Course CDEN 815
Assignment 2
Patient Information Web Search

Instructions:

1. Verify your group number. Same as last week. The number corresponds to an item in the list of assigned sites below.
2. The sites were selected by Dr. Pelok, and the questions were generated by him. For clarification of a site or question, please contact Dr. Pelok directly.
3. The scenario for this assigment is that a patient or patient advocate has come into your office bearing a printout from a web site. The link is given below, and should be the same as that which your group evaluated in Assignment 1, Pt. 2. You are to respond appropriately to this patient's concerns, INCLUDING:
   • in a nonconfrontational way, helping them better understand how to identify quality health information on the Internet, and
   • directing them to another source which offers reliable patient information on the topic of their concern.
4. To do this, your group is asked to perform a web search (NOT a MEDLINE search!!!) to locate additional web sites on this topic, and to document the search process on the FRIAR/SECT Internet Search form. (Link should be active Monday afternoon. In the meantime here is a link to the first page of the form.) Criteria which usually most strongly impact on the grade are:
   • Properly defining the most important concepts in the question.
   • Properly defining irrelevant or unsearchable concepts in the question.
   • Generating alternate terms for most important concepts.
   • Selecting an appropriate search engine for the question (ie. Usually not Yahoo). If you have questions or concerns about this section of the assignment, you may want to refer to this PDF of a decision tree for matching health questions to health search engines. Other criteria to keep in mind:
     • (1) appropriate use of large or small search engines (to find out which are large or small, refer to Danny Sullivan's work at SearchEngineWatch.com);
     • (2) common or general questions search in small engines and especially those focused on the topic;
     • (3) technical, rare or clinical questions, try using the larger search engines.
       NOTE: If a MEDLINE search is given as part of the answer, points are deducted.
     • Properly citing the web site or web sites you select to complete the assignment. Examples of acceptable citation formats for Internet resources are given at the Internet Public Library. Required components of the citation include:
       • Author and/or "publisher" (information provider).
       • Title of the web page.
       • Title of the web site of which it is a part (if different).
       • Date information was last edited or put on the web (I will be checking this myself).
       • Date/time viewed.
       • URL for the web page, not for the web site of which it is a part.
         NOTE: If I am not able to locate a matching page on the right topic with the URL given, the assignment will not be graded. This means absolutely do NOT use pages from sites which are passworded, since a typical patient would not have access and I will not have access.
       • NOTE: A printout of the web sites selected is not sufficient and does not qualify as a proper citation.
     • There is an example of this strategy development exercise given below.
   • What you need to turn in:
     • A brief legible explanation of how you would communicate with the patient about this.
     • A completed FRIAR/SECT form, including both pages. Be sure to identify your group number. Identifying members of your group is optional.
     • A brief legible bibliography with at least one properly cited reputable patient information web site on your topic.
       NOTE: If you have multiple items in your bibliography, you will be scored on the most complete and most accurate citation included.

Topics for Assignment 2: Web Search

1. Respiratory Problems: http://www.pnf.org/ccmd.html
   • A patient is sure her respiratory problems (asthma) is due to her bad bite.
   • What do you tell her?
2. Sjögren's syndrome: http://www.pnf.org/remedies.html#Herbal
   • A 42 y/o female has been a patient for many years in your office. She has recently been diagnosed with Sjögren's syndrome. She wants you to suggest the right herbs to treat it.
   • What do you tell her?
3. Crohn¹s Disease: http://www.whale.to/d/crohns.html
   • A 25 y/o male patient presents for routine check up. He has been diagnosed with Crohn¹s disease and is afraid the fillings he needs will lead to more health problems as described in the web site.
   • How do you help him?
4. Braces: http://www.whale.to/v/nickel.html
   • You have recommended braces to a patient and they are afraid it will cause cancer.
   • What do you tell them?
5. Periodontal Disease: http://www.whale.to/d/gum2.html
   • A patient has found out that it is his coffee that is causing his gum disease. So if he stops his coffee, he does not need the root planning, correct?
   • What do you tell them?
6. Alzheimer¹s: http://www.whale.to/d/alzheimers.html
   • Your silver fillings are causing Alzheimer¹s disease in the mother of patient of record, they can prove it.
   • Now what do you tell them?
7. Alternatives to Mercury: http://www.medical-library.net/specialties/framer.html?/specialties/_biological_and_mercury_free_dentistry.html
   • A patient wants to find information about alternative to mercury fillings.
   • Where do you point them?
8. Fluoride: http://www.whale.to/d/fluoride.html
   • A patient is outraged that you recommended fluoride for her child without asking first.
   • Now what do you tell them.
9. Root canal: http://www.hugnet.com/rcanalbklt.html
   • That root canal you recommended to a patient has them really worried that they will get cancer and die from it.
   • What do you tell them?
10. Dental Products: http://www.hugnet.com/dental.html
    • A patient has a location where they can get a blood test to substantiate this. The blood test shows the white fillings you placed in their mouth are causing the nervous disorder and stress they are feeling. The fillings are toxic to this person's blood.
    • What do you tell them?
11. Dentures: http://www.frontiernet.net/~dwag/DENTURE-DENTURISTS.html
    • You really cannot make those dentures for grandpa, can you?
    • What do you tell them?
12. HIV: http://www.lightstreamers.com/horowitz.htm
    • A HIV positive patient wants you to help them find out more about the new therapy for healing his DNA.
    • Where do you point them?
13. Fillings to correct a bite: http://www.pnf.org/orthodontics_for_children.html
    • You really don¹t have to do braces do you? You can correct junior's bite with a filling.
    • What do you tell them?
14. Whole Body treatment: http://www.pnf.org/dentistry.html#Health-Centered%20Dentistry
    • A patient wants to have a whole body realignment staring with the jaw.
    • Do you participate and where do you point them?
15. Trigeminal Neuralgia: http://www.whale.to/d/cavitations.html
    • A patient with chronic facial pain wants all the fillings to be removed.
    • What do you show them?
16. Birth Defects: http://www.whale.to/d/birth.htm
    • Can fillings cause birth defects?
    • Where do you point them?
17. Sealants: http://emporium.turnpike.net/P/PDHA/health.htm
    • A mother of several children in your practice is happy that her children do not need any more dental care now that they have sealants.
    • What do you show her?
18. Flossing: http://www.burtonwellnesscenter.com/index.cfm?do=dental
    • A 55 y/o male patient does not understand why you recommend perio therapy, he uses his toothpicks all the time, every day.
    • What do you tell him?
19. Local Anesthesia: http://www.sciential.net/alternatives_to_anesthesia_for_dent.htm
    • A fearful patient wants you to offer alternatives to the needle that they believe will cause "permanent nerve damage".
    • What do you say?
20. Crowns: http://www.animated-teeth.com/dental_crowns/t9_dental_crowns_alternatives.htm
    • A patient asks if all his teeth need to be crowned.
    • What do you say?

