Informatics in Occupational Health Medicine by liaoqinmei

VIEWS: 2 PAGES: 21

									Informatics in Occupational Health & Medicine


   Michelle Sinotte
   Health Instructional Librarian
   Health Sciences Library/Community Health Sciences
   Phone: 210-3959
   Email: msinotte@ucalgary.ca
                      Seminar Outline
• Evidenced based medicine, the landscape for occupational medicine
• Finding the information you need
   – Subscription or fee based resources
   – Free on the Web
• Options for using the library
• Guidelines for practice in occupational medicine
• Managing your information
                            Objectives
• Increase awareness of the tools available to answer your clinical
  questions
• Increase understanding of evidence informed practice and the
  special challenges for Occupational Medicine
                       Evidence Based Medicine
...the conscientious, explicit and judicious use of current best evidence
    in making decisions about the care of individual patients…
                                                                            BMJ 1996 312: 71-2.
…the integration of best research evidence with clinical expertise and
  patient values…
                           Sackett DL, et al ,How to Practice and Teach Evidence-Based Medicine


“Evidence-based medicine is simply a process of life long self-directed
   learning in which the practice of our specialty creates a need for
   clinically important information…”
   Excerpt from editorial by Dr. Denis D’Auria taken from Occupational Medicine 50:4 pp211, 2000
Converting information needs into focused
            clinical questions

 P =     Patient or Problem
 I = Intervention
         (treatment, diagnostic test, exposure)
 C=      Comparison Intervention
 O=      Outcome
hazard 1                         exposure(s)
non-occupational                 route
                                 duration
                                 intensity
                                 dose estimates
                                                        health
                                                        effect(s)
hazard 2
occupational                     susceptibility

biological                       genetic
chemical                         developmental
physical                         medical conditions
psychological                    behavioral
                                 nutritional


Dr. Ken Corbet, Faculty of Medicine, University of Calgary
Challenges in locating the best evidence in occupational
                         health
  • Interdisciplinary - wide ranging search
  • Grey literature - unpublished, un-indexed
  • Lack of synthesized secondary literature
            –Cochrane, UK CRD - therapy, RCTs
            –Few RCTs, SRs in OM literature
            –OH organizations evaluative literature
  • Regulations/Policies don‟t align with existing evidence
  • Lack of time / training to conduct searches
  • Lack of access to e-journals, DDServices
                                                  Courtesy of Lorraine Toews
                           Systematic Reviews & Meta-analyses

               Randomized Controlled Double Blind Studies       Rigour &
                                              Cohort Studies    Validity

The Evidence                           Case Control Studies

  Pyramid                                     Case Series

                                           Case Reports

                        Ideas, Editorials, Opinions

                                Animal Research

                 In vitro (‘test-tube’) research

Oxford Centre for Evidence-based Medicine Levels of Evidence
http://www.cebm.net/levels_of_evidence.asp
           Where is the Evidence?

                 Information Resources
•   Books/Textbooks (Current and evidence based)
•   Guidelines/Clinical Support Systems
•   Systematic Reviews/Meta-analyses
•   Articles/Studies
•   Association websites/government publications
                Searching for Information
• Clinical Support Systems
   – ACP‟s PIER (Physicians Information & Education Resource)
   – FIRSTConsult
   – Clinical Evidence

