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Problem-based Learning & Finding the Evidence: Case 5: Alma Carlsson -- Oh no, not again!


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Alma Carlsson -- Oh no, not again!

Dealing with abbreviations - search with them or spell it out?  For example, h pylori or helicobacter pylori; MALT or mucosa-associated lymphoid tissue?  Abbreviations like these two, because they are so well known, will give you pretty good results, but often, searches will be better with the full phrases than the abbreviations.  Be prepared to search again with a the full term whenever you search with abbreviations and the results seem limited.


Textbooks (look left)

Search Tips -- PubMed & EBM using PICO

Accessss - an EBM federated search tool

DDX & Symptom Checkers (reminder) -- a tip from Dr. Gates

National Organizations    

MedlinePlus -- Fruit & Veggie Resources

Search Tips -- PubMed & Clinical Queries

PubMed can help you answer the question about diagnositc tools for h pylori.  This case is also a great example of using the PICO format for structuring your query.  

PubMed via the PICO tool:  

(Great when you use all the Comparisons)

Patient (details)  ---  60 yo female, possible h-pylori infection

Intervention (pick one)  --  urea breath test

Comparison (list one or all)  --  serology  OR  stool

Outcomes (optional this time) -- diagnosis


Although recent changes have made using abbreviations much more successful, a search in PubMed is better when you use the full spelled out version instead of its abbreviation, so your terms will be something like:

helicobacter pylori diagnosis urea breath test stool

Depending upon your question - do you need evidence from Clinical Trials or do you want a bigger picture with Review articles - you could limit it further with a filter for either a Clinical Trial or Review.

You will get a short list of potential articles - this topic has been particularly well discussed in 2014.


ACCESSSS - Search Across Multiple Clinical Resources

Ever wish there was something like Access Medicine for some of those clinical tools?  Well, we have partnered with the people at McMaster to use their search tool called ACCESSSS.  Give it a shot this week and let me know how you liked it.  It is new for me too, so any comments you have for me are helpful.  You will need to create an account to use this tool.

Need an example?  Try the PubMed search above and see what you get.

Clinical Reasoning Tool

If you have this look up this week, here's your link as well as the links below that will help you work with this tool.  Remember, it will ask you to login, but once done will take you to the tool.

UCSD SOM Clinical Reasoning Tool

DDX Resources

Perhaps your questions this week deal with understanding the different symptoms the patient mentioned.  What do they indicate?  Without some good hunches it is hard to move forward.  There are a number of differential diagnositc tools to help with the process.

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.

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).

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

Online Look-up Tools

Navigating Stat!Ref

Stat!Ref is not qiute a slick as Access Medicine but it is another place to find books.  One search will turn up drug info, info from textbooks and snippets from Smart Medicine.


National Organizations

MedlinePlus: Information Tool for Patients

MedlinePlus is a great place to find consumer-friendly materials along with directories, a dictionary & encyclopedia, and more.  These week, if you have a look up for fruits & vegetables, the consumer info might be very helpful.  Take a look and see what you find - try fruits vegetables.

Search MedlinePlus: