ebm for the busy clinician putting your smart phone to work gil c. grimes, md
TRANSCRIPT
EBM for the busy Clinician‘Putting your Smart Phone to Work’
Gil C. Grimes, MD
Bias Identification Slide
• I have reviewed sections in DynaMed in the past
• I do not have any commercial affiliations outside Health PEI
• I am from Texas and at times may feel better about myself than required by law.
• I like technology.
Why Bother?
Objectives
• Levels of Evidence• DOE vs. POEMs• Sources for Evidence• Tools for the Bedside• Non-medical Handheld Tools
First a few Questions
• I am familiar with Evidence Based Medicine?• Databases and sites that I routinely use to obtain
information?
What is EBM?
• Simply put it is the integration of research evidence with clinical expertise and patient values.
• EBM will allow us to do more good than harm• Patients want to know the following
o “Will it make me live better”o “Will it make me live longer”
Levels of Evidence
• This is a method for grading journal articles, guidelines etc.
• This is not “universal” • AAFP uses Level A, B, C • Centre for EBM Oxford uses 1,2,3
o Focuses on the type of article and qualityo Therapy/Prevention/Etiology/Harm,
Diagnosis, Prognosis• Either way is just fine
Where’s the beef?
• Levels of evidence are good….
• What I want to know is how this will work for me.
• Friends the path requires moving from DOE to POE…
Disease Oriented Evidence• Most common type of
evidence found in research journals
• Important to our understanding of disease
• Responsible for many therapeutic advances
• Intended for a research audience
• Pathophysiology • Pharmacology • Etiology
Patient Oriented Evidence
• Uncommon in most journals
• Outcomes patients care about
• Mortality • Morbidity • Quality of Life• Cost• Harm
POEMs
• Patient-Oriented Evidence that Matterso Addresses a clinical
problem encountered by primary care physicians
o Uses patient-oriented outcomes
o Potential to change our practice if valid and applicable
DOES vs. POEMs
• The Numbers….o 6 month survey of 90 journalso 8,047 articleso 213 POEMs
• 97% DOEs and other material
• 2.6% POEMsJ Fam Pract 1994;38:505-13.
So where do I find this?
• You could search the literatureo Yeah like you have that much time!
• You could ask you colleagueso Expert opinion Level C
• You could familiarize yourself with one or two good sourceso That sounds pretty good…
Usefulness equation
• Usefulness= relevance x validitywork
• Go for sources that have done the work for you
Systematic Reviews
Summarized Evidence-Referenced Resources
Research Articles
Other Sources
Search Strategies
• Database Sizeo Larger the database, tighten the searcho Small database, broaden the search
• Languageo A little time on a tutorial can save you hours
over a montho Especially PubMed
DynaMed• Created by Brian Alper, MD• Evolved from his ‘black book of facts’• Background information
o Better for review than Up-to-dateo Discusses diagnosis, treatment, etc.
• Evidence based• Peer reviewed• Can be used to generate scholarly activity in
residency• I use this resource multiple times daily
DynaMed
• Supported Deviceso Palmso Pocket PCo Windows Smartphone o BlackBerryo iPhone and iPod Touch Android
Smartphones• Web Based availability
Essential Evidence Plus
• Founded by three Family Physicians, a PharmD and a Psychologist
• Goal to improve the health and lives of people by providing patient-oriented evidence that matters in a rapid and accessible form
• Very good on computers, OK on handhelds
Essential Evidence Plus
• Essential Evidence are good quick summaries (slightly shorter than Dynamed) o Nice bottom line approach to diseaseo Not as frequently updatedo Little clunky on the BlackBerry
• Calculator Section very useful o Mortality, warfarin, pre-op eval etc.
• Let’s Look
Web Based Stuff
• Trip Database- an aggregator service for medical data that sorts by Level of Evidenceo Excellent resource for patient handoutso Free
• PubMed- great site for research, no really, you just have to know how to use it.
Relevance
• Slice the bedside stacko Is this something that is common to my
practice?o Is it an outcome my patients would care
about?o If the outcome is true would I have to
change my practice?• If relevant then examine for validity
Pushed or Pulled
• Keeping up in medicine is tough• Pushed information helps
o InfoPOEMSo Journal Contents
• Pulled Informationo Learning as you need too Just in time information
Handhelds
• This is the key to just in time information
• InfoRetriever and DynaMed can run off Palm or Microsoft handheld
• Very functional• Gives you decision tools in your hand
when you need them
Programs worth Having
• Epocrates• iSilo• LyteMeister• ICD Meister• CPT Meister
• Geriatrics at your Fingertips
• Family Practice Management has a good articleo July/August 2006
Demonstrations of Handheld
Non-medical Programs
• Google Bookmarkso www.google.com/profiles/doctorgilgrimes?hl=en
• Evernoteo www.evernote.como A means to an end for keeping everything in the
cloud• reQall
o www.reqall.como Reminding yourself of things you forgot
Questions?