First Consult

Source: First Consult website Are you interested in contributing to HLWIKI International – hlwiki.ca? contact: dean.giustini@ubc.ca To browse other articles on a range of HSL topics, see the A-Z index. Last Update 9 May 2013 Introduction See also ClinicalKey by Elsevier| DynaMed (EBSCO) | Evidence-based health care | Point of care decision-making tools - Overview | UpToDate FIRSTConsult is a point-of-care tool produced by Elsevier and is usually coupled with MD Consult. It is available for mobile devices, updated weekly and comprises four (4) sections: Differential Diagnosis contains a list of 350 chief complaints which lead to lists of their associated differential diagnoses, sorted by age of patient and prevalence. Clicking on a differential diagnosis brings up a comparison of clinical features with images Medical Topics contains information on common issues found in in/out patient settings. Summaries cover evaluation, management, outcomes, and prevention. There are 475 summaries available as of Dec 15, 2006 Patient Information provides 300 clearly written handouts for patients in both English and Spanish. They are written at a Grade 5-6 reading level. There are separate handouts available for patients who have been diagnosed with a disease, and for a more general overview of the disease. Procedures files provide clear, systematic guidance, including videos and medical animations of the procedures integral to practicing medicine across many specialities. The videos are available in 3 formats: windows media player, realplayer, and quicktime. Searching Under each section, users can search via a search box or an alphabetical list. Users can modify searches as required. The search engine does not support truncation. It is updated quarterly. The print version is a series of 15 books entitled FirstConsult Books. The series includes a differential diagnosis volume and a medical condition series by specialty. Literature surveillance Evidence is summarized principally from three critically evaluated sources: Cochrane Systematic Reviews are respected throughout the world as some of the most rigorous research into randomized controlled trials. This database provides access to highly-structured searching for the systematic review, with evidence included or excluded on the basis of explicit quality criteria. Many reviews include meta-analyses to increase the power of the findings. Clinical Evidence provides synopses of the best currently available evidence on the treatment and prevention of many clinical conditions, based on searches and appraisals of the available literature. The National Guideline Clearinghouse is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality in partnership with the American Medical Association and the American Association of Health Plans. In addition, where evidence exists that has not yet been critically reviewed in one of the three sites above, the evidence is summarized briefly, categorized, and fully referenced. Guidelines are also sourced from governmental and professional bodies. Additional information is taken from MD Consult, consensus statements, reference texts, and peer-reviewed articles. Medical Condition summaries are written from this evidence by physicians. The summaries are reviewed by an editorial advisory board of experts, and by clinical reviewers. Disease summary overview Each medical condition summary follows a structured template. Each contains section titles such as Summary, Background, and Diagnosis. Where possible, citations have LinkOut to articles contained in MDConsult or to consensus statements. Levels of evidence are also cited where applicable. Usefulness The online version provides access to the largest number of sections as well as weekly updating. The PDA version is updated quarterly but only 2 out of 5 sections are available. The available sections have been abridged which has resulted in misleading information. FirstConsult is meant to be used in primary care offices, clinics, and emergent or urgent care settings. Even though it does not cover as many topics as UpToDate it has more options for navigation. Patient information in FirstConsult is easier to read. In sum, FirstConsult is more useful to primary care providers, house staff, newer clinicians, physician assistants, nurse practictioners, and clinical nurse specialists. Fox et al found that some information is not available; seeking information on hyponatremia or SIADH in differential diagnosis produced little of consequence. Patient education handouts on Hepatitis C were not findable. Some discrepancies exist between patient handouts and Medical Condition summaries. FirstConsult only uses generic drug names in its contents. References Elsevier. FIRSTConsult Online and Handheld Content http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/demo Differential Diagnoses http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/desc_ddx Medical Topics http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/desc_medi Procedures http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/desc_proc Sources of Evidence http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/desc_source FirstConsult Collaborative Authoring Process http://www.firstconsult.com/fc_home/public/?urn=com.firstconsult/1/home/desc_create Fox GN, Moaward NS, Music RE. FIRSTConsult: a useful point-of-care clinical reference. J Fam Pract. 2004;53(6):466-472. 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. J Clin Epidemiol. 2012 Sep 10. Taylor MV. FIRSTConsult. J Med Libr Assoc. 2004;92(2):285–287. Useful Tools. Computers in Libraries. 2004;24(5):45.