Electronic Resources Guide

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The information below was compiled by librarians at the UNC Health Sciences Library.

The table below contains descriptions of and instructions on how to use several important electronic resources. These resources will be very helpful during your clinical years. Most of these resources are also available via the HSL Clinical Reference page.

Special Note: When off-campus, you will also need your UNC-Chapel Hill onyen and password for access to some licensed resources. For more information, go to: http://www.hsl.unc.edu/services/Access/access.cfm

For additional questions or problems, please use the phone numbers and links listed at the bottom of this page to reach the appropriate source of help.

ACP Journal Club provides electronic access to the print journal ACP Journal Club (2002 to date). It is produced by the American College of Physicians.

Top clinical journals are screened on a regular basis and articles reporting original studies and systematic reviews are selected. These articles are summarized in "value added" abstracts and enhanced with commentary by clinical experts.

Suggestions for searching:

• May view Table of Contents of either the current issue of ACP Journal Club or all past issues
• Click on "search" to search subject term(s) and/or limit by type of clinical question such as therapeutics, diagnosis, etiology, etc
• Enter single word; a phrase must be in "quotes"
• See "Search Help"

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ACP Pier (Physician's Information and Educational Resource) is a web-based decision support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for clinicians. ACP PIER is part of the Stat!Ref collection. Click on ACP PIER to open the table of contents. You can also enter a search term in order to find information from all Stat!Ref books.

* Please remember to log off.

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Cancer.gov is a public website. It is produced by the National Cancer Institute (NCI), the Federal Government's principle agency for cancer research and training.

The Cancer.gov web site is organized into five major units:

• Cancer Topics
• Clinical Trials
• Cancer Statistics
• Research and Funding
• News

Suggestions for searching:

• Go to the Cancer Topic unit when you need an overview of the types of cancer including treatment, prevention/genetics/causes, screening/testing and coping with cancer. This unit also provides access to the PDQ database that you can use to search for clinical trials in addition cancer information summaries written by cancer experts.
• Use the Clinical Trials unit to learn how to find a praticular clinical trial, clinical trial results and educational materials.
• Cancer Statistics covers finding cancer statistics, understanding statistics and funding opportunities.
• The Research and Funding provides NCI Research priorities, NCI Supported Research, Partner with NCI, unit covers plans and priorities in research, a project directory, a description of research supported and conducted by NCI and research resources. Funding Opportunities provides information about funding announcements from NCI and other government and private organizations. Research Resources are included in this unit.

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The CDC National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention web site is a good source of information about various topics on HIV. This site provides access to Fact Sheets in areas such as Prevention of HIV/AIDS, Surveillance, and Transmission.  See Global HIV/AIDS.

Suggestions for searching:
From the main page, read Fact Sheets on the following topics:

• Prevention
• Surveillance
• Transmission
• Virology
• CDC's Role in HIV Prevention
• Coinfection

From left yellow side bar, Topics, additional information includes Global HIV/Aids, statistics, surveillance, etc.

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• premier database used for the practice of Evidence-Based Medicine

• provides the full text of systematic reviews of the effects of healthcare
• Search reviews by topic
• Cochrane Library is updated quarterly

Suggestions for searching:

• May search entire Cochran Library by using search box in left corner
• Browse Cochrane "Database of Systematic Reviews"
• Search for "Cochrane Central Register of Controlled Trials"

* Please remember to log off.

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Facts and Comparisons provides comprehensive drug information, interactions, drug identifier, natural products/herbal information, and MedFacts. It incorporates information from the print publication Drug Facts and Comparisons, Review of Natural Products, etc.

Suggestions for searching:

• Enter single term or multiple terms
• Use "Search Help" to learn more about searching or to understand search results

* Please remember to log off.

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Harrison's Online provides access to the 18th Edition of "Harrison's Principles of Internal Medicine". The tool bar provides links to drug monographs, a collection of images, a differential diagnosis tool, practice guidelines, patient education, and health news, as well as updates.

* Please remember to log off.

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Lexi-Comp Online provides up-to-date information for drugs and their interactions, drug ID, calculations, IV compatibility, patient care, toxicology and web search query.

The following indices are available in LexiComp:

• Lexi-Drugs
• Pediatric Lexi-Drugs
• AHFS Essentials
• AHFS DI
• Lexi-Drugs International
• Geriatric Lexi-Drugs
• Natural Products
• Pharmacogenomics Online
• Infectious Diseases
• Lab Tests & Diagnostic Procedures

* Please remember to log off.