• Subscription databases (University of Calgary)
   – Cochrane
   – DARE (Database of Abstracts of Reviews of Effectiveness)
   – Medline
   – OSH References
             Refining Your Database Searches
Strategies to Narrow Your Search (to retrieve fewer results)
• Reframe your question to make it narrower
• Use more specific, or only the most relevant, subject headings or keywords
• In OVID databases select the Focus option. In the PubMed MeSH
   Database, select the Restrict Search to Major Topic Headings option
• Add subject headings or keywords (using AND) to represent other aspects of
   the question
• Decrease the number of synonyms for each search concept
• Do not use truncation in keyword searches
• Use the Limit feature (eg. language, publication types, age)
            Buckingham, Jeanette. Evidence Based Medicine: Mini-Manual, 2004 (unpublished)
                                    University of Alberta John W. Scott Health Sciences Library
              Refining Your Database Searches
Strategies to Broaden Your Search (to retrieve more results)
• Reframe your question to make it broader
• Use broader, more general subject headings or keywords
• In OVID databases do not select the Focus option. In the PubMed MeSH
   Database, do not select Restrict Search to Major Topic Headings
• Remove the least important concept(s) from your search
• Check relevant records for subject headings or keywords, then use these in
   your search
• Add synonyms for each search concept
• In keyword searches (but not in subject heading searches) use the
   truncation symbol at the end of word stems to retrieve word variations (eg.
   therap$ to retrieve therapy, therapies, therapeutic)
• Apply fewer, or no limits to your search results
• Use the Related Articles feature in PubMed, or the Find Similar feature in
   OVID
            Buckingham, Jeanette. Evidence Based Medicine: Mini-Manual, 2004 (unpublished)
                                    University of Alberta John W. Scott Health Sciences Library
                   Searching for the Information
                  Freely available on the Internet
•   Cochrane Database of Systematic Reviews (abstracts only)
•   DARE (abstracts only)
•   Pubmed (abstracts only)
•   Google Scholar or Google
•   Grey Literature
    "that which is produced on all levels of government, academics, business
    and industry in print and electronic formats, but which is not controlled by
    commercial publishers." 1

       1: New frontiers in grey literature: Fourth International Conference on Grey Literature: GL'99
                            proceedings;1999 Oct 4-5; Washington, D.C. Amsterdam: GreyNet; 1999.
                 Searching for Information
Using Google Scholar for Health Sciences Research
• For research in the health sciences, particularly that of a clinical
  nature, which must be current, precise and from a trusted source,
  Google Scholar is insufficient. Google has not released information
  regarding which databases it searches or when it is updated, making
  it difficult to determine how comprehensive your search has been. It
  is also difficult to determine what Google Scholar includes as
  „scholarly research‟, leaving you, the searcher, to make this often
  difficult distinction for yourself.
                                McMaster Health Sciences Library website
              Getting the least from Google…
•   Limit search to certain domains (.gov .org .edu)
•   Limit search to document types (.pdf .doc)
•   Use “” to limit to a phrase – search for words together
•   Use more terms and try synonyms
•   Try Google book search
•   Use advanced search
•   When you find good sites don‟t assume you can find them again –
    bookmark them
  Beyond the Citation…Getting the full text
• Google
• Free medical journals online
Health Sciences Library
• Catalogue and E-journal list
• Drop in use (photocopy/printer cards $10)
• TAL card /Community Reader card
• Fee based searching ($60/hour + photocopying charges)
Health Information Network
• Document requests
                      Guidelines
Sources for guidelines
• Pubmed
• ACOEM
• ODG (Occupational Disability Guidelines)
• National Guideline Clearinghouse
• Clinical Support Systems
   – InfoPOEMS
   – Uptodate
                      Grey Literature
American Occupational and Environmental Clinics
  Epidemiology tools
   Guidelines for lead exposed adults

Canadian Standards Association: Occupational Health & Safety program

Alberta WCB: Medical Advisory Guidelines

ILO International Labour Organization: database access list

World Health Organization :Research Tools
              Managing Your Information
• Bookmarks
   – del.icio.us (my list)
   – furl
• Citations
   – RefWorks ($100/year USD)
   – Jabref (open source)

   Note: privacy is an issue with many free programs.
   Posting documents protected by copyright, or storing electronic
     copies of such documents on a server is a copyright violation
                                       Summary
“Evidence-based medicine is simply a process of life long self-directed
   learning in which the practice of our specialty creates a need for
   clinically important information…”
    Excerpt from editorial by Dr. Denis D’Auria taken from Occupational Medicine 50:4 pp211, 2000



•   Clinical Support Systems/Textbooks/Systematic Reviews
•   Databases - Articles/Studies
•   Grey literature – Associations/Regulatory bodies/Others
•   Capturing what you find -
                    Getting Help
• University of Calgary Health Sciences Library
• Calgary Health Region Knowledge Centres
       • Rockyview General: 943-3373
       • Peter Lougheed Centre: 943-4737
       • Alberta Children‟s Hospital: 943-7077
       • Women‟s Health Resource Centre: 944-2267
• Michelle Sinotte
  Phone: 210-3959
  Email: msinotte@ucalgary.ca

								
To top