Finding most recent Practice Guidelines

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Etorphine

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I feel like I've made it to 3rd year with a good basic understanding of physiology and pathology. For diseases I am not familiar with, I know where to look on Uptodate, Access medicine, Pocket Medicine to learn more on the wards. What I do NOT know how to do is look up the most recent clinical guidelines for a particular disease, whether for diagnosis, treatment, etc.

I know about guideline.gov , but I don't know how to use correctly. For instance, let's say you had a 30 y.o. female pt. with confirmed cystitis who you now want to treat. If you navigate on website guidelines-->treatment/intervention-->diseases--> female urogenital diseases, there is no information on the hypothetical example of cystitis. Am I doing something wrong?

How do you personally find the most recent treatment guidelines with simplicity, ease, and relevance? What other sources do you use to find guidelines?

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I love AccessMedicine. For your example, just search for 'cystitis' and then on the left filter by "guidelines" and it's right there. Beautiful figure; click on 'print' to bring up a nice full screen easy to read view. Includes recommendations from multiple professional organizations, gives years, etc. I've never seen anything better.

I also like AccessMedicine for algorithms (Quick reference --> algorithms) and you can also find one for UTI.

For Cancer stuff, the gold standard is the NCCN guidelines. Requires you create a free account but otherwise easy to access and gives the latest evidence based treatment guidelines for most types of cancer and is more than enough for you to look like a rockstar as a student.

Another way to look like a rockstar is to call your hospitals pharmacist on call and ask for recs based on the latest resistance patterns in your hospital. Even if the team doesn't use their recommended drug, you still look good for having thought about asking.
 
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I love AccessMedicine. For your example, just search for 'cystitis' and then on the left filter by "guidelines" and it's right there. Beautiful figure; click on 'print' to bring up a nice full screen easy to read view. Includes recommendations from multiple professional organizations, gives years, etc. I've never seen anything better.

I also like AccessMedicine for algorithms (Quick reference --> algorithms) and you can also find one for UTI.

For Cancer stuff, the gold standard is the NCCN guidelines. Requires you create a free account but otherwise easy to access and gives the latest evidence based treatment guidelines for most types of cancer and is more than enough for you to look like a rockstar as a student.

Another way to look like a rockstar is to call your hospitals pharmacist on call and ask for recs based on the latest resistance patterns in your hospital. Even if the team doesn't use their recommended drug, you still look good for having thought about asking.

easy to do and right on the money. thanks!
 
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Unless you don't have access to AtM. :(
 
Unless you don't have access to AtM. :(

Check with your library and see what services they do pay for. I think all VA medical centers have AccessMedicine too, and you can sign up through them for a temporary username/password to access it from home. I did that because my library had some issues with their proxy server and sometimes I couldn't get AM and it always worked great. Your school may also have a subscription to some other service.

Another place to look is on website for appropriate professional organizations. AAP has guidelines listed for peds, ACOG for OB/GYN, AAFP for Family/internal, etc. Many of these are free on their sites. You can also pubmed search as many guidelines are printed in major journals when they come out.

All that said, do make sure to learn for yourself WHY things are done the way they are, both for shelf questions and just being a good doctor.
 
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Check with your library and see what services they do pay for. I think all VA medical centers have AccessMedicine too, and you can sign up through them for a temporary username/password to access it from home. I did that because my library had some issues with their proxy server and sometimes I couldn't get AM and it always worked great. Your school may also have a subscription to some other service.

Another place to look is on website for appropriate professional organizations. AAP has guidelines listed for peds, ACOG for OB/GYN, AAFP for Family/internal, etc. Many of these are free on their sites. You can also pubmed search as many guidelines are printed in major journals when they come out.

All that said, do make sure to learn for yourself WHY things are done the way they are, both for shelf questions and just being a good doctor.

Yeah, I checked the library first :) They have a good amount of stuff though. UptoDate is a godsend.

How would you recommend ideally going about the WHY bit?
 
Yeah, I checked the library first :) They have a good amount of stuff though. UptoDate is a godsend.

How would you recommend ideally going about the WHY bit?


That's a tough question. I think you start to figure it out if you ask questions and make an effort to understand. For example, you'll see lots of protocols for all sorts of things: PE, fever, delirium, DKA, etc. Try and think through why a fever workup in an adult consists of CXR, UA, and blood Cx x2 rather than just recite it. In that case, those are very common sources of infection so it makes sense. Extrapolate to kids now and if an infant comes in with fever, you'll want to add an LP because they're also much more likely to have CNS infections, but at some point the kid will be old enough that if you find another source for the infxn you can probably skip the LP without much worry. Figuring out where these lines are what guidelines are great for, and understanding the dilemma at hand will make them more meaningful and then ultimately allow you to develop your own clinical judgement.
 
That's a tough question. I think you start to figure it out if you ask questions and make an effort to understand. For example, you'll see lots of protocols for all sorts of things: PE, fever, delirium, DKA, etc. Try and think through why a fever workup in an adult consists of CXR, UA, and blood Cx x2 rather than just recite it. In that case, those are very common sources of infection so it makes sense. Extrapolate to kids now and if an infant comes in with fever, you'll want to add an LP because they're also much more likely to have CNS infections, but at some point the kid will be old enough that if you find another source for the infxn you can probably skip the LP without much worry. Figuring out where these lines are what guidelines are great for, and understanding the dilemma at hand will make them more meaningful and then ultimately allow you to develop your own clinical judgement.

Thanks :). I guess was hoping you had an easier answer, maybe 2-3 resources. With Step 2 and 6 shelves to study for, along with all that time in the hospital, it certainly isn't going to be an easy year. Simple, but not easy :/
 
Thanks :). I guess was hoping you had an easier answer, maybe 2-3 resources. With Step 2 and 6 shelves to study for, along with all that time in the hospital, it certainly isn't going to be an easy year. Simple, but not easy :/
Remember that the tests often lag reality... current guidelines & hospital antibiotograms (to use your example of cystitis) are money on wards & treating patients.

Tests, however, are not that up to date. Makes for a really f'ing annoying situation...

Just my $0.02,
-d
 
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agree,understanding the dilemma at hand will make them more meaningful and then ultimately allow you to develop your own clinical judgement.thanks
d5HleJ
 
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