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“Doctor, please cure my bloody tears…” Practising Evidence-Based Medicine Clinical Scenario:
Searching Medical Literature & the Role of Medical Librarians
A 24-year-old man developed severe chronic conjunctivitis in his left eye, which resulted in minor symblephara and dry eye after 10 months. One year later, the patient developed recurrent bloody tears in his left eye and several hematomas in the left periorbital region. Even after extensive workup, local causes or a systemic condition could not be determined.
Imagine you are a doctor handling this case, what would you do when you can’t seem to find the root cause of why this man bleeds from his left eye? What is the best treatment for his condition? What would your decision processes be? When faced with mysteries in life, the inquiring mind naturally asks questions. Constructing good clinical questions is one of the first steps in practising Evidence-Based Medicine (EBM). The most commonly cited definition of Evidence-Based Medicine (EBM) comes from Dr David Sackett (1996) where EBM is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” The integration of the above three components into clinical decisions enhances the opportunity for optimal clinical outcomes to ensure the patient gets the best possible care.
What is Evidence-Based Medicine?
Clinical Judgement
Relevant Scientific Evidence
One of the steps in practising EBM requires the medical practitioner to systematically search the best medical literature available. In Lee Kong Chian School of Medicine, medical students are taught how to search for medical literature. The Medical Library provides access to the highest quality medical literature through three sources: OVID, a platform which provides seamless searching on Medline, EMBASE, EBM Reviews (Cochrane Collaboration) databases, fulltext medical journals and e-books. ClinicalKey, a clinical insight search engine, draws evidence-based information from more than 900 textbooks, 500 medical journals, and more than 9,000 videos. UpToDate is an evidence-based clinical decision support resource, enabling medical practitioners to make the right decisions at the point of care. Integrated with VisualDx, a medical image database that has 30,000 high-quality peer-reviewed medical images spanning diseases of the skin, nails, hair, oral mucosa, genital mucosa, eyes, and lungs as well as other internal and systemic diseases to assist in visual diagnosis. Medical librarians can guide students and practitioners on the usage of these databases by teaching them search strategies and evaluation skills. This will enable them to apply these steps in the EBM framework: Critical appraisal which involves testing evidence for validity, clinical relevance, and applicability (usefulness in clinical practice) Making a decision – applying the results in practice taking into account patients’ preferences and Evaluating decisions
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Applying the steps above, our medical students and practitioners will discover through the medical literature found in the databases recommended in this article, that after eliminating all possible causes, a treatment for the man with bleeding eyes would be the administration of vitamin C 1000 mg daily to promote vascular stabilization. In some cases, it was reported that the bleeding lessens and stops completely with no intervention. With such evidence from the literature, medical practitioners can discuss the choice of treatment with their patients who suffer from bloody tears.
Patients’ Values and Preferences Caroline Pang Head, Medical Library carolinepang@ntu.edu.sg
Sackett DL, et al. BMJ. 1996,312(7023):71-72 Accessed from http://www.psychiatrictimes.com/uspc2013/evidence-based-useantipsychotics-quick-how-to, 7 April 2014
Maggie Yin Medical Librarian maggieyin@ntu.edu.sg
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