Problem-based Learning & Finding the Evidence: Case 17: Aswut Trujillo -- Hikwisa - Breathe in Luiseno

Point of Care, Decision Support Tools

Just so the links are easy to get to.

Which organizations are helpful on a specific topic? 

How do I find them?  Is there a way to know which are good ones without having to investigate everyone?  Which ones have guidelines on diagnosis, prevention, management, or treatment?  How many do I have to know?

Well, as you progress in your field, you will become familiar with the key organizations; however, there will often be organizations worth knowing that are outside your area of expertise.  You can always Google for them, but I would propose a different plan - use the search tools that vette those organizations.

One search tool for finding organizations that can provide patient-level information (in English and several other languages) is MedlinePlus.  As a student, you can find good images there, some full-on surgery videos, and a direct link to topic-specific PubMed searches (see the tip below).

Another search tool is the Trip Database.  This will provide you an internationally focused list of organizations providing expert and evidence-based opinions on a variety of topics.  For this case, you may be interested in the Institute for Clinical Systems Improvement guidelines, the Cincinnati Children's Hospital, or the American Academy of Allergy, Asthma and Immunology.  Don't forget you can also compare them side-by-side.

Change happens all the time and the most recent one is the guidelines from the Global Initiative for Asthma (GINA) which recently brought out new guidelines for symptom management and prevention.  They have both slides and a report you could download. 

PubMed Tip #1

UC San Diego Health System is building a culture of patient-centered care.  As you begin to refine your searching, don't forget to keep the patient outcomes in mind as you do your searches.  Often, treatment's yardstick is mortality, and yes, patients care about that, but they also have questions about living with a disease or prevention of it, its treatment and possible side-effects, and more.  I encourage you to bring those concerns into your searching, especially with those topics that are clinically focused.  One mnemonic to use is PICO

Patient:  who is he? what is he dealing with? how old is he? is ethnicity a factor that should be searched?

Intervention:  what is a treatment you would like to try?

Comparison:  is there a "gold standard" that is used?  (can be optional)

Outcome:  again, think about patient-oriented outcomes, not just mortality, but decreased ER visits or hospitalizations or ...

In addition, clinical effectiveness is a growing topic for diagnostic services and treatment at the national level.  A growing body of literature can be found in PubMed.

PubMed Tip #2:  Search the Titles Reminder & Cited By

Before you say, oh, yeah, she's pointing us to PubMed again, let me give you a workflow that might work to cut through the thousands of results on a topic like asthma.  It will not work in all situations, but it is an easy way to see what it might do for you. 

Title Search in PubMed
If you saw the previous tip, you can add the [ti] after the terms or used the Advanced search capability of PubMed. 

1. How many words can you search for in the title?
   As many as are necessary.  Just keep in mind the more terms you use, the narrower you results and you could find nothing.  Let's use this example ---  How is adolescent asthma diagnosed and managed?  Give yourself a second to think - how would I see this idea in an article?  That will influence the word choices you make. 
   One example is:
   adolescents[ti] asthma[ti] diagnosis and management[ti]  
    
2. This is a very narrow search but should give you some background and overview information.  
   There is a review that looks very good.(Diagnosis and management of asthma in adolescents) but it is from 2009.  Is there anything newer?
    
3. Maybe.  Click on the title and check the Cited By group of articles to see if anything there might be good.  (Spoiler alert, yes, I think the "Keeping Pace ..." article is worth a look.
    
4. Now, for this case, you might want to focus on just the management aspect and want to see some of the newer research on how that is being done.  Drop the diagnosis part.  I would also add the wild card * instead of the "s" on adolescents so you can get the singular or plural version of the term.  
   adolescent*[ti] asthma[ti]  management[ti]  
   More results, but also more details on the management side of the question.

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 Peak Flow - perhaps the "action plan" from the NIH.