Wednesday, April 18, 2007

April JMLA case posted: diagnosing acute pancreatitis

The April issue of the Journal of the Medical Library Association is now available in PubMed Central and it includes the latest installment in our case study series, "Using the literature to evaluate diagnostic tests: amylase or lipase for diagnosing acute pancreatitis?"

The case:
Your hospital's Emergency Department (ED) holds weekly teaching conferences for its residents. These sessions are composed of didactic lectures and oral case reports in which one resident presents a challenging patient case and another resident works through the process of evaluating and managing the situation. These sessions are a key part of the residents' training and present opportunities to evaluate current medical practices and determine the best methods of care based on the evidence.

During a particular case conference, a resident is managing a practice case that is clinically suspicious for pancreatitis. The two most common tests for diagnosing acute pancreatitis are serum amylase and serum lipase levels, and the resident requests both tests as part of the laboratory work-up of the case. The attending physician interrupts and queries the resident regarding his rationale for ordering both tests and whether one of the tests may be sufficient. An animated discussion ensues, with opinions voiced by several attending physicians and residents, about whether it is necessary to order both tests in this kind of case and, if not, which one should be used. During this debate, the lead attending turns to you as the group's consulting librarian and asks you to search and report on the literature surrounding the issue.

The question:
Which diagnostic test, serum amylase or serum lipase, is the best for making an accurate diagnosis of acute pancreatitis in the adult ED setting?

See the full case write-up for more details. Feel free to post your thoughts and questions about the case in the comments, and stay tuned for follow-up posts on sensitivity and specificity, the pancrease, physician diagnostic test ordering practices, and more...

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Friday, April 13, 2007

Aristotle quote on cases from today's BMJ

Classical commentary on the case report? Today's issue of the British Medical Journal includes a brief Aristotle quote captioned, "Aristotle: Clinical Epidemiologist?,"
None of the arts theorise about individual cases. Medicine, for instance, does not theorise about what will help to cure Socrates or Callias, but only about what will help to cure any or all of a given class of patients. This alone is business: individual cases are so infinitely various that no systematic knowledge of them is possible.
-- Aristotle. Rhetoric. book I, chapter 2: 1356b

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Tuesday, April 10, 2007

JAMA this week: ventilator-associated pneumonia

Our inaugural JMLA case study focused on an adult patient with ventilator-associated pneumonia -- this week's Journal of the American Medical Association includes two items that provide useful background information for further understanding this condition:

- a patient-level description of VAP (risk factors, prevention, diagnosis, and treatment), and

- an article that analyzes how to most accurately diagnose pneumonia in a mechanically ventilated patient (the study's objective: "To review the published medical literature describing the precision and accuracy of clinical, radiographic, and laboratory data to diagnose bacterial VAP relative to a histological gold standard.")

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Online Case Reports

Several journals and professional organizations publish case reports as a continuing education tool for readers. These are often similar to the JMLA's case feature, in that a problem is presented, and the reader is walked through the findings and solutions. A few examples you may want to check out for building your own medical knowledge base:

  • BMJ Interactive Case Reports - case presentations, laboratory results, and questions to consider for the clinical case, with readers' thoughts in the Rapid Response Section.

  • Case Records of the Massachusetts General Hospital, January 2000-present - From the New England Journal of Medicine, this site presents case records, including presentation, differential diagnosis, discussion and diagnosis. Users can search by keyword or browse by specialty. Some cases have associated lab, radiology, and/or histopathology details. NEJM also includes a recurring feature, Clinical Problem-Solving, that uses a narrative approach to work through diagnosing and treating a patient case. They’re interesting and fairly quick reads, and do an excellent job of illustrating a clinical decision making process. For example, see the April 2007 entry, "Building a Diagnosis from the Ground Up — A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever."

  • Journal of Medical Case Reports - This BioMedCentral journal was launched in February 2007, and publishes cases on a variety of general medicine topics.

  • If you're especially interested in case reports, you can find citations for more than 1 million of them in PubMed.

  • Finally, the Clinical Cases and Images blog features links to general information for clinical knowledge-building (such as ECG training, step-by-step procedure guides, and physical examination videos) as well as cases on cardiology, pulmonology, gastroenterology, nephrology, endocrinology, hematology/oncology, rheumatology, infectious diseases, and other specialties.

    What is your favorite source of clinical cases? Tell us in the comments!
  • Monday, April 09, 2007

    Finding quality health information on the Internet

    There's a free tutorial posted on MLANET, "Medical Information on the Internet: Guide for Health Reporters and Consumers," developed by two MLA members (Patricia Gallagher and Kathel Dunn) and geared toward aiding consumers with identifying and appraising health-related information on the Internet.

    It includes discussion of general web searching, using PubMed and other databases, finding drug or genetic information, and finding information about doctors and hospitals, among many other topics. It also includes an introduction to the basic roles of the medical librarian.

    (Update: link to tutorial fixed; thanks, Cynthia!)