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PBL Information Resources and Tools for the First Year: Case 27: Mac - I've got what, Doc?

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

Books of interest for this case include:

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Mac -- I've got what, Doc?

As you start off this case I think many of the questions from this first round can be answered in textbooks, background resources and the Point of Care tools.  As the case develops, check back for more resources.

 

Resources for this case include:

Textbook Suggestions (look left,)

A Quick Search Tip (for databases or search engines) -- Think Like an Author

Biostatistics -- in other words, Kaplan - Meier

National Organizations -- Organizations for Rare Disorders 

Point of Care Resources

Getting to the Diagnosis or the DDX

Advanced Directives -- Resources & Organizations

MedlinePlus -- Don't forget to try this one too

Search Tip - From Databases to Search Engines

A Quick Search Tip 

This tip should work for any resource like a database or the internet, and it simply is, think like an author.  

Often, when searching a resource like PubMed, you may be uncertain of the best search terms to use.  Because PubMed does a little translation or matching of MeSH terms to your terms, simple searches often work well.  When you "think like an author" you are looking for the ways that an article might be titled and if needed, you can tell the search tool (PubMed or Google) to find those terms in the title.

For example, say you wanted to know what the latest was on anticoagulant drugs.  Any new ones?  What is in the research phase?  I would hope for a review (systematic would be great) on them for the first question, and expect in the title something like new anticoagulant drugs.

In PubMed, you can do this in a couple of ways:

Option #1:  Use the Advanced search screen (link under the search box) and change the "All Fields" setting to "Title" and enter your search terms. 

Option #2:  Type your search terms and add [title] at the end with no space.

 

In Google, you can do this by:

Adding intitle: before your most important search term or before each search term you have.  For this search, you might want to use the filter on the side and narrow your results by year - perhaps the last 5 years would be good.

 


 

Drug Databases

Sometimes, these resources like to have the name of a drug to give you good results but sometimes a category of drugs may work (e.g., anticoagulants).

One resource you may want to explore is Clinical Pharmacology.  When looking at a specific drug, it has a section specifically on the mechanism of action.

Diagnostic Suggestions

Suggestions for Figuring out the Diagnosis or Developing the DDX

Two suggestions for you:

Kaplan Meier Curves

Finding Resources Regarding Statistics 

We have many books on understanding statistics - such as:

However, for understanding the survival curves for this case, a Google or PubMed search will work well and give you similar article results.  Top of the list will be a PubMed Central article, but Google will also find some resources from a few universities. Something as simple as:

understanding "kaplan meier" survival curve

should do the trick.

Synthesized Resources & Point of Care Tools

Point of Care Tools

Once again, the point-of-care resources will be a great way to find answers:

  • Up to Date -- general medical topics
  • Medscape -- great for pathology & lab images
  • Cochrane Library -- look for systematic reviews on your topic (e.g., thrombosis, DVT, hemolytic anemias); these types of articles summarize several studies into one cohesive article instead of making you read several different studies to find the best answer.

Learning More About Breaking Bad News & Advance Directive

Advance Directive

Most of us have a passing idea, but what are these really?  What about the medical "power of attorney" - how does that fit in? What are the ethics?  What do the professional organizations have to say?

 

What about the POLST form?​

The POLST, or Physician Orders for Life Sustaining Treatment, form complements the Advance Directive and is not intended to replace it. An Advance Directive is necessary to appoint a legal health care representative and provide instructions for future life-sustaining treatments.  The POLST is for a serious illness and specifies current treatment.  Here is a comparison for the national POLST organization.

ADVANCE DIRECTIVE POLST
  • For anyone 18 and older
  • Provides instructions for future treatment
  • Appoints a Health Care Representative
  • Does not guide Emergency Medical Personnel
  • Guides inpatient treatment decisions when made available
  • For persons with serious illness — at any age
  • Provides medical orders for current treatment
  • Guides actions by Emergency Medical Personnel when made available
  • Guides inpatient treatment decisions when made available

National Organizations