The nature of the problem

• Medline
  • How many articles are there?
  • Choosing search terms
  • Can you easily use MEDLINE to find the best initial drug for hypertension?
• Barriers (we are also learning how to retrieve articles here):
  • Lots, of complicated information and even some misinformation
  • How do physicians answer questions?
  • Searching is harder than you think

Offcampus access

• Proxy

• VPN - http://www.uthscsa.edu/tn/vpn/
• Sites
  • http://www.library.uthscsa.edu
  • http://clinical.uthscsa.edu
  • http://stvhcs.med.va.gov/clinical/library
    • this is the intranet hompage + '/clinical/library/'; also from CPRS
    • this is a copy of a page only accessible within the VA

Spiffing up your computer

• Google toolbar

  • Examples:
    • "Conflict of Interest in the Debate over Calcium-Channel Antagonists"
    • How much phenytoin (15 mg/kg) to give a 75 kg male in status
    • When was this patient taking albuterol?
• Bookmarklets
  • http://medinformatics.uthscsa.edu/bookmarklets (mainly the 'proxy me' bookmarklet)
• Browser search plugins
  • http://medinformatics.uthscsa.edu/searchplugins/

Storing articles

Go to MyNCBI (at PubMed.gov) or connotea.org or www.RefWorks.com. Consider starting at http://clinical.uthscsa.edu or http://www.library.uthscsa.edu so you can proxy.

Resources

General

• http://clinical.uthscsa.edu
  • Includes other UHS and VA information
    • Antibiotic sensitivities, etc
• Systematic hypertexts
  • Examples

• UpToDate

  • UT and UHS http://www.uptodate.com
  • VA Located on both Intranet homepage and CPR

• PIER - http://pier.acponline.org

• Sample searches
  • Pneumonia treatment for uncomplicated adults
  • Duration of pneumonia treatment for children
• What about the editorial processes of these references may make them better than other references?
• Limitations
  • Recent knowledge
  • Subtle knowledge (PMID: 15070633)
  • Occasional misinterpretations of knowledge

Pharmacology

• MicroMedex

• Limitations
  • Recent knowledge
  • Subtle knowledge
    • Can statins cause myopathy?
    • ...but with normal CK? (PMID: 12353945)
  • Occasional misinterpretations of knowledge

Things not covered

Looking up information for patients

• Medical knowledge
• www.MedlinePlus.gov
• Patients.UpToDate.com
• Local resources (support groups, pharmacies)
• Local.google.com