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 Evidence-Based Medicine
How to evaluate and apply medical literature to patient care
EBM - a growing, international movement in health care that encourages physicians, nurses, pharmacists, and allied health professionals to seek out, appraise, and apply the best evidence from the medical literature when confronted with patient treatment decisions.
Evidence based health care promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgements and facilitate cost-effective health care. Copyright © 1997 McMaster Evidence-Based Medicine Informatics Project
POEMs - Patient Oriented Evidence that Matters, is relevant to primary care practice, and has the potential to change what you do.
Resources for EBM Reviews
- Evidence-Based Medicine Reviews (EBMR) contains the Cochrane Database of Systematic Reviews, (full text of the reviews),Best Evidence (a database that contains the journals ACP Journal Club and Evidence-Based Medicine), and the Database of Abstracts of Reviews of Effectiveness (DARE)(full text database containing critical assessments of systematic reviews).These sources provide systematic reviews of important healthcare interventions as well as reviews of high-quality, clinically relevant journal articles. Connect through OVID.P - Ovid password required, or N network access.
InfoRetriever evidence-based information for clinicians includes over 1000 brief synopses of relevant, valid articles in the primary care literature, over 55 clinical prediction rules such as the Ottawa Ankle Rules, Strep Score, detailed information on diagnostic tests, history and physical examination maneuvers in a diagnostic calculator, Access via the Web from a desktop computer or download to your PocketPC. P
The Cochrane Library site provides free, unrestricted access to the abstracts only of systematic reviews and offers individual in addition to organizational subscriptions to the full database.
PubMed, the free MEDLINE from the National Library of Medicine, offers specialized EBM search features. Limit your search retrieval to evidence-based articles by using the Clinical Queries option (in the left frame under PubMed Services). Clinical Queries are built-in search "filters" for four study categories--therapy, diagnosis, etiology, and prognosis.
A new Ovid Medlinesearch capability will permit you to limit your MEDLINE search to "Evidence-Based Medicine Reviews" and to immediately locate articles that have met strict quality criteria and that have associated Evidence-Based articles or topic reviews. "Article Review" links point to items in the Best Evidence database, while "Topic Review" links point to items in the Cochrane Database of Systematic Reviews.
National Guideline Clearinghouse makes evidence-based clinical practice guidelines and related abstract, summary, and comparison materials widely available to health care professionals. NGC is operated by the U.S.Dept. of Health and Human Services, Agency for Health Care Policy and Research (AHCPR) in partnership with the American Medical Association (AMA), and the American Association of Health Plans (AAHP).
POEMs from the Journal of Family Practice - the editors of JFP carefully review over 80 peer-reviewed medical journals and apply the "POEMs" criteria to identify the most important articles for primary care physicians.
Reading through a Cochrane or Best Evidence Review is an excellent introduction to EBM.
Resources for Practicing EBM: how to find and how to read the medical literature
The following sites provide a wealth of information and tools.
Essays
EBM: What it is and What it isn't article by David Sackett, one of the founders of EBM, based on an editorial from the British Medical Journal 1996; 312: 71-4
Evaluating the Literature: Quality filtering and Evidence-Based Medicine & Health from the National Library of Medicine. "Not all studies are created equal. Not all articles are equally good." Essay reviews the importance of sampling, assignment, assessment, analysis, interpretation, and extrapolation
JAMA's Users Guides to the Medical Literature: a bibliography - full text articles are NOT available through the JAMA web site; however,
they can be accessed by using OVID MEDLINE. Once in OVID, Select "MEDLINE 1966-present," type"users guides".ti. as your search statement, and then link to the full-text articles
Discussion Lists
Evidence Based Health-related Discussion Lists - a listing of EBM-related e-mail discussion lists
Filters
Evidence-Based Filters for OVID MEDLINE from the University of Rochester limit search retrieval to evidence based articles (i.e., for Diagnosis, combine disease terms with 1.exp "sensitivity and specificity"/
2.false negative reactions/ or false positive reactions/
3.(sensitivity or specificity).ti,ab.
4.(predictive adj value$1).ti,ab.
5.(likelihood adj ratio$1).ti,ab.
6.(false adj (negative$1 or positive$1)).ti,ab.
7.(randomized controlled trial or controlled clinical trial).pt.
8.double blind method/ or single blind method/
9.practice guideline.pt.
10.consensus development conference$.pt.
11.random$.ti,ab.
12.random allocation/
13.(single blind$3 or double blind$3 or triple blind$3).ti,ab.
14.or/1-13
Also includes filters for Etiology, Prognosis, Meta-analysis, and Therapy.
More Filters - Sarching for the Best Evidence
Glossaries
EBM Glossary
Journal Clubs
Journal Club on the Web - an experiment in implementing an on-line, interactive general medical "journal club" which periodically summarizes and critiques articles from the recent medical literature and collects and posts readers' comments.
Journal Club: Novice Level Bibliography Intermediate Level Bibliography Advanced Level Bibliography
PedsCCM Evidence-Based Journal Club
Tool Kits
Evidence Based Medicine Tool Kit from the University of Alberta. An incredible resource for "how to" information, this collection of tools for identifying, assessing and applying relevant evidence for better health care decision-making is based on the work of the Evidence Based Medicine Working Group. The site includes User Guides with very helpful worksheets, search strategies, filters, etc.
Evidence-Based Medicine Toolbox from the Centre for EBM contains Likelihood Ratios, NNTs (Numbers Neeeded to Treat), SpPins and SnNouts
Evidence Based Medicine: Finding the Best Clinical Literature a guide designed to assist health care professionals and students become effective and efficient users of the medical literature from the University of Illinois at Chicago
Netting the Evidence : A ScHARR Introduction to Evidence Based Practice on the Net - a comprehensive collection of links compiled by Andrew Booth of the School of Health and Related Research (ScHARR) of the University of Sheffield, UK to EBM web sites
Outcomes Database of Structured Abstracts provides information on the literature covering the development of outcome measures and the measurement of outcomes in various topic areas. Includes information in the subject areas of asthma, with stroke, severe mental illness and diabetes to be added in the near future
Resources for Practicing EBM - a helpful collection of links
Tutorials
Evidence Based Clinical Practice Tutorial, Miner Library from the University of Rochester
Evidence Based Medicine: Finding the Best Clinical Literature tutorial from University of Illinois at Chicago from the University of North Carolina at Chapel Hill Health Sciences Library
Introduction to Evidence-Based Medicine from Duke University and the University of North Carolina
Jefferson Medical College Tutorial: EBM Searching Strategies
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