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Finding the Evidence: Ann McKibbon, MLS, PhD, discusses "Chapter 4: Finding the Evidence" from the Users' Guides to the Medical Literature.
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Finding the Evidence: Ann McKibbon, MLS, PhD, discusses "Chapter 4: Finding the Evidence" from the Users' Guides to the Medical Literature.
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Language: EN.
Segment:0 .
>> I'm Joan Stevenson, Editor of JAMA's Medical News and Perspectives Section. Today I have the pleasure of speaking with Dr. Ann McKibbon about finding the evidence to answer clinical questions. Dr. McKibbon, why don't you introduce yourself to our listeners? >> Joan, thank you for that introduction. As you say, my name is Ann McKibbon. I've worked at McMaster University with the Evidence-Based Medicine Working Group for probably the last 25 years or so. My background is information sciences, and I just recently finished a PhD in medical informatics looking at how clinicians use information.
>> Dr. McKibbon, several studies have shown that when clinicians use information resources to answer clinical questions, the resources they choose provide the best evidence only about 50% of the time. Why do you think clinicians have trouble finding good resources? >> Well I think it's a couple of things. Certainly, the old bugaboos of time and the information explosion have really contributed to problems in finding information or having the time to find information, but I think more and more there are new information resources that are becoming available.
Because of technology we're able to start to synthesize some of the evidence, start to make it so that we can bring the evidence closer into clinical care. I think sort of the Holy Grail of all of this is to be able to take high-quality information resources and actually put them into things like electronic health record systems so that when the need for information arises, that information is quite handy. >> What are the four categories of information sources and how can clinicians use them?
>> There are more and more information resources out there all the time that are being developed that are doing sort of more synthesis of the evidence. Pulling evidence together, evaluating it and making sure that it's ready for clinical use. I think if you start sort of at the bottom of things, all of the original studies that you have are what I consider sort of raw clinical evidence. You know it has to be synthesized, you have to look at it before you can apply it to clinical questions. So at the basis you have the studies, the things that you find in Medline.
Sort of the next level up are syntheses of articles. They're your systematic reviews, narrative reviews, meta-analyses where someone has taken the evidence on a topic and pulled it together and they're actually just a little bit easier to use than the studies and there are fewer of them. Another group we're getting closer to being more useful clinically are something that are called synopses and they're actually studies or reviews that have been sort of given the blessing, the good clinicians seal of approval.
These synopses, things like ACP Journal Club, those sorts of products where they'll take an article, they'll look at it and they'll ask several clinicians, you know, how useful is this? How newsworthy is this? How can you apply this? So you not only have the evidence, but you have usually a practicing clinician telling you how for you to apply that evidence. So moving on we get to the summaries and here we're moving away from the way we look at information from sort of an article-by-article basis.
We're moving to things like textbooks, textbooks and textbook-like things actually take clinical care and rather than look at articles, they take issues, things like diseases. They'll divide the evidence up into disease categories and then they'll further divide that up into things like assessment, screening, diagnosis, etiology, treatment, prognosis. So these summaries are actually based on the existing healthcare world.
And as I said, the Holy Grail is the next S in the progression systems and those are the place where a system will be in place, say a clinical decision support system that it will actually give you an answer to the question. There's not many of them out there and as I say that is where I think we're going to be going in the next 5 to 10 to 20 years of actually having systems that can supply intelligent answers. >> What are the four criteria for choosing information resources? >> Well, a lot of it has to do with how you approach information, how you feel about the information, what information resources you have on hand.
But no matter what information sources you choose, be aware of the soundness of the evidence-based, the evidential base that your information resource is built on. There's a lot of variation out there. Also, your information resource has to be comprehensive. Is it going to cover everything that you need? You should have one or two information resources that really support what you're doing, and it not only has to be comprehensive it has to be specific enough. If you're dealing with children with sleep disorders, you're going to want a chapter or a section that deals with children with sleep disorders, not just general sleep disorders.
It also has to be easy to use and, again, that's different for different people. Just like we have a variety of choices of cars and trucks and things, we also have a variety of information resources. And another thing it has to be available. Not all of these resources are readily available. Although many of them are available through hospital libraries and academic libraries and some of your professional organizations. >> What evidence-based resources would you recommend that clinicians use first when they're seeking information?
>> I think the first thing you have to do is think about where this information is going to be found, and then I would start sort of at the top. I would look for summaries or textbook-like information or some of these synopses. I would not go to Medline first. Medline is wonderful but remember there's 20 million articles in there and many, many of those articles are important to the healthcare, but many of them are not important to clinical care. So I would start sort of at the top at some sort of service that provides some summarization for you.
>> You mentioned PubMed. I wonder if you could describe the process for running a search using PubMed and offer some tips for using PubMed effectively. >> Okay. PubMed to me is an absolutely wonderful resource that is put up by the U.S. National Library of Medicine. It was actually designed not for the librarians of the world but designed for the researchers and the clinicians of the world. And from a clinician point of view, there have been some enhancements to PubMed that will actually turn PubMed into a clinical PubMed.
And what I'm talking about are clinical queries. So if you want a clinical topic, look at the clinical queries, do a checkbox on the clinical queries and it will turn your PubMed into a clinical PubMed. You can search for things like therapy, you know, just give me high-quality therapy articles. Or I'm interested in the prognosis of a certain disease. You can also use clinical PubMed to find things like clinical prediction guides, you know, what are the three easy questions for sorting out whether this is sinusitis or not.
Or the four easy questions on alcohol problems or the two on depression, those sorts of things. So I would use the clinical queries in PubMed and they will turn PubMed into a clinical PubMed for you. And related to PubMed there's something called PubGet out there. It's also a free service and PubGet goes with PubMed in that it will go out to the Internet and pull back all of the full-text articles that it can find for you.
So do PubMed for your searching and your PubGet to get your full types of articles. >> Is there anything else JAMAevidence users should know about choosing the best resources for their clinical use? >> I think there's two things I want to add here. The first one is I want you sincerely to go and make friends with your hospital or your academic health sciences librarians. There's some wonderful librarians out there who really can help you with choosing information resources or helping you access information resources that you already have access to that you don't even know.
I'd also check out the residents and the young clinicians that you're working with. They've come out of school learning more about some of these newer information resources and they can make some really good suggestions at how you can choose your best resources. >> Thank you, Dr. McKibbon, for this overview of finding the evidence to answer clinical questions. For additional information about this topic, JAMAevidence subscribers can consult the online chapter on finding the evidence, that's Chapter 4, in Users Guide to the Medical Literature.
This has been Joan Stevenson of JAMA talking with Dr. Ann McKibbon for JAMAevidence.
