MD39S01: Gout

Bottom line: Information on gout was used to modify the management of a patient, and to persuade a patient and a resident to make changes (preventive measures). It contributed to prevent health deterioration (acute gout).

Acquisition: On August 16, 2008, MD39 did a search at work, by themselves, in the teaching room, and during an encounter with a patient. They retrieved two information hits about gout. The reported search objectives were: to address a clinical question, to fulfill an educational objective, to share information with a patient, and to exchange information with other health professionals. “The resident was seeing the patient. [...] It was a man [between 50 and 60 years old] who was suffering his third [gout] crisis. [...] I felt that the student was not comfortable with regards to nutrition advice to the patient. [...] And that’s what I wanted to check, nutrition advice.” According to MD39, Essential Evidence+ (EE+) was the only source for information, and the found information was relevant.

Cognition: Two hits were associated with a report of a highly positive cognitive impact (practice improvement). “I found that it [the information] was undoing a myth I had related to it [nutrition advice]. So I felt that it was going to change the advice I will give to future patients with gout [about alcohol]. [...] In the practice guideline, [...] there was a multivariate study on factors that can trigger gout, and alcohol is not a true [factor] after all.”

Retrieved information hit(s):

1) EBMG clinical topics (CIRT): Dietary treatment of gout

2) InfoPOEMs (CIRT): Meat, seafood, and little dairy are risk factors for gout

Application: Information on gout was retrieved for a patient, and was used to modify the management of the patient, and to persuade patients and other health professionals to make changes (information used as presented in EE+). “We did not give the printed document [to the patient], but we told him about what we found. [...] It contradicted a myth, so to [persuade] a colleague, it would be more like: "Listen, I read this, have a look; it contradicts what we often tell our patients.”

Outcomes: Regarding patient health, MD39 reported that the information contributed to prevent health deterioration (another acute gout – probabilistic statement based on the assumption that the patient will follow the preventive measures). “After the discussion we had, I think that he [the patient] will pay more attention to the way he eats and to the factors that can trigger gout.”

Type of path: Patient behaviour

Acquisition	Cognition	Application	Outcomes
Address a clinical question Fulfill educational objective Share information Exchange information	Practice improved Learned something	Persuade Manage differently Understand issue	Prevent