VisualDX integrates with UpToDate, so during our trial you may notice additional content within UpToDate marked with this icon .  There is also a mobile version for Apple and Android devices that you can freely download during the trial.

VisualDx helps in the identification of dermatologic, infectious, genetic, metabolic, nutritional and occupational diseases, benign and malignant growths, drug-induced conditions, and other injuries.  It allows physicians to search by diagnosis, build a patient-specific differential, or look up drug-induced adverse reactions by medication.  It includes over 25,000 images covering more than 1,200 pediatric and adult conditions.

Click here to start searching VisualDX. (EVMS Network account required for off-campus access. Call 757-446-5871 or email comphelp@evms.edu with any Network access problems.)

You can view a quick tutorial here – http://www.visualdx.com/features/video-overview.

Please let us know what you think about VisualDX by completing this short survey - https://www.surveymonkey.com/s/EVMS_VisualDX

According to the American Academy of Family Physicians (AAFP), “Continuity of care is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-patient perspective efficiently… The continuity of care inherent in family medicine …enables family physicians to be more effective patient advocates and … makes early recognition of problems possible. “¹

The family physician, Dr. Clarkson, suspected eclampsia because of subtle changes in Sybil and ordered urinalysis to confirm it.  The expert refused to be swayed by the evidence.

BMJ published a tongue-in-cheek article in 1999 called Seven alternatives to evidence-based medicine. Unfortunately for Sybil, the expert was a proponent of two of these alternatives, Eminence and Vehemence-based medicine. ²

Eminence based medicine—The more senior the colleague, the less importance he or she places on the need for anything as mundane as evidence…These colleagues have a touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence over an impressive number of years.”

Vehemence based medicine—The substitution of volume for evidence is an effective technique for brow beating your more timorous colleagues and for convincing relatives of your ability.

Sybil’s death caused a rift between her father, Lord Grantham – who put his faith in the expert – and her mother, Cora – who trusted the family doctor. The grandmother, Lady Violet, attempted to heal the rift through the use of evidence-based medicine. She asked Dr. Clarkson to “Look at the evidence honestly and without bias”³  to see if prompt treatment could have saved her.

Looking at the evidence “honestly and without bias” when treating patients is exactly what we ask of practitioners. It may not always save a marriage, but it will save lives.

1        http://www.aafp.org/online/en/home/policy/policies/c/continuityofcaredefinition.html

2        Isaacs, D and Fitzgerald, D. Seven alternatives to evidence-based medicine. BMJ 1999;319:1618 http://www.bmj.com/content/319/7225/1618

3       Downton Abbey (TV Series) 2012. Episode 3.05.

David Brown, MD was a 1982 graduate of EVMS and one of the astronauts on the Columbia.  Robert McCombs, the former Dean of Student Affairs, received an email from David the day before the disaster. The email ended with the following: “I will make one more observation. If I’d been born in space, I know I would desire to visit beautiful Earth more than I’ve ever yearned to visit space. It’s a wonderful place.”

According to Dr. Brian Haynes of McMaster University, it’s helpful to think of clinical reference sources as being arranged in a six level hierarchy of evidence with the most efficient to search – i.e., evidence-based Point of Care databases – on the top.    Databases of individual studies make up the bottom of the pyramid.  He calls this the “6′S’” model for the organization of evidence-based information services.” ¹

The different levels are outlined below together with some of the representative databases available through EVMS.  Ideally, you should start your search at the top of the pyramid and move down through the levels if you need more detailed information.

Systems are decision support systems that link individual patient records to the best evidence about their conditions.  These are rare at this time, but you may find rudimentary systems at some hospitals.

Summaries provide critically appraised, concise information on all aspects of patient management and derive their information from the best evidence found in the lower “S” levels.  The Brickell library subscribes to several summary type resources.  Most of these are available to EVMS associates from on and off campus through this link: http://www.evms.edu/library/resources/databases/#EBMCat.

• ACP PIER (through STAT!Ref)
• DynaMed
• Up-to-Date (Available on campus only.)

Synopses are critically appraised summaries of individual trials or systematic reviews.   Synopses of systematic reviews make up the 3rd level and synopses of individual studies make up the 5th level.  EVMS subscribes to one of the best examples of this type of database.

• ACP Journal Club

Syntheses are systematic reviews of individual trials.  Most systematic reviews address treatment or prevention; but the number of systematic reviews answering other types of clinical questions – e.g., diagnosis, etiology, and prognosis – is growing.

• Cochrane Library (Primarily covers treatment and prevention -  Diagnostic reviews are in the works)
• DARE Database (free and through the Cochrane Library)
• PubMed LinkOut/ MEDLINE * (use article type limit “Meta-Analysis” or “Systematic Reviews”)

Studies are the original trials or studies – i.e., the primary literature.  You must critically appraise this evidence yourself before deciding whether it will be helpful for your patients.  Some of the primary research databases licensed by EVMS include

• PubMed LinkOut or MEDLINE OVID*
  Particularly Clinical Queries (Filters available to limit search to studies of treatment, prognosis, etiology, diagnosis, and systematic reviews.)
• CINAHL (allied health and nursing literature)
• PsycINFO (for research with a behavioral or psychological component)

Please contact April Pace in the library (paceaa@evms.edu, 446-5846) if you would like more information or training in the use of any of these databases.  Also contact her if you would like DynaMed on your mobile device.

1. Haynes, Brian.  Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model.  ACP Journal Club. 2009 Sep 15;151:JC3-2.

*PubMed LinkOut and OVID Medline provide links to EVMS full-text electronic journals.

Below find a sample of recent and upcoming outreach events.

Southside Senior Center
January 10, 2013

The Brickell Library had an exhibit booth at the Health and Wellness Expo at the City of Norfolk’s Southside Senior Center. Booth visitors learned how to access consumer health information about Alzheimer’s and Dementia through the consumer health resources found on the Brickell Library webpage.

Rotary Club City Center
January 23, 2013

The Outreach Services Coordinator will present “EVMS CARES: Consumer Health Information at Your Fingertips!” to 15+ members of the Rotary Club City Center in Newport News VA

Norfolk Fitness and Wellness Center
January 24, 2013

The Outreach Services Coordinator will present “EVMS CARES: Consumer Health Information at Your Fingertips!” at the Norfolk Fitness and Wellness Center (NFWC) This event is open to the public and the staff of the NFWC. If you are a member of the public and would like to attend please contact NFWC at 823-4301 for additional details.

Breadth of coverage, i.e., percentage of ICD-9 topics covered, ranged from highs of 83% (UpToDate) and 82% (DynaMed), to a low of 25% (Clinical Evidence). Five of the texts had 60% coverage or more.  Average update time for topics ranged from 3.5 months (DynaMed) to 30 months (FirstConsult).

The authors concluded that no single source was ideal, so clinicians should consult more than one when making a decision about the care of a patient.

EVMS Library subscribes to or has access to several of the sources evaluated, including DynaMed, UpToDate, First Consult (iPhone app), Medscape Reference (free source), and ACP PIER (through STAT!Ref).

Reference:
1. Prorok JC, Iserman EC, Wilczynski NL, Haynes RB. The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey. Journal of Clinical Epidemiology. Vol. 65 (12) December 2012, Pages 1289–1295

Below find a sample of recent and upcoming outreach events.

Three Old Folks on a Bench Event
November 10, 2012

25 professional caregivers attended Three Old Folks on a Bench: Looking at Alzheimer’s and Dementia Disease through the Eyes of the Person with Dementia. The EVMS Brickell Library had an exhibit booth at the event.

Booth visitors learned how to access consumer health information about Alzheimer’s and Dementia through the consumer health resources found on the EVMS Brickell Library webpage.

Grandparents as Parents Support Group
November 13, 2012

9 members of the Grandparents as Parents Support Group attended EVMS CARES: Consumer Health Information at Your Fingertips. Attendees learned how to access reliable quality consumer health information via the EVMS Brickell Library. Attendees were excited to learn about the Consumer Health link that features Health Smart Virginia and MedlinePlus.

Norfolk Sunrise Rotary Club
December 20, 2012
25 Rotary members will be attending EVMS CARES: Consumer Health Information at Your Fingertips.  Attendees will learn how to access quality consumer health information via the EVMS Brickell Library.

Deep Creek High School Science and Medicine Academy
September 25, 2012
60 freshmen students attended the presentation “EVMS CARES: Consumer Health Information at Your Fingertips.”  Attendees learned how to access quality consumer health information via the EVMS Brickell Library to help with their school assignments.

Hampton Public Library
September 28, 2012
10+ attendees attended the presentation “EVMS CARES: Consumer Health at Your Fingertips”. Attendees learned how to access quality consumer health information via the EVMS Brickell Library.

2012 Senior Showcase Presented By The Virginia Beach Mayor’s Commission on Aging
October 31, 2012
100+ seniors are expected to visit the EVMS Brickell Library booth and learn how to locate quality consumer health information via the Consumer Health link found on the EVMS Brickell Library homepage.

Epocrates Essentials‘ “all-in-one clinical reference suite provides you with drug & disease monographs and diagnostic tools. The evidence-based disease content distinguishes this suite from Epocrates Rx.” (Epocrates Rx is always available for free from Epocrates.)
You can find out more about the different Epocrates mobile products here – http://www.epocrates.com/mobile.

Since 2007, regional academic, public and military librarians have attended a 12 hour certification program in Consumer Health Information held at the Brickell Medical Sciences Library. On July 30th and 31st, 2012, 25 area school librarians attended classes taught by Kathy Wheeler, Reference / Clinical Medical Librarian and Ruth Smith, Outreach Services Coordinator. The attendees represented grades k-12 and were from the Chesapeake, Newport News, Norfolk and Suffolk Public School Systems. Their coursework complete, they will receive Medical Library Association Consumer Health Information Specialization Level 1 Certification for Non-Health Librarians and will return to their schools prepared to help their students and students navigate the complicated area of health information. Congratulation to our School Librarians!