevention, links to patient education resources, and the most common ICD-9 Codes.

• PIER (From ACP) - an evidence-based, clinical decision support tool containing more than 330 disease modules, 11 videos, 14,000 pages of medical condition and diagnostic text, and 2500 graphs and tables. Integrated with STAT!Ref. Accessible from local and remote locations.

• UpToDate -  an expert opinion and evidence-based, clinical decision support tool containing more than 60,000 pages of original text covering 7,000 topics in primary care and internal medicine from 3000 expert contributors, 250 patient education sheets, 15,000 graphics, and 160,000 MEDLINE abstracts. Accessible only from the OSU CHS Campus on West 17th Street and the Health Care Center at 2345 Southwest Blvd.

• FIRSTConsult -  an evidence-based, clinical decision support tool containing more than 600 medical conditions, 1500 diagnoses, 300 signs and symptoms, 300 patient education sheets in English and Spanish, 1400 of the most common ICD-9 Codes, and 30 Surgical/Diagnostic procedures. Accessible from local and remote locations.

• Cochrane Database of Systematic Reviews -  contains full text articles, as well as protocols focusing on the effects of healthcare. Data is evidence-based medicine and is often combined statistically (with meta-analysis) to increase the power of the findings of numerous studies, each too small to produce reliable results individually.  
More Information

• Database of Abstracts of Reviews of Effects (DARE) -  includes comprehensive abstracts of published systematic reviews on the effects of health care from around the world, which have been critically analyzed according to a high standard of criteria. This database provides access to quality reviews in subjects for which a Cochrane review may not yet exist.   More Information

For an answer to our clinical question about Laura's condition, we have chosen DynaMed as our point-of-care resource. To bring up DynaMed in a new window click on the DynaMed link above.

We now go to Searching the Resource.