New Self-Paced Tutorials: Answering Clinical Questions in Real Time

The Answering Clinical Questions in Real Time class is now available as self-paced tutorials!

This set of tutorials is intended for students, residents, faculty, or staff with patient care responsibilities or an interest in patient care.

Access the tutorials at:

https://library-cuanschutz.libguides.com/AnsweringClinicalQuestions/SelfPacedTutorials

Tutorial Description:

Quickly find answers to patient care-related questions using clinical point-of-care resources, such as Clinical Key, DynaMed, Isabel, UptoDate, Micromedex, or Natural Medicines Comprehensive Database. Find resources that provide information for clinical decision-making, such as decision trees, clinical practice guidelines, differential diagnosis, and drug reference. 

Learning Objectives:

After completing this set of tutorials, participants will be able to:

  1. Identify clinical point-of-care resources available through the Strauss Health Sciences Library.
  2. Recognize which resource is best suited to use depending on the type of clinical information needed.
  3. Use the appropriate resource to locate the answer to a clinical question in a timely manner.

For questions, contact the Strauss Health Sciences Library Monday through Friday, 8:00 am-5:00 pm via AskUs using chat, text, phone, or email.

COVID-19 Topics in DynaMed

DynaMed has developed topics related to COVID-19 and specific practice areas. These include:

If one of these topics aligns with your practice area, sign up to get automatic email notifications whenever new information has been added:

  • Create a personal account by going to DynaMed and clicking on the “Sign In” icon in the upper right corner, then clicking on “Register now” and registering using your @cuanschutz.edu email.
  • When you’re on the page of interest, click the plus sign in the upper right corner.

Strauss Library also has a COVID-19 online resource guide with even more information and resources for clinicians, researchers, and consumers. You can find the guide at the following link: http://hslibraryguides.ucdenver.edu/covid. Be sure to check out the “For Practitioners” tab for links to patient care information.

You can get help from Strauss Health Sciences Library Monday through Friday, 8:00 am-5:00 pm via AskUs using chat, text, phone, or email.

Temporary Access to AccessMedicine and Case Files Collection

McGraw-Hill

AccessMedicineStrauss Health Sciences Library was granted complimentary access to these resources by McGraw-Hill through May 31, 2020, due to COVID-19.

AccessMedicine

AccessMedicine provides medical students with a variety of resources needed to excel in basic science studies and clerkships; helps residents, nurse practitioners, and physician assistants with instant access to videos, self-assessment, and leading medical textbooks that facilitate decision-making at the point-of-care; and allows practicing physicians to brush up on their medical knowledge to ensure the best patient outcome.

AccessMedicine Case Files Collection

AccessMedicine’s Case Files Collection offers Case Files content in an interactive format. Updated regularly, this comprehensive case collection helps students learn and apply basic science and clinical medicine concepts in the context of realistic patient cases. The Case Files Collection includes basic science, clinical medicine, and postgraduate-level cases, enabling students and residents to learn in the context of real patients at this challenging time.

Once you’re on the Case Files Collection site, a pop-up window will appear asking you to sign in. You do not need to sign in to access this resource. You can click the X in the upper right corner and it will temporarily go away, but it will reappear when you navigate to a new page. To keep it from reappearing, or if you would like to save answers to cases, create a Favorites folder, or access comprehension quizzes, you can click on “Create a Free MyAccess Profile” in the pop-up window, then sign in. If you’re accessing either of the sites off campus, you will be prompted to sign in to the library website using your Passport ID account.

  • Distance Learning features in Access platforms : Orientation tools for important features in the platform for distant learning.
  • Content Maps : These are vital resources for faculty in Medicine, PA and Advanced Nursing. You will find content maps for different programs that will help faculty find and map out content in Access Medicine to different classes and course quickly and stress-free!
  • COVID 19 Central – Access Medicine: Daily updated Information about guidelines, studies and research…on COVID 19

The Strauss Health Sciences Library is closed, but you can still get help from library staff and ask questions M-F 8am-5pm via AskUs using chat, text, phone, or email.

This was written by Kristen, you can contact AskUs with questions.

Micromedex Now Using AI

Micromedex is now using Watson artificial intelligence (AI) to help you quickly find answers to drug information questions. Ask Watson questions in natural language about drug dosage, administration, safety, pharmacokinetics, and interactions.

What types of question can I ask?

  • What is the mechanism of action of lisinopril?
  • What is the adult dosage of metformin for type 2 diabetes?
  • What are the adverse effects of bupropion?

Access Micromedex through the Health Sciences Library homepage.

Visit this page for more information about Micromedex with Watson.

Sign up for a 30-minute webinar (through September) to learn how to use Micromedex with Watson.

Clinical Corner: Medical Images are Just a Click Away

Clinical Corner

Looking for high-quality medical images from reputable sources? The Health Sciences Library subscribes to two resources that I find particularly helpful for finding images: VisualDx and Clinical Key.

 

visualdx

VisualDx started as a dermatology resource and is now a medical image library containing over 32,000 images. For a given medical condition, VisualDx provides multiple images that vary according to age, location on the body, skin pigmentation, and other clinical features. In addition to images, you can also:

  • read a synopsis of the conditions
  • learn diagnostic pearls as well as pitfalls
  • see a list of associated medications if the condition can be drug-related
  • find out the latest evidence for therapeutic treatments
  • download the mobile app

Type in the name of a condition, or use the “Quick Start Differential Builder” on the home page.

 

clinicalkey

Clinical Key can be used to access both electronic textbooks and journals, but it is also a good source of high-quality medical images. Type in the name of a condition and press enter, then look for the “Filter by” section on the left-hand side of the page. Click the check-box next to “Images.” From the results page, you can click on an image to view it in a larger size, or go to the source book or journal from where the picture came. All images have originated from either a book or journal.

 

Try out these resources today! If you have questions or would like to schedule a one-on-one consultation to learn more about these or other resources, contact me at the email address or phone number below. There are many other sources of high-quality medical images, and a list has been compiled by Health Sciences Library staff on a LibGuide titled Images and Media.

 

Kristen DeSanto, MSLS, MS, RD, AHIP      

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121

Clinical Corner: FREE Exam Prep Questions

Clinical Corner

Are you studying for the USMLE, shelf exams, board certification exams, or the NCLEX? Sign up for a Board Vitals account and get free access to extensive question banks that will help you prepare. You can find a link to Board Vitals on the library homepage, in the Top Resources column on the left side of the page, scrolling down until you get to the Students heading. Or use this direct link: http://marketing.statref.com/lp/uc_denver_boardvitals.html. Be sure to use your @ucdenver.edu, @childrenscolorado.org or @uchealth.org email address when you register for an account.

BoardVitals offers:

  • The highest quality questions with detailed explanations
  • High-yield, vetted questions listed up front in an effort to maximize study time
  • Constantly evolving cloud-based system that updates based on feedback
  • Ability for users to create customized practice tests and review advanced statistics to know strengths and weaknesses
  • Detailed, up-to-date explanations, with references and links to sources
  • Administrators can monitor performance to serve as a proactive remediation tool
  • Faculty can send customized exams to students or utilize questions in discussions

 

Continue reading

Clinical Corner: Mobile Apps for Healthcare Professionals and Students

Clinical Corner

Whether you’re new to the Anschutz Medical Campus or a seasoned veteran, you may not be aware of the number of healthcare-related mobile apps made available to you by the Health Sciences Library. Before you start purchasing apps with your own money, check out the list of those that are already provided for you. Start taking advantage of this free benefit today!

Take a look at some of the following popular apps:

 

DynaMed icon

DynaMed – quickly gain access to evidence-based summaries on medical conditions, drug reference, clinical practice guidelines, and medical equations and calculators.

Micromedex icon

Micromedex – high-quality drug information, including dosing and administration, contraindications and precautions, adverse effects, drug interactions, and a drug identification tool for identifying a drug based on description.

Natural Medicines icon

Natural Medicines Database – reputable, evidence-based information on herbal and natural products, including data on safety, effectiveness, and interactions with drugs, food, or other herbs.

UpToDate icon

UpToDate – summaries of medical conditions in an electronic textbook-style format, with CME/CE credit available.

VisualDx icon

VisualDx – database of images of dermatological conditions and radiographics, along with disease information summaries; look up images by disease name or create a differential based on your patient’s clinical features.

 

  

Kristen DeSanto, MSLS, MS, RD, AHIP      

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121

Clinical Corner: IOM’s “Improving Diagnosis in Health Care”

Clinical Corner

On September 22, 2015, the Institute of Medicine (IOM) released a new report titled “Improving Diagnosis in Health Care.” This continues the series of reports that began in 1999, the first being “To Err is Human: Building a Safer Health System.”

