The following are textbooks of possible interest. You will also find good stuff in Access Medicine where you can search across 40+ books.
Evidence-Based Cardiology Consult by 
Comprehensive Cardiovascular Medicine in the Primary Care Setting by 
Hurst's the Heart by 
Acute medicine : a practical guide to the management of medical emergencies by Not finding what you need? Having trouble using one of our resources? Please let us know.
Ask Karen - you can reach me at 858-534-1199 or at kheskett@ucsd.edu
Ask a Librarian - for those late night hour questions, chat with a Librarian 24/7
Resources for this case include:
Textbook Suggestions (look left)
Resource Highlight -- Multimedia Resources
Clinical, Point of Care Resources
Differential Diagnosis Tools - including Dr. Goldberg's Digital DDX
Resources for Understanding Lab Tests
National or State Organizations
Life-long Resources -- Smoking Cessation
Multimedia Resources
With the growth of Youtube, you might think that is the only place to look for a video of the stent procedure, but there are other sources you could use.
Clinical, Point of Care, Tools
Micromedex and Up to Date will be helpful encyclopedic resources this week. The ACP Journal Club is a unique resource that reviews articles, elevates the evidence, and provides commentary on the article. This is a helpful tool to find relevant articles and quickly see if it is pertinent to your look up questions. See what it has to say about chest pain. You can be broad like chest pain or even very specific, for example, a specific drug.
Symptoms & DDX 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.
Dr. Gates has found a very helpful text within Access Medicine - Symptoms to Diagnosis: An Evidence Based Guide. Presented through a series of cases of patients complaining of a specific issue, then walks you through buiding the DDX and prioritizing it, and making the diagnosis. Unlike the interactive tools that give you list, this text helps explain the thinking process. Topics include a variety of non-specific complaints from low back pain to weight loss to GI bleeding, to abdominal pain. Check out Chapter 1 as an overview of the diagnostic process.
The books we have include one that 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).
Isabel - is an up and coming tool that is starting to be integrated into the EMR environment. This free version should be very helpful for many look ups.
Also listed below are some of the interactive DDX tools and their advantages.
Symptom to Diagnosis by 
Differential Diagnosis in Internal Medicine by 
The Patient History by 
Differential Diagnosis in Primary Care by 
Differential Diagnosis in Primary Care by 
Differential Diagnosis of Common Complaints by 
Improving Diagnosis in Health Care by Online Look-up Tools
DDX Checker Tools
From home grown tools to mnemonics.
Looking up information about the results of lab tests are mostly background questions. The following resources are easy to use tools to find very reliable information about the normal values, reference ranges, and more.
Henry's Clinical Diagnosis and Management by Laboratory Methods by 
Ferri's Clinical Advisor by 
Pocket Guide to Diagnostic Tests by 
Delmar's Guide to Laboratory and Diagnostic Tests by National organizations have funded a great deal of research and the results not only become journal articles, guidelines, and recommendations, but might include risk calculators based on the results of the research.
One of the questions you have this week might be about some of the drugs used in this case. What if you didn't already know what the problem is when giving nitroglycerin to a patient with a history of taking sildenafil - where would you look? You can also run a drug interaction report to see the info with taking these 2 drugs. We have several drug resources you might think to check. The following two are the resources used by UCSD Medical Center.
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Clinical Pharmacology : Use the drop-down options for Find by ... Contraindication/Precaution or look for the "Reports" option below the search box to run report for drug interactions between these two drugs. |
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Micromedex : Look for the tab at the top to run the report for drug interactions. You can even search for smoking cessation and find drugs used for it. Or ask Watson and see the drugs by categories of "effective" or "evidence favors efficacy." |
I know Google might be an easy tool to use for some questions. If you do use it, think about the source of the information. Is it reliable? Do you know who is providing the info? Do they have a bias or an agenda that colors the facts? Are they selling something? Going to reliable resources to start with means less analysis as you look at the information.
Searching PubMed
Which procedure gives a better outcome, stents or bypass? What does the evidence say on this topic? This clinical question lines up very well for the PICO way of searching (part of evidence-based practice).
PICO stands for:
P = Patient & problem
I = Interventions
C = Comparison
O = Outcome
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Note: this is just an example and you could easily change it to ETT with a completely different outcome. |
P:
C:
O: |
Search terms are easy to highlight with this model and you can also identify filters to help refine the results -- such as, patient's age and possibly, gender. An English Language filter might be helpful to apply as well 59 year old male, chest pain - possible CADYou want to treat with stents What you might also use is the bypass procedure What you want to see is an improvement in survival, but you might also use the term mortality. What you want to see is an improvement in: survival, - that's the patient focus. If you thought of the term mortality that is not as patient focused. Understanding what the highest level of research type you can expect for the question you ask is another way to narrow your results to very pertinent results. Because one of the highest level of evidence in this case is a randomized trial, I would look for those from the start. |
Smoking Cessation Counseling Techniques and Patient Resources
The following resources are available to everyone without a subscription and for the most part have been developed with government funding. These tools will be available to you even when you graduate and move on from UCSD.
