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Problem-based Learning & Finding the Evidence: Case 8: Karina Johnson -- Menstrual Madness


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Karina Johnson -- Menstrual Madness

Compelentary and alternative medicine resources are topics once again this week.  If you missed them last week, no worries, I've reprised and augmented the list this week.

For the more mainstream contraceptive drugs, don't forget to use the Drug Info Resources tab for some good databases to use.


Resources for this Case

Textbooks (look left)

Featured Resource : Complementary & Alternative Medicine Resources

PubMed Search Tip :  A therapy example of a PICO Search 

Finding FIGO Classification System Information of AUB

Clinical Reasoning Tool & DDX Resources

Patient Information Resources

Natural Standard & Natural Medicines Database

Complimentary & Alternative Treatment Resources

Sometimes, an internet search will help you understand what your patients are finding out on the web.  But when it comes time for finding good evidence about those items, there are several really good resources on alternative, complementary, or integrative medicine.  Each has strengths to recommend it.  Keep in mind that not all CAM treatments are well studied so the conclusion that can be made varies based on the level of study and evidence available.

Sometimes, an internet search will help you understand what your patients are finding out on the web.  But when it comes time for finding good evidence about those items, we have a really great resource for you on alternative, complementary, or integrative medicine: Natural Medicines.  

Natural Medicines

Natural Medicines is the new combined resource of Natural Standard and Natural Medicine Comprehensive Databases and their information aims for evidence-based practice principles and uses as many references as they can find on their topics.  Links to the references allows you to put your EBMI skills to good use in evaluating that component - typed of study and levels of evidence.  The interface does a good job at calling attention to possible interactions and the possible strength of the interactions.  Search or browse the resource.


 Try the "Effectiveness Checker" for this case's look ups - perhaps accupuncture or dysmenorrhea.


National Center for Complementary & Alternative Medicine

A special division under the National Institutes of Health, the NCCAM provides information and funds research on various CAM interventions.  In addition, they provide Clinical Practice Guidelines for practicioners on a number of topics.  It may not be the best resource for this week's case, but it is a good resource to know about.  

Find info on topics, find a practioner, look up details on herbs, find information in Spanish, or see their information for health professionals.

PubMed Search -- Complementary & Alternative Medicine (CAM)

Did you know PubMed has a special set of CAM articles?  It is a combination of key journals (identified by the NCCAM) and CAM MeSH terms.  Use it to cut through to the literature you need.  Since it is PubMed, you have all of the side filters available to you.  For example, did you know that there are over 19 systematic reviews on acupuncture and menstral issues?  Try your topic and see if it identifies some good articles.

PubMed Search Tips: Reminders

PubMed Search -- Finding the Evidence About Therapy

Want to focus in on the literature?  Perhaps your question this week is about myomectomy vs. uterine artery embolization, then a well-formed clinical question based on PICO is going to help your search process tremendously.  (Remember, PICO stands for patient & problem, intervention, comparison, and outcome.)  What that would look like is

P: 37 y/o african american woman with uterine fibroids
I: hysteroscopic myomectomy
C: uterine artery embolisation
O: preserving fertility 

My search would be something like the following:

uterine fibroids hysteroscopic myomectomy uterine artery embolisation (fertility OR pregnancy)

You will notice that I used fertility OR pregnancy.  The reason is that I'm thinking that authors might have used one or the other to describe the outcome I'm interested in, so I want to use both terms.  Keeping them between parenthesis helps PubMed know to process them together before adding all the other words.

The more details you can give PubMed, the better your results will be.

Finding New Classification Systems

Classification of Abnormal Uterine Bleeding

Throughout your career, as information and knowledge expands and progresses, updates will be made.  In fact, studies indicate that within 5 years, half of what you know when you graduate will change.  That is why some of the synthesized resources will be valuable for keeping up with the newest information, conventions, & guidelines. Check out what the following resources have to say on AUB or if you know the name of the new system, search for that.  Your course textbook came out just before the latest guidelines did, so it won't cover this latest way of classifying AUB.

Differential Diagnosis Resources

DX 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

Passing along a Tip from Dr. Gates regarding a DDX & Symptom Checker 

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. For example, here's a small screenshot of the hypercalcemia section.


Also listed below are some of the interactive DDX tools.

MedlinePlus: Information Tool for Patients

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.

Search MedlinePlus: