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Problem-based Learning & Finding the Evidence: Case 12: John Dewey -- My Girlfriend Heard a Noise

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John Dewey -- My Girlfriend Heard a Noise

Up to Date will be good for both the clinical type questions as well as the background info - perhaps murmurs, endocarditis or heart failure.  Be sure to check out some of the other resources too - maybe a guideline or a systematic review.  

You will also find some great heart images in eMedicine (you saw some of them during group)

 

Resources for this Case

Textbooks (look left)

Access Medicine - Telling AM which book to search

Clinical Guidelines Clearinghouse &

Finding Guidelines or Systematic Reviews

Health Insurance : Pre-existing Conditions & Family Programs

Patient Information Resources

 

 

Access Medicine - By the Book

Access Medicine - Telling it Which Book to Search

Have you tried this trick?  Access Medicine has such a key cardio  book - Hurst's the Heart - that you might find it better to search within the book instead of across all the books in Access Medicine.  You start this process on the home page and just scroll over to click on the book.

 

Then, you get a page that limits your search terms to just Hurst's.  Give it a try with murmurs and see if you like those results.

NOTE:  This is edition 13 (2011) so the insurance info will be historic not current.

Guidelines Clearinghouse

Guideline Clearinghouse

You may have checked out the National Guidelines Clearinghouse before, but you really should be familiar with it, the information it provides, and the tools it offers to compare guidelines.  Hospitals probably have specific guidelines they follow, but what about those doctors who are dealing with patients outside of the hospital?  Here's what you might find with this case.

Once you are there, you need to figure out the terms to use which is something to do with just about every search.  What terms will work best?  There are 2 concepts for this search (not necessarily just 2 words), but a couple of ways to search.  For example:

Dental Visit Drugs
dental prophylaxis
dental prophylactic antibiotics
dent* prophyla*

So why bother with the variations?  It depends upon your needs.  The first is short and concise, but has the potential to miss possibly helpful results.  The second is a little more specific by including the term antibiotics.  Either of these is fine when you are simply looking for some good results and don't need to worry that you are finding everything on the topic.  The last option includes truncation so you don't have to worry about synonymous terms.  So try it out.

The ones that have been selected can then be compared side-by-side on their main points.  Select the ones you think might apply and click the compare button.

It is a little glitchy because it asks you to select them again and click compare again.  I don't know why the intermediary page is needed, perhaps it is so you see the tips they have about using the tool.

Then, you will see a grid with all three compared side-by-side.

Clinical Guidelines

Finding Guidelines and Systematic Reviews

National Guidelines Clearinghouse is not the only place to find some synthesized information.  You could also try some of these resources.

Health Insurance - Pre-existing Conditions & Family Programs

Finding Info on Health Insurance for those with Pre-existing Conditions, Now & Then

This question is easier than I expected.  California has a great website about the new program called the PCIP - Pre-Existing Condition Insurance Plan which is part of the recent health care reform.  Because many of you will be practicing in California, I've included it here.  So, if you need to brush up your understanding and want to see what is out there, a search of websites is in order.  Whichever search engine you prefer will work just fine.  A smart searcher might want to do some of the following: 

  • be as specific as possible
  • use the limit for sites within the gov domain (site:gov)

What about the patient's family, is there coverage for them?  Again, a simple search should help you find the Healthy Families Program and details about coverage.  The same tips as above apply to this search too.


Curious about what things were like before?  Journal articles, editorials & news stories from 2+ years ago will help you gain that perspective. 

  • Medical perspective:  Check out PubMed and be sure to apply the date filter for the timespan in question. Perhaps, also ask for editorials with the Article type filter. 
  • Patient perspective:  Check out news stories in Google News and be sure to check the time period on the results page to get to the stories with either a current viewpoint.  (Can you find the report, HHS: Pre-existing conditions leave 12.6M adults uninsured, that outlines some of the problems that existed.)

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 about heart valves.

Search MedlinePlus: