Research Guides: Medical Student Course Guide for accessing UCI Libraries' Resources: Clinical Foundations III

Clinical Foundations III Resources

Differential Diagnosis and Clinical Decision Support Tools

BMJ Best Practices This link opens in a new window
Step-by-step guidance is provided for symptom evaluation, diagnosis, treatment, follow up and prevention. Updated daily using robust evidence based methodology and expert opinion.
ClinicalKey This link opens in a new window
A clinical search engine and point-of-care database that provides access to thousands of online resources including books, journals and multimedia.
DynaMedex This link opens in a new window
Current and accurate, evidence-based content for practicing clinicians. A multidisciplinary systematic database of emerging scientific literature and clinical practice guidelines.
Isabel Differential Companion This link opens in a new window
Isabel is used by healthcare providers around the world to help construct or broaden a differential diagnosis.

Isabel is a diagnosis checklist tool, which helps clinicians broaden their differential diagnosis and recognize a disease at the point of care. By entering the information normally captured in a patient workup, you are provided with a list of possible diagnoses to assist with making an accurate final diagnosis quickly and easily at the point of care.
UptoDate This link opens in a new window
Point of care resource of filtered, synopsized, and evidence-based information. Contains clinical references which are the equivalent of 40,000 pages of original peer-reviewed text. Specific practical recommendations for diagnosis and treatment are provided.
VisualDX This link opens in a new window
A diagnostic and visual clinical decision support system designed to enhance diagnostic accuracy, aid therapeutic decisions, and improve patient safety. Designed by clinicians to aid medical professionals in the diagnosis of visually identifiable diseases. Includes thousands of images representing hundreds of visually identifiable diseases, drug reactions, and infections. Quickly search by diagnosis, build a patient-specific differential, or review travel or medication-related events at the point of care.

*5-Minute Clinical Consult
- Available online. Restricted to UCI
*Rational Clinical Examination: Evidence-Based Clinical Diagnosis.
- Available online through JAMAevicence. Restricted to UCI.

Resources Paid by UCI Medical School

Aquifer Student: Stand Out in Rounds
Calibrate for Students (note Family Medicine faculty must assign Calibrate)
- UCI Family Medicine Clerkship Students will receive an invite to access and sign in to the Aqueduct LMS portal once the instructor sets up the cases to be assigned.

Journal Club

SDL / EBM Literature Search & Critical Appraisal

Journal Club Goals & Objectives

Clinical clerkship students must be able to search the medical literature, appraise and assimilate scientific evidence, and assess and improve their patient care practices. Clerkship students are expected to:

Address clinical questions they may have encountered during their CF3 clerkship rotations.
Perform PubMed searches and select a journal article that answers their clinical question.
Evaluate the hypothesis, the study design, the method, and the results of the relevant study as well as information on the diagnostic and therapeutic effectiveness.
Determine the clinical applicability of the selected study in their clinical clerkship practices.
Receive feedback and support from a UCI health sciences librarian, peers, and Dean Scholar.

A Three-step Approach

Step 1:

Identify a clinical scenario encountered during one of the clerkship rotations that you would like to further research for evidence.

Step 2:

Download and complete Worksheet #1 below. "Asking a Clinical Question & Conducting a PubMed Search."

Worksheet #1: Asking a Clinical Question & Conducting a PubMed Search This worksheet provides step-by-step guidance on structuring a well-built clinical question and identifying search terms within the PICO framework. The steps will help you to conduct an effective PubMed search and find a relevant study to answer your clinical question.

Complete Worksheet #1. You are welcome to see guidance or feedback from one of the Health Sciences Librarians.

Step 3:

Download and complete the appropriate worksheet below that matches the type of question and study methodology you have selected.

Appraising the Evidence (Critical Appraisal Worksheets)

Therapy (e.g., Randomized Controlled Trials, Open Label, Case series, etc.) This worksheet is designed to help you with the critical appraisal of a therapeutic study.
Diagnostic Test Study This EBM worksheet is designed to help you to critically appraise a diagnostic test study.
Systematic Review/Meta Analysis This EBM worksheet is designed to help you to appraise a Systematic Review study.
Prognosis Study This EBM worksheet is designed to help you to critically evaluate a prognosis study.
Harm / Etiology Study This EBM worksheet is designed to critically evaluate a Harm/Etiology study.
Qualitative Study Qualitative Research is primarily exploratory research. It is used to gain an understanding of underlying reasons, opinions, and motivations. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. The questions listed on this worksheet is designed for evaluating a qualitative study.

Watch the video below to guide you through the steps in identifying information needs, locating relevant resources for background reading, and developing a focused clinical question within the PICO framework that is directly relevant to your patient.

Searching PubMed@UCI: A Step-by-Step Tutorial on how to conduct a PubMed search with key terms and key concepts deriving from the PICO elements. The tutorial includes using the PubMed filters to find recent literature and the best available evidence to support your clinical decision-making.

What Needs To Be Done:

Briefly describe a clinical case scenario encountered during one of your clerkship rotations that you would like to further research for the evidence.
Construct a well-built, patient-oriented clinical question derived from your case scenario according to the PICO framework.
Decide the category of your clinical question (e.g., therapy, diagnosis, etiology/harm) and the ideal study type that contains the best evidence (e.g., randomized controlled trial, cohort study)
Identify possible search terms from your PICO question and incorporate them into a PubMed search strategy.

The PICO framework

P = Patients / Population and Problem

I = Intervention: a treatment, a diagnostic test, or an exposure (to a known or presumed risk factor, etc.

C = Comparison: a standard or alternate treatment, placebo, gold standard diagnostic test, absence of risk factor, etc.

O = Outcome of interest

The Most Common Types of Clinical Questions

Therapy / Prevention
Diagnosis / Screening
Prognosis
Etiology/Harm
Cost-benefit Analysis

Examples of Well-built Clinical Quesitons

A question about Therapy: In females diagnosed with breast cancer suitable for breast conserving surgery, what is the efficacy and safety of partial breast irradiation as compared to whole-breast irradiation?
- P = Females diagnosed with breast cancer suitable for breast conserving surgery
- I = Partial breast irradiation
- C = Whole-breast irradiation
- O = efficacy and safety of partial breast irradiation
A questions about Prevention: Does placement of postpartum contraceptive implant decrease rapid repeat pregnancy?
- P = Postpartum mothers
- I = Immediate placement of contraceptive implants
- C = Delayed or no placement of contraceptive implants
- O = Decrease rapid repeat, unintended pregnancy
A question about Diagnosis: For patients with suspicious breast calcification, what is the accuracy and safety of percutaneous ultrasound-guided vs. stereotactic biopsy?
- P = Patients with nonpalpable breast lesions
- I = Ultrasound-guided
- C = Stereotactic
- O = Sensitivity and specificity of the breast biopsies
A question about Prognosis: Would secondhand smoke exposure during pregnancy increase the risk of asthma among offspring?
- P = Pregnancy women
- I = secondhand smoke exposure
- C = Smoke-free environment
- O = increase the risk of asthma among offspring
A question about Etiology/Harm: Does Estrogen therapy increase the risk of blood clots and strokes in patients with menopausal symptoms?
- P =Patients with menopausal symptoms
- I = Estrogen therapy
- C = No treatment / placebo
- O = increase the risk of blood clots and strokes
A question about Cost-benefit Analysis: What are the clinical and socioeconomic benefits of increasing access to reproductive health services and supplies for women with substance abuse disorders?
- P = Reproductive age females with substance abuse disorders
- I = Contraceptive care & services (family planning program, counseling, contraceptive supplies, patient education programs, etc.)
- C = Unmet needs for contraception or reproductive health
- O = Socioeconomic factors (e.g., reduce health care cost, unintended pregnancy, HIV infections, abortion rates, etc.)

Resources & Tools

Collections of case scenarios
- *The Case File Collections
  - Basic Science Cases
  - Clinical Rotation Cases
- Challenging Patient Curriculum for Family Medicine Residents: Sample Case Scenarios from the University of Virginal School of Medicine.
- *Diagnosis: New York Times Magazine. Dr. Lisa Sanders recreates hard-to-solve medical case studies.
- Yale School of Medicine Case Discussions

Evidence-Based Practice: PICO -- Duke University Medical Center Library & Archives.
- Case example: Asking the Well Built Clinical Question.
Asking Focused Questions -- CEBM: The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for health care.
- Finding the Evidence 1 - Using PICO to formulate a search question (3 min)

After you complete the 20-question PubMed quiz and click submit, you will receive a certification for completion at the end. To begin the quiz, click the image below.

https://uci.libwizard.com/f/PubMed_quiz4ms

PubMed@UCI This link opens in a new window
Provides access to millions of citations from MEDLINE and life science journals. Includes links to many sites providing full text articles and other related resources.

PubMed Search Tips

PubMed may add a number of synonyms, spelling variations, MeSH, etc. Check the Search Details to see how PubMed translated your search terms. Did it interpret your search how you wanted?
Use only “essential” terms. PubMed's simple search box may look the same as Google’s, but PubMed is constructed very differently with a sophisticated search engine. Unlike Google, PubMed has a database of subject headings and key medical terminology through which every search is filtered. When conducting your search, use nouns or MeSH terms with the Boolean search concepts AND, OR, or NOT connecting them. Putting too many words or full sentences will only muddle your search results. PubMed is not Google!
Use PubMed Additional Filters to refine your search results to recent publications, Language - English, Species - Human, and Article Types - Clinical trial, Randomized Controlled Trial, etc.
Don’t restrict the search results to Free Full-text or Full-text. Very few articles are available free of charge for download. Most peer-reviewed journals require annual subscriptions. The Full-Text filter option may cause you to miss relevant results from resources that the UCI Libraries own or those that could be requested through UC-eLinks Request It.
Avoid using acronyms or other abbreviations as search terms. PubMed is often able to discern the meaning of SOME acronyms and abbreviations, e.g., GERD = gastroesophageal reflux. However, some common abbreviations are NOT recognized by PubMed, e.g., UTI, AOM, ACBE, etc.
Do not include “placebo” OR “no treatment” in the search strategy.Avoid using imprecise search words. Some words you might try as search terms may be used inconsistently in published articles or are too imprecise to be useful, e.g., increased, better, greater, less, worse, etc.
Display Options – Summary or Abstract. Sorted by Best match is set as the default display. Select Sorted by Publication Date or Most Recent.
Cite – Allows you to o copy or download a single citation in a specific style format.
Similar articles – if you find too few results, the abstract page of a citation provides a pre-calculated set of additional PubMed citations closely related to that article.

PubMed Tutorials

PubMed: Find articles by author A 2-minute brief tutorial on how to find articles by an author using PubMed.
PubMed: Find articles by journal A 2-minute brief tutorial on how to find articles from a journal using PubMed.
PubMed: Find articles from a citation A 2-mins brief tutorial on how to find articles from citation information using PubMed.
PubMed: Find articles on a topic A one-minute brief tutorial on how to find articles on a topic using PubMed.
PubMed: Find the latest treatments for a disease or disorder A brief 2-minute tutorial on how to find the latest treatments for a disease or disorder using PubMed.
PubMed: Save searches and set e-mail alerts A 2-minute brief tutorial on how to get alerts for articles on a topic using PubMed.
PubMed subject search: How it works A brief 4-minute tutorial on how automatic term mapping and explosion enhance your search.
What is PubMed? A 3-minute brief tutorial to learn what you can find in PubMed, and how it got there.
PubMed Using the Advanced Search Builder

What Needs To Be Done:

After you have completed worksheet #1 and received approval from the librarian, download the appropriate critical appraisal worksheet from Canvas.
Download the article you selected to perform the critical appraisal.
Read the selected article and complete the worksheet.
Upload the completed worksheet and the article to Canvas by November 1st.
Present your case scenario, search method, and critical appraisal of the selected study to your assigned group during the CF3 intersession.

Example Scenarios Appraisal Worksheets from Evidence-Based Medicine Toolbox

Critical Appraisal Mini Videos by Terry Shaneyfelt

How to Critically Appraise a Therapy Study - Part 1 (9 min)
How to Critically Appraise a Therapy Study - Part 2 (9 min)
How to Critically Appraise a Diagnostic Study (13 min)
How to Critically Appraise a Prognosis Study (14 min)
How to Critically Appraise a Harm Study - Part 1 (5 min)
How to Critically Appraise a Harm Study - Part 2 (7 min)
How to Critically Appraise a Systematic Review - Part 1 (7 min)
How to Critically Appraise a Systematic Review - Part 2 (5 min)
Overview of Cohort Study Design and their Strengths and Limitations (5 min)
Case-Control Studies: A Brief Overview of (5 min)

Provided by the Evidence-Based Medicine Toolbox