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PBL Information Resources and Tools for the First Year: Case 3: Mark Montague - I'm just so tired

This guide provides resources and strategies for finding background, clinical and drug information, including evidence-based medicine strategies and specific information for problem-based learning exercises.

Textbooks

The following are textbooks of possible interest and are available either in print or online.  To find more books of interest, use the search box below and to the right.  

What more resources? Search Roger.

Google Tips

Google Quick Tip

If you don't know the best patient resources to suggest, what do you do?  Well, if you don't use Medline Plus, Google might be able to help.  There are most likely 2 types of resources you might want to recommend -- government organizations or national organizations dedicated to specific diseases or conditions.  Here's how you identify them:

Put your terms into Google for the condition of disease of interest and add one of the following:

site:gov

site:org

 

Case 3: Mark Montague - I'm just so tired

 

Resources for this case include:

 

Textbook Suggestions (look left)

Differential Diagnosis Tools

Resources for Interpreting the CBC

Resource Highlight - Up to Date

National or State Organizations - National cancer Institute & Leukemia Society

PubMed Search Tips -- Find Adherence articles or  Historical articles

Drug Information Resources

There is More to Access Medicine than Just Books

Cost & Cancer Medication -- using popular press to lead you to a journal article

Patient Resources - a couple of reliable organizations 

Google Quick Tip

 

DDX & Symptom Checker Resources

Symptoms and differential diagnositic information is often buried in a number of our resources.  However, a few tools (both online and for your smart phone/PDA) have special tools to help with this process.

One book helps explain the thinking process (Symptom to Diagnosis) with topics that include a variety of non-specific complaints from low back pain to weight loss to GI bleeding, to abdominal pain.  One book has a list of mnemonics (Collins' book) as well as the symptom info.  Another book (Syed & Rasul's book) is organized by body areas and the last one (DDX of Common Complaints) focuses on the most common symptions and presents the way a doctor might pursue to diagnosis (images & tests).

Also listed below are some of the interactive DDX tools and their advantages.

Online Look-up Tools

Tools for Interpreting CBC's

Resource Highlight -- Up to Date

Highlighting Up To Date

Up to Date, is a unique resource that provides the clinical picture as well as sometimes, answering the background questions -- the what, when, where, why, how type questions. For example: 

  1. Some symptoms or patient complaints are non-specific problems and don't seem to point to a specific problem, making it difficult to narrow down to a manageable differential diagnosis. Try looking up fatigue in some of the online or print resources and you will see what I mean. Try the fatigue search in UpToDate for comparison. 
  2. Medical genetics regarding BCR-ABL. A search of BCR-ABL will get you to a diagnosis for this case and a nice encyclopedia like entry on this topic. You may need to revise your search if you need information beyond the medical genetics info.

National Organizations

National organizations

Both government and private organizations often have very useful information for patients as well as physicians.  As a health professional it is good to be aware of the patient sites but probably better to use the professional literature for your own information.

PubMed Search Tips

Searching PubMed

1)  Using PubMed's Custom Vocabulary, MeSH

If you saw last week's example, we used a term of patient compliance to search for articles on patient adherence to a prescribed regimen.  The term, combined with a limit for adolescent age group helped focus the results to pertinent articles about Maria's situation.  This week, we can borrow that idea, but make it more specific.

If you are looking for articles that cover the consequences of not adhering to a treatment regimen, you might try the more specific MeSH term of "medication adherence" instead of treatment adherence.  

  • You can locate the term in the MeSH database and then search right from there.  (See the main PubMed page for the link to the MeSH database).  Or,
  • You can also just use the phrase in the main PubMed search box and let PubMed make some behind the scenes asumptions about how to use it (not a bad way to do it).  
  • Or, better yet, now that you know it, tack a little bit on the end to search only for the MeSH term:    

medication adherence[mh]

 

2)  History of Medicine 

Usually, your PubMed search will be about looking for current or recent research articles.  But, did you know that historical perspectives and individual biographies are also part of the PubMed literature?  There is a special field you can use to limit to historical articles.  Use the following,  "Historical Article"[pt] along with the disease - spell it out is better than abbreviation. 

So, if there is something that has been around for years and you want to know more about it, a historically oriented article is a good way to get that historical info.

 

With just a couple of terms you can get a short list of possible articles.

Even More in Access Medicine

What Else does Access Medicine Offer?

I have categorized this as a background resource which means it is a resource for answering those factual questions you might have -- think what, when, where, how, why type questions.  This is because the main part of Access Medicine is the textbooks.  There are other tools that are very helpful, such as:

  • Diagnosaurus, a DDX tool
  • Diagnostic Test (a pocket guide book that is highlighted in their blue banner)
  • Drugs, a guide to generic or trade names, as well as drug classes
  • Quick Dx & Rx - another book that, like the pocket guide, gives brief details and tips for any number of diseases or conditions
  • Guidelines:  Concise guidelines on various diseases and conditions published and collected into a book.

 

The pocket and guide books in Access Medicine assume a level of education you may not have attained yet.  They are ideally designed for a busy clinical environment where bullet points will help you remember all of the details you have already learned.  So, their brief descriptions may not help you fully flesh out a PBL write up.  When you search Access Medicine, keep that in mind.  If you need brief info, to augment what you already have learned, then okay, but if you need more detailed understanding, make sure you read the textbooks, e.g., Harrison's, DeGowin's, etc.

Drug Information Resources

Drug Information Resources

Two resources to use for treatment and drug information: Clinical Pharmacology & Micromedex.  Look up the drug options for a general type of disease or a very specific disease.  Both have similar information but work a little differently.  Use the one that you like best - both are great tools.

Already know what drug will be prescribed?  Search it by name.  For example, find out more about imatinib - how does it work?  what are its pharmacokinetics?  what are the contraindications or precautions?  

Cost & Cancer Medications

From a News Story to the Original Journal Article:  Example with the Cost of Cancer Medications

Example 1

One of the doctors in 2014 mentioned a (somewhat) recent New York Times article about the cost of cancer medication and that a group of physicians were protesting the high cost of these drugs.  When you find "popular press" type of resources like this, they can often give you a clue as to where the information comes was initially published.  Fast forward to today, and the cost of cancer medications are once again in the daily news and there has been an recent article on the topic.

Here's a "Googling" example of getting to the reliable information.

Finding the recent comments about the very high cost of cancer medications, you can go to Google and simply look for:  cancer drug prices  new york times.  I added NY Times because my tipster mentioned that and logically, some of the news stories should have appeared there.

Reading through the first story, I noticed that they gave me the name of the journal - Mayo Clinic Proceedings but not much else.  So, logically, I know the year is 2015.  

 Head to PubMed to find the full article -- search using the info you have which is 3 bits of info -- Mayo Clinic Proceedings for the name of the journal and the year - 2015.  Also, use the Title field indicator and enter drugs[ti]. Enter that info and search

"Mayo Clinic proceedings" AND 2015 AND drugs[ti]

You should get just a few articles.  The published article is a commentary piece.  

 

Example 2

There is a 2013 article that was highly pertinent to today's case - so see if you can get to it with the data points:  Blood  (that's the journal names)   2013  (publication year)   and the title words,  cancer drugs.  From the home page of PubMed, click on Single Citation Matcher and enter this info.  You will get just 1 article. on unsustainable prices of cancer drugs from a group of CML experts.  

Consumer Health Resources

National Organizations - Consumer Health Resources

Search MedlinePlus: