Can the Internet help with clinical problems?
Here are a few examples of clinical queries that will let you work through a
number of the Internet sites suggested in the workshop.
Information sources beyond the immediate reference sites.
Conjunctivitis should be straightforward to manage – or is it?
Read up the treatment of conjunctivitis in GP Notebook – your trainer then
challenges you that a BMJ article recently suggested frequent bathing is
as good as giving antibiotics.
Go to Clinical Decisions and this time click on Clinical Evidence –
Conjunctivitis is listed under Full Review list – the PIL is worth a look at.
The alternative way into Clinical Evidence is via Best Practice.
A patient has a spreading rash round a tick bite – they’re concerned
they’ve picked up Lyme disease. This is the last patient in your afternoon
surgery and your mind has gone blank – how can you quickly reference
Use DermNetNZ under Clinical Information and look for Lyme disease
under L in the alphabetical listing.
Want more info on best evidenced treatment? – go to Clinical Decisions
and enter Dynamed – look up Lyme Disease.
Restless legs syndrome is becoming a real intrusion into a patient’s life
and an O/P visit didn’t go well. The patient is now asking for your help in
GP Notebook has some information but compare this to the information
available on a search for Restless legs Syndrome on the Clinical
Decisions search engine.
Could it be worthwhile to eat dark chocolate? A patient queries your
dietary advice to reduce their sweet consumption by quoting a newspaper
article claiming chocolate is good for you
Go to the e-library and carry out a search on TRIP using dark chocolate as
your search term.
A particularly useful resource for media related stories and queries is NHS
Choices: Behind the headlines on the Keeping Up To Date page
Challenging the evidence base
A patient ascribes his unusually low BP reading in the surgery to having
started drinking Beetroot juice recently – “there’s lots about it on the
Try Googling “Beetroot juice”. Is the case for beetroot juice established?
Try TRIP and Medline to establish a more authoritative idea of the
A patient is referred to you by the midwife at AMH advising on
breastfeeding – she feels she has Candidal Mastitis and wants the patient
started on Fluconazole. Having dealt with the patient you decide to look
into this condition – what information can you find and how would you
tackle the situation now?
You can access a variety of information – but Medline is quite helpful here.
Accessing figures to help patients.
An elderly patient has a mild anaemia attributed to his Chronic Kidney
Disease. He’s been on Ferrous Sulphate recently and queries whether to
continue. How easy is it to access guidance and numbers to guide how
you manage his case?
Use the Clinical Decisions search engine – using “Chronic Kidney
Disease” and “anaemia” – narrow the search to guidelines only.
A 70 yr old patient was seen 4/52 ago with a TIA secondary to recent
onset AF. The recommendation is to start Warfarin but the patient is
reluctant. She had a friend who had a major bleed on Warfarin. However
she wants to reduce risk of having a CVA. She’s asking for information on
the effectiveness of medication and the risks of taking it.
Go to TRIP – search on “CVA”, “AF” & “Warfarin” – narrow to systematic
reviews and choose the appropriate Cochrane review. The full text of the
review is available by clicking on the Cochrane Library tag and this gives
you access to numbers you can use.
I’ll work through this example with you using a Powerpoint presentation.