FRIAR/SECT Example

Part 1: FRIAR

A 25-yr-old woman is taking a cephalosporin, Cephalexin, 500mg 3 times daily for cystitis. She needs SBE prophylaxis for your perio therapy. Do you just have her take additional doses or what?

RELEVANT:

Concept 1. SBE prophylaxis
Concept 2. Currently already taking antibiotics.
Concept 3. Cephalexin

IRRELEVANT:

patient gender
patient age
cystitis
perio therapy

ALTERNATES/ALIASES:

Concept 1. SBE prophylaxis

• subacute bacterial endocarditis
• endocarditis prophylaxis
• endocarditis guidelines
• prophylaxis guidelines
• bacteremia
• antibiotic prophylaxis
• NOT dental prophylaxis

Concept 2. Currently already taking antibiotics.

Concept 3. Cephalexin

• cephalosporin
• cephalosporins

REVIEW:

Part 2: SECT

Type of question.
This question is fairly technical, focused on health professional information, and uses some pretty specific terminology.

Select a type of search engine.
Therefore, I am selecting a general search engine rather than a health search engine, since general search engines do a better job with more technical and specific questions, also with professional questions and with rare diseases. Since the terminology is also specific, I am making sure to choose a search engine with a large database. If I retrieve too much, I can always narrow my search the next time around by either adding more terms or choosing a smaller search engine.

Select specific search engine.
I pick Google.

Run a search using first level terms for main topic.
I search with the following terms.

• First search: "SBE Prophylaxis" and "Cephalexin"
• Second search: "endocarditis prophylaxis" and "Cephalexin"
• Third search: "endocarditis prophylaxis" and "cephalosporin"

EVALUATE

Keeping in mind the criteria from the previous assignment (Patient Information Web Evaluation Checklist), would you actually recommend this site to a patient? Is it a site the patient will be able to access on their own from their home computer or those at a public library or other public computers? If you are not content with your findings so far, return to the searching step and repeat. If you are satisfied, continue by documenting what you recommended to the patient.

CITE

Adnan S. Dajani, MD; Kathryn A. Taubert, PhD; Walter Wilson, MD; Ann F. Bolger, MD; Arnold Bayer, MD; Patricia Ferrieri, MD; Michael H. Gewitz, MD; Stanford T. Shulman, MD; Soraya Nouri, MD; Jane W. Newburger, MD; Cecilia Hutto, MD; Thomas J. Pallasch, DDS, MS; Tommy W. Gage, DDS, PhD; Matthew E. Levison, MD; Georges Peter, MD; Gregory Zuccaro, MD Prevention of Bacterial Endocarditis. Originally published in print: JAMA. 1997;277:1794-1801. Internet version published: 1998. Last updated: Tue, Feb 16, 1999 11:07:02 PM GMT. Date viewed: September 16, 2001; 3:55PM EDT. URL: http://www.americanheart.org/Scientific/statements/1997/079701.html

NOTE: The article cited above does NOT directly answer the question specified, but could be used as partial justification for a clinical decision, and is given as an example of how to cite an Internet source. To add to a patient's record, I would recommend also including clinician's notes about what clinical decision was made on the basis of this information.

TEST

If this was a real patient, at this point you would implement your proposed solution or test out your strategy. If it doesn't work in the real world with a real patient, or if you don't trust your answer enough to try it on a real patient, then perhaps you should reconsider.