Library classes
Level III Evidence-based Practice
Instructor: Jan Kraus, MLS
ACP Journal Club (Clinical Research Critiques)
The ACP journal club is published bimonthly by the American College of
Physicians-American Society of Internal Medicine and provides abstracts
and expert commentary on important studies and reviews from the
biomedical literature. The ACP Journal club surveys over 100
peer-reviewed medical journals and provides clinicians with summaries of
the most important articles. The aim of this journal is to provide
evidence-based clinical information necessary to practice good medicine.
Past issues of the journal are available from 1991 and selected
full-text articles are available.
Bandolier (Clinical
Research Critiques)
The first issue of Bandolier, an independent journal about
evidence-based healthcare, written by Oxford scientists, was printed in
February 1994. It has appeared monthly ever since and has become the
premier source of evidence based healthcare information in the UK and
worldwide for both healthcare professionals and consumers. Each month
PubMed and the Cochrane Library are searched for systematic reviews and
meta-analyses published in the recent past. Those that look remotely
interesting are read, and where they are both interesting and make
sense, they appear in Bandolier, first in the paper version and, after
two months or so, on the website.
CINAHL (Ebsco Cinahl)
CINAHL, is the authoritative resource for nursing and allied health
professionals, students, educators and researchers. This database
provides indexing for over 1,700 current nursing and allied health
journals and publications dating back to 1982, totaling over 961,000
records.
Clinical Evidence (Evidence Guidelines Summaries)
Clinical Evidence is a directory of evidence on the effects of common
clinical interventions, published by the BMJ Publishing Group. Updated
monthly online, it provides a "concise account of the current state of
knowledge, ignorance, and uncertainty about the prevention and treatment
of a wide range of clinical conditions based on thorough searches of the
literature." It summarizes the current state of knowledge and
uncertainty about the prevention and treatment of clinical conditions,
based on thorough searches and appraisal of the literature. It is
neither a textbook of medicine nor a set of guidelines. It describes the
best available evidence from systematic reviews, RCTs and observational
studies where appropriate, and if there is no good evidence it says so.
Cochrane
(Systematic Reviews Meta-Analysis)
Gold standard for high-quality systematic reviews. The Cochrane
Collaboration is an international non-profit organization that aims to
help people make informed decisions about health care, by reviewing and
promoting the best available evidence on interventions and treatments.
Cochrane Collection includes: Cochrane Database of Systematic Reviews
(only RCTs), DARE, Health Technology Assessment Database and NHS
Economic Evaluation Database.
DynaMed
DynaMed (Dynamic Medical Information System) is a quick and easy-to-use
medical reference system designed for use at the point of care. DynaMed
contains clinically organized summaries of nearly 1,800 topics and is
updated daily from review of the research literature. This means that
the reference information is always up-to-date and does not require new
editions. DynaMed is a useful resource in clinical, educational and
research settings. DynaMed searches 