PubMed’s Clinical Queries: Using Evidence Based Medicine in Clinical Situations

PubMed’s Clinical Queries can save you time when trying to incorporate evidence based medicine or evidence based practice into the fast-paced and time sensitive clinical environment or other patient settings.  Clinical Queries gives you a fast and easy way to throw in a few search terms and limit to one of five categories – Therapy, Etiology (Harm/Causation), Prognosis, Diagnosis, & Clinical Prediction Guide – and begin to see some of the best types of articles related to the category and your search terms.  Clinical Queries also allows you to limit the scope of your search to Broad/Sensitive – where the search includes more citations even if they may be more peripheral or less relevant – or Narrow/Specific – where the search may miss some citations but is trying to identify the most relevant core citations.  When you search Clinical Queries to find citations concerning the prevention of deep vein thrombosis (dvt) with the use of compression stockings during traveling, you’ll get results similar to this (Table results searched as of 3/25/2013).

Number of PubMed Citations Found: Search Strategy by Category & Scope

PubMed’s Clinical Query Search	Prognosis (Prevention)		Therapy		Etiology (Harm / Causation)		Diagnosis		Clinical Prediction Guide
	Broad	Narrow	Broad	Narrow	Broad	Narrow	Broad	Narrow	Broad	Narrow
deep vein thrombosis	12166	3333	28459	2227	26308	3268	22434	1110	9529	253
deep vein thrombosis AND compression stockings	183	51	572	114	597	82	242	4	136	5
deep vein thrombosis AND compression stockings AND travel	8	4	26	4	39	9	5	0	7	0

You can see that as you add applicable search terms with the Boolean operator ‘AND’ you can quickly  reduce the number of appropriate citations that you’ll need to wade through to find good relevant evidence to support or deny the use of compression stockings to prevent (prognosis) DVT when traveling.

If this is new to you, schedule a consultation with one of our librarians for more info about using Clinical Queries as well as other searching tips and tricks we can help you with.

[John Jones, Librarian]

Heroin Addiction Pearls

At Internal Medicine Report involving a case of potential infection and heroin addiction, one of the infection vectors brought up was – did the person reuse needles?  For a lot of practitioners that probably seems like a pretty obvious question but one of the Hospitalists brought up a couple of other transmission vectors for practitioners to consider when looking for potential infection sources when dealing with needle administered drug addictions.  Here’s 3 things to think about when working with potential infection and a needle drug addiction:

• Does the person reuse needles?
• Does the person lick the needle before injection?
• Has the person put the needle plunger in their ear?

The hospitalist conveyed that a wide held belief among injection drug users is that licking the needle will make the tip sharper and therefore ease the insertion.  You can easily see that if this is their practice, injection drug users are opening themselves up to any number of contaminates from the mouth and saliva.

Did they stick the plunger where?  Apparently as needle plungers become less effective, addicts may use ear wax to create a tighter seal to prolong the use of the needle which introduces another transmission vector for infections or pathogens.

If you know of other journal articles,  pearls or questions like this or have anything else to add, please comment below or send me the information to update this posting – John.Jones@ucdenver.edu.

Here’s some articles that may be of interest:

• Del Giudice P, Vandenbos F, Boissy C, Cua E, Marion B, Bernard E, Dellamonica P, Counillon E. Cutaneous complications of direct intra-arterial injections in drug addicts. Acta Derm Venereol. 2005;85(5):451-2. PubMed PMID: 16159743.  For more articles like this one use Related Articles.
• Del Giudice P. Cutaneous complications of intravenous drug abuse. Br J Dermatol. 2004 Jan;150(1):1-10. Review. PubMed PMID: 14746612.  For more articles like this one use Related Articles.
• Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002 Sep;16(3):697-712. Review. PubMed PMID: 12371123.  For more articles like this one use Related Articles.
• Deutscher M, Perlman DC. Why some injection drug users lick their needles: a preliminary survey. Int J Drug Policy. 2008 Aug;19(4):342-5. doi:10.1016/j.drugpo.2007.06.006. Epub 2007 Jul 26. PubMed PMID: 18638706.  For more articles like this one use Related Articles.
• Oh S, Havlen PR, Hussain N. A case of polymicrobial endocarditis caused by anaerobic organisms in an injection drug user. J Gen Intern Med. 2005 Oct;20(10):C1-2. PubMed PMID: 16191149; PubMed Central PMCID: PMC1490230.  For more articles like this one use Related Articles.
• Swisher LA, Roberts JR, Glynn MJ. Needle licker’s osteomyelitis. Am J Emerg Med. 1994 May;12(3):343-6. Review. PubMed PMID: 8179747.   For more articles like this one use Related Articles.

JAMAevidence now available!

Do you teach about Evidence Based Practice? Run a Journal Club? Or, just want to learn more about EBP and critical appraisal?  Then, JAMAevidence is the resource for you!

The Health Sciences Library is pleased to provide JAMAevidence (go to J in All Databases), an online resource for learning and teaching about evidence based health care.   Available both on and off campus, JAMAevidence includes the full content of the JAMA Users’ Guides to the Medical Literature, The Rational Clinical Examination,  Care at the Close of Life, and Core Topics in Evidence-Based Medicine.   In addition, calculators, podcasts, education guides, and a host of other tools for teaching, learning, and practicing evidence based clinical care are available.    Try it today!

• Take a guided online tour to learn more.
• Try it on your mobile device – http://m.jamaevidence.com/