M3 Practice Based Learning and Improvement Presentation Guide: Step 4

• If question relates to a specific patient, collect patient specific data
  • demographics, diagnosis, CC, HPI, past medical history, social history, ROS, medications, laboratory tests
• and disease factors 
  • pathophysiology, signs and symptoms, treatment, risk factors, complications, prognosis
• and medication factors
  • pharmacology/ dynamics, pharmacokinetics, adverse effects, allergy, contraindications, drug interactions, dosage, monitoring parameter

For this example case:

• Patient specific data
  • 50 yrs old, Caucasian, HTN, cholesterol 240, LDL 160.  Hyperlipidemia.  Metoprolol for HTN. No tobacco, no ETOH, no drugs.
• Disease factors 
  • what do you know about hyperlipidemia and HTN?
• Medication factors
  • what do you know about statins? what about garlic?

• Most questions require multiple references to get appropriate answer
• Conduct search via tools learned earlier in EBM and PACE (PubMed search, databases, evidence based summaries, tertiary references)

Your presentation should include the following information about step 4:

• Name the databases that were searched
• MeSH or keywords used
• PubMed filters used
• How you chose your article/guideline
  • It should match your patient as closely as possible.
  • The reason for choosing your article should not be that it is freely available. You can order any article you need for free via the library's ILLiad Inter-Library Loan service.

• List of Library Databases. PubMed tutorials are available if needed.
• List databases searched (PubMed, Google Scholar, Cochrane Library, etc.).
• If you choose to use a clinical guideline, list the library resource or other resource used to locate your guideline. 
  • How can locate clinical guidelines?
    • AccessMedicine - See the quick reference tab. There is links for primary care and inpatient medicine guidelines.
    • UpToDate
    • PubMed - Go to filters --> Article Type --> Guidelines
    • ECRI Guidelines Trust
• List keywords, MeSH terms, and filters (limits) used for your search
• Include the article citation somewhere in your presentation.
• Discuss why you chose your article. Why is it relevant to your patient.
• Remember the EBM Pyramid.
• Articles should be chosen because they are relevant to your patient not because they are freely available. Remember that you can use ILLiad to order any articles that you may need for free from the library. See the library resources and support page of this guide for more information.
• Meta-analyses are at the top of the EBM pyramid and higher than RCTs. It can sometimes be difficult to determine if your patient could have been included in the individual studies included in a meta-analysis. Meta-analyses also can vary in quality and heterogeneity. A large, well-conducted RCT can sometimes be a better choice than a meta-analysis for a PBLI presentation.

• Searched PubMed and the Cochrane Library
• PubMed Keywords: garlic AND hypercholesterolemia
• PubMed Filters: Clinical trial, publication date range: 2005-present
• Chose fifth article in the results list because the article was an RCT and best fit my patient and the clinical question.

ILLiad is the library's Inter-Library Loan Service. You can order journal articles for free via ILLiad.