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Choose Micromedex 2.0

* Please remember to log off.

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MD Consult is a collection of books, journals, patient information as well as drug information, images, and guidelines. Link to First Consult for point-of-care clinical information.

*Please remember to exit.

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The National Guideline Clearinghouse (NGC) is a public web site from the US Dept. of Health & Human Services that provides access to a collection of evidence-based clinical practice guidelines and related documents.

Suggestions for searching:

• Use "Search the Site" window to enter a term, a phrase, an organization, or use 'and' to combine terms.
  
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NC Health Info is an online guide to websites of quality health and medical information and to local health services throughout North Carolina.

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PubMed (for MEDLINE)

Stat!Ref is an electronic collection of full text books including ACP PIER and joint Commission Resources.

Suggestions for searching:

Click on "Titles" tab to view alphabetical list of titles
Click on "Tools" tab to use dictionary, National Guideline Clearinghouse, MedCalc 3000, or PubMed
Enter search term(s) into white search box (top of page) and click "Search"
Choose Advanced Search to select specific text book(s) to search, enter search term(s), and click "Search"
Advanced Search automatically performs a PubMed search and can be limited to EMB or point-of-care books

*Please remember to log off.

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UpToDate is a clinical decision support system that helps clinicians throughout the world to provide the best patient care.

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Evidence-based medicine is usually defined as the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The practice of evidence-based medicine means "integrating individual clinical experience with the best available external clinical evidence from systematic research."

[Source: Sackett, D. L. (2000). Evidence-based medicine : how to practice and teach EBM [xiv, 261 p]. Edinburgh ; New York: Churchill Livingstone]

The EBM model emphasizes the balance between relevant evidence from methodologically sound research and clinical expertise gained through practice and experience. EBM builds on clinical skills, judgment and proficiency while attempting to reduce disparities between practice and research. In addition, EBM-based practice recognizes the need to integrate knowledge of the unique preferences, concerns and expectations each individual patient brings to the clinical encounter.

Sackett also states, "By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer."

How is EBM actually practiced? There are five steps in the process:

1. Converting the need for information about prevention, diagnosis, prognosis, therapy, causation, etc. into a focused, answerable format -- formulating the well-built clinical question.
2. Locating the highest quality, relevant information from the medical literature to answer the clinical question from Step 1.
3. Critically appraising the evidence for its validity, impact (size of the effect) and applicability (usefulness in clinical practice).
4. Integrating the critical appraisal with clinical expertise and knowledge of the patient.
5. Evaluating the effectiveness and efficiency of the EBM process and seeking avenues for improvement.

The practice of evidence-based medicine involves the use of research findings from a relatively small portion of the medical literature. Several EBM resources are available on the Clinical Reference page. For a more detailed discussion of sources, see "Using Electronic Health Information Resources in Evidence-Based Practice," (http://www.cche.net/text/userguides/resources.asp), part of the JAMA series of Users' Guides to the Medical Literature (http://www.jamaevidence.com/)

The following is a summary of EBM files on the Clinical Reference page:

http://www.hsl.unc.edu/collections/clinicalref.cfm

ACP Journal Club

The editors of ACP Journal Club screen the top clinical journals on a regular basis and identify studies that are both methodologically sound and clinically relevant. They write an enhanced abstract of the chosen articles and provide a commentary on the value of the article for clinical practice.

Cochrane Database of Systematic Reviews (CDSR)

The Cochrane Collaboration is an international organization that assembles and maintains systematic reviews of health care interventions, primarily examining controlled trials of therapeutic interventions. The CDSR contains two types of reviews:

• Complete Reviews - Regularly updated Cochrane Reviews, prepared and maintained by Collaborative Review Groups.
• Protocols - Protocols for reviews currently being prepared. The protocols provide the background, objectives and methods of reviews in preparation as well as an expected date of completion.

Database of Abstracts of Reviews of Effectiveness (DARE)

DARE is a full text database containing critical assessments of non-Cochrane systematic reviews from a variety of medical journals. DARE is produced by the National Health Services' Center for Reviews and Dissemination (NHS CRD) at the University of York, England. DARE consists of structured abstracts of systematic reviews from all over the world covering topics such as diagnosis, prevention, rehabilitation, screening, and treatment.

For further information on EBM, see the Introduction to Evidence-Based Medicine (http://www.hsl.unc.edu/services/tutorials/ebm/index.htm) self-paced tutorial developed by and the Health Sciences Library at the UNC -- Chapel Hill and the Medical Center Library at Duke University

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