Problem-based Learning & Finding the Evidence: Case 18: Carole Glass -- Part 1

Narrow by Topic

Sometimes, Access Medicine gives so many results it is difficult to find the best one.  With the Topic filter, it may help you find the most pertinent results.  So a search for heart failure or hypertension will give you so many results while narrowing to an additional and more specific subtopic will give you a much more manageable set of results.

Now, if you are a fan of a specific book (or you want your course textbook), you could just use the Textbook filter, but there may be other worthwhile books.

If multimedia is your preference, use that filter.  There is a relevant podcast from 2 Johns Hopkins doctors.

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 - the last one in the list - 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.

Online Look-up Tools

More DDX Checker Tools

Check out our home grown tool or use one of the mnemonics.

Searching PubMed

A)  Lung Function Improvement after Smoking Cessation  

One topic I  can imagine as a PubMed search this week is the question of lung function improvement after smoking cessation. 

Often you can jump in with your terms and let PubMed do what it does well - expand your search to include MeSH terms (think hashtags if it helps) as well as synonyms.  So, for the benefits of quitting smoking, what phrase do you use?  Well cessation or quitting both work well because of how PubMed processes things.  In general though, try to lean toward more clinical phrases.

 Best Bets:

• Put in your keyword terms and phases.  Check the Details on your search history on the Advanced page if you need to make any tweaks or understand things better.
  
• Use quotation marks -- or not?  The "..." turn off PubMed's tool that matches your terms with MeSH terms and synonyms.  Use quotes sparingly and mainly for unique terms.
  •    For example:
    • search: smoking cessation  lung function   -  no quotes needed  (with quotes you miss authors saying cessation of smoking).
    • Maybe you are thinking benefits of cessation or improved lungs?  Either is a good way to go and the new PubMed automatically gives some spelling variations for this type of search.
    • Your search could now be:
      1)  benefits smoking cessation lung function   or, get more specific
      2)  smoking cessation improved lung function

B) Shortness of Breath OR Dyspnea  --  Tip for using the Advanced search form

Sometimes, you will know - or can guess - that a term is a MeSH term and without having to worry about the associated punctuation, you can easily get it set up on the Advanced search page.  With a little information and a MeSH term, you can quickly get to the new consensus statement regarding dyspnea.

• Info:  The American Thoracic Society has recently categorized this condition in a consensus statement.
• Guess that dyspnea is a MeSH term by changing the drop-down list to MeSH term, click on Index List,  and start typing dyspnea and see the list of terms appear. Click on dyspnea.

• Use the next line to add ATS  to the MeSH term dyspnea.  It will look like this.

• Look for the ATS practice guideline.

National and State Organizations  

Which One(s) to Choose?

Depending upon your question, many of the POC tools will provide great information:

• Micromedex  has some good DDX and work up information, etiology & epidemiology on dyspnea as well as pulmonary HTN. 
• Up to Date has some details on ventillatory gas analysis of exercise testing as well as chronic dyspnea.

Even some of your background questions are more clinical and therefore, these tools are also helpful for these topics.  Both Micromedex and Up to Date are subscription resources and that means as you progress in your career you may not always have your favorite resource.  Knowing your options will be helpful and necessary. Take the time now to get familiar with them.

MedlinePlus is a great place to find consumer-friendly materials along with directories, a dictionary & encyclopedia, and more.  Take a look and see what you find for this week's topics.