The National Academies Press is currently offering a prepublication print copy for sale, or you can pre-order a paperback. But there are also several free options: you can read it online in HTML format, or download a copy in PDF format. To download a PDF you can either create a free MyNAP account or download it as a guest.

IOM1

  • A new page will open. From there, select either Download Free PDF or Read Online (on the right-hand side of the page).

IOM2

Kristen DeSanto, MSLS, MS, RD, AHIP

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121

Clinical Corner: Acute Care for Older Adults

Clinical Corner

Today’s Department of Medicine Grand Rounds featured an informative and entertaining presentation by Dr. Samir Sinha, from Toronto’s Mount Sinai and University Health Network Hospitals. Dr. Sinha, whose presentation was titled “Rethinking Traditional Models of Acute Care for Older Adults,” discussed how current healthcare delivery in Canada and the United States can negatively impact older adults. He presented the Acute Care for Elders (ACE) Strategy, employed at his hospital, as an alternative.

The following articles and resources, many of which were discussed by Dr. Sinha, are related to the topic of patient and system outcomes for older adults:


Continue reading

Clinical Corner: Inpatient Glycemic Control

Clinical Corner

Today’s Internal Medicine Morbidity and Mortality Conference focused on a patient with type 1 diabetes who had difficulty with glycemic control during hospitalization. Here are several articles for background information:

  • Inpatient glycemic control: Best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Qaseem A, Chou R, Humphrey LL, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Am J Med Qual. 2014 Mar-Apr;29(2):95-8. PMID: 23709472. Full text (free to UCD-AMC affiliates).

 

  • Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, Seley JJ, Van den Berghe G; Endocrine Society. J Clin Endocrinol Metab. 2012 Jan;97(1):16-38. PMID: 22223765. Full text (free to UCD-AMC affiliates).

 

  • Hospital management of hyperglycemia. Lleva RR, Inzucchi SE. Curr Opin Endocrinol Diabetes Obes. 2011 Apr;18(2):110-8. PMID: 21358407. Full text (free to UCD-AMC affiliates).

 

  • Intensive insulin therapy in hospitalized patients: A systematic review. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Ann Intern Med. 2011 Feb 15;154(4):268-82. PMID: 21320942. Full text (free to UCD-AMC affiliates).

 

Three studies were presented at the end of conference as teaching points:

  • Patient communication during handovers between emergency medicine and internal medicine residents. Fischer M, Hemphill RR, Rimler E, Marshall S, Brownfield E, Shayne P, Di Francesco L, Santen SA. J Grad Med Educ. 2012 Dec;4(4):533-7. PMID: 24294436. Free full text.

 

  • Exploring emergency physician-hospitalist handoff interactions: Development of the Handoff Communication Assessment. Apker J, Mallak LA, Applegate EB 3rd, Gibson SC, Ham JJ, Johnson NA, Street RL Jr. Ann Emerg Med. 2010 Feb;55(2):161-70. PMID: 19944486. Full text (free to UCD-AMC affiliates).

 

  • Chart biopsy: An emerging medical practice enabled by electronic health records and its impacts on emergency department-inpatient admission handoffs. Hilligoss B, Zheng K. J Am Med Inform Assoc. 2013 Mar-Apr;20(2):260-7. PMID: 22962194. Free full text.

 

Kristen DeSanto, MSLS, MS, RD, AHIP

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121

Clinical Corner: Seizure/Epilepsy Videos

Clinical Corner

Cameron Ludt, DO (Neurology PGY-3) gave a presentation at Internal Medicine noon conference last Friday on epilepsy and seizure disorders. A highlight of the presentation was the showing of several videos recorded on the epilepsy monitoring unit, so that students and residents could see firsthand what different types of seizures looked like.

To see even more seizure/epilepsy videos, the Health Sciences Library subscribes to the Neurology Video Textbook (2013), by Jonathan Howard from NYU School of Medicine. Here are the steps to browse and view videos:

Neurology TOC

  • Scroll down the page to view all available videos.

Please contact me for further questions or if you have problems accessing the book.

