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Problem-based Learning & Finding the Evidence: Case 6: George Mackenzie - Is there any hope?

Books

The following are textbooks of possible interest and are available either in print or online.  AccessMedicine has a nice diagnostic tests text but may be busy. 

To find more books of interest, use the Roger search box below.

Roger Search Box

George Mackenzie - Is there any hope?

This case is a nice review of many topics you have covered which means you can approach your topics with a more clinical eye instead of always needing to fill in the background information.  The medical center has a special focus of patient-centered care which connects nicely with evidence-based care.  A little practice now means more flexibility later.  What does this really mean?  In general, try looking for the highest evidence possible.     It is a good time to pull together everything you've learned about studies & the evidence they provide from the EBMI thread.

 

Resources for this Case

Textbooks (look left)

Dr. Gass's Recommended reading -- NEJM Liver Transplantation Article

DynaMed vs Up to Date

Surprise! Micromedex is for more than just drugs

PubMed Tips Finding Prognosis Literature 

Zoom in to articles with data : Cochrane Database of Systematic Reviews 

Lab Tests Resources : Henry's & more

National Organizations & MELD Resources

Patient Information Resources

Dr. Gass' Recommended Reading - a NEJM article

Synthesized Resources - High Quality Evidence

DynaMed vs. UpToDate

We have two resources that do similar things.  You most likely have heard of Up to Date but DynaMed might be new.  They both have have resources for this week's topic - e.g., liver disease, cirrhosis - that includes the basics like pathophysiology as well as the clinical application.  DynaMed this week might offer a few desired options such as images (especially for skin findings), a format that permits easy scanning, and easily identified (and linked) resources in the same space as where it is referenced.  

Both are good tools but it is good to have options.  As you move more in to the clinical realm DynaMed's style of making the evidence for their recommendations in the text of the document will help in the clinic - especially if your patient is a little different than "the norm."

Micromedex

Micromedex

A surprise for this week is the detail Micromedex offers for medical topics.  

 

It provides both Quick Answers and In-Depth Answers - and that is where the good stuff can be found.  For example, a search for alcoholic liver disease has some very interesting info for this week's look ups.  Enter that in the main search box to get to this page with the Quick & In-Depth Answer tabs.

PubMed : Finding Prognositc Literature

PubMed - Clinical Queries for Prognosis

Don't forget to check the latest research, which usually means a PubMed search.  Use PubMed's built-in tool to target the type of articles you want without having to know all the tricks to filter out what you don't need.  Start with Clinical Queries - look for it on the main PubMed page, under Tools.

 

Next, enter your term(s) and search.  I tried liver cirrhosis.  Then, adjust the drop down category box for Prognosis and leave the Scope to Broad.

 

See All option to get the full list of articles.  Since the most recent 5 are in the list, there maybe others that are a little older in the see all list.

Featured Resource: Cochrane Database of Systematic Reviews

Evidence-based Tools

What is the evidence?  How do you quickly find the best evidence is a better question.  It is all about the tools, so know your tools.

 

Cochrane Library, or more specifically, the Database of Systematic Reviews

The good news, when you find your answer here, it is a very quick process.  The data of many research trials is combined into one cohesive resource.  The bad news, great stuff takes time to build so not all topics are here in Cochrane.

For this case, see what the resource has to say (if anything) about alcohol withdrawal or try spontaneous bacterial peritonitis.

 

  

When viewing the reviews, don't forget to view the full-text as the default initial view is only the plain-language summary. 

This tool is great for boiling down multiple studies into one with the added benefit of synthesizing into a cohesive single opinion.  Jump to the Figures tab to take a look at the data presented - make good use of your EBMI skills.

Lab Tests Info

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.

National Organizations


 

Patient Information Resources

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