Kristen DeSanto, MSLS, MS, RD, AHIP

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121

Clinical Corner: High-Value, Cost-Conscious Care

Clinical Corner

Steven Weinberger MD, of the American College of Physicians (ACP), gave a presentation on Friday, July 31 at internal medicine conference on the topic of high-value, cost-conscious care. The ACP High Value Care initiative has two aims:

  1. Helping physicians to provide the best possible patient care.
  2. Simultaneously reducing unnecessary costs to the healthcare system.

Here are resources to learn more about this topic:


Choosing Wisely®

www.choosingwisely.org

Choosing Wisely® is an initiative of the ABIM (American Board of Internal Medicine) Foundation, which explores ways to avoid unnecessary medical interventions. The website contains recommendations from over 70 medical specialty societies and health care organizations.


ACP High Value Care

hvc.acponline.org

The ACP High Value Care site contains guidelines and clinical recommendations that address the benefits, harms, and costs of various interventions. There are also curriculum and public policy recommendations, and resources for consumers.


Ann Intern Med. 2013 Jan 1;158(1):55-9.

Design and use of performance measures to decrease low-value services and achieve cost-conscious care.

Baker DW, Qaseem A, Reynolds PP, Gardner LA, Schneider EC; American College of Physicians Performance Measurement Committee.

Abstract

Improving quality of care while decreasing the cost of health care is a national priority. The American College of Physicians recently launched its High-Value Care Initiative to help physicians and patients understand the benefits, harms, and costs of interventions and to determine whether services provide good value. Public and private payers continue to measure underuse of high-value services(for example, preventive services, medications for chronic disease),but they are now widely using performance measures to assess use of low-value interventions (such as imaging for patients with uncomplicated low back pain) and using the results for public reporting and pay-for-performance. This paper gives an overview of performance measures that target low-value services to help physicians understand the strengths and limitations of these measures, provides specific examples of measures that assess use of low-value services, and discusses how these measures can be used in clinical practice and policy.


Ann Intern Med. 2012 Aug 21;157(4):284-6.

Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine–American College of Physicians Curriculum.

Smith CD; Alliance for Academic Internal Medicine–American College of Physicians High Value; Cost-Conscious Care Curriculum Development Committee.

Abstract

Health care expenditures are projected to reach nearly 20% of the U.S. gross domestic product by 2020. Up to $765 billion of this spending has been identified as potentially avoidable; many of the avoidable costs have been attributed to unnecessary services. Postgraduate trainees have historically received little specific training in the stewardship of health care resources and minimal feedback on resource utilization and its effect on the cost of care. This article describes a new curriculum that was developed collaboratively by the Alliance for Academic Internal Medicine and the American College of Physicians to address this training gap. The curriculum introduces a simple, stepwise framework for delivering high-value care and focuses on teaching trainees to incorporate high-value, cost-conscious care principles into their clinical practice. It consists of ten 1-hour, case-based, interactive sessions designed to be flexibly incorporated into the existing conference structure of a residency training program.


Ann Intern Med. 2012 Jan 17;156(2):147-9.

Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.

Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, Humphrey L, LeBlond R, Moyer D, Wiese JG, Weinberger S.

Abstract

Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.


Ann Intern Med. 2011 Sep 20;155(6):386-8.

Providing high-value, cost-conscious care: a critical seventh general competency for physicians.

Weinberger SE.

Abstract

There is general agreement that the U.S. economy cannot sustain the staggering economic burden imposed by the current and projected costs of health care. Whereas governmental approaches are focused primarily on decreasing spending for medical care, it is the responsibility of the medical profession to become cost-conscious and decrease unnecessary care that does not benefit patients but represents a substantial percentage of health care costs. At present, the 6 general competencies of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) that drive residency training place relatively little emphasis on residents’ understanding of the need for stewardship of resources or for practicing in a cost-conscious fashion. Given the importance in today’s health care system, the author proposes that cost-consciousness and stewardship of resources be elevated by the ACGME and the ABMS to the level of a new, seventh general competency. This will hopefully provide the necessary impetus to change the culture of the training environment and the practice patterns of both residents and their supervising faculty.


Ann Intern Med. 2011 Feb 1;154(3):174-80.

High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions.

Owens DK, Qaseem A, Chou R, Shekelle P; Clinical Guidelines Committee of the American College of Physicians.

Abstract

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.


Kristen DeSanto, MSLS, MS, RD, AHIP

Clinical Librarian

kristen.desanto@ucdenver.edu • 303-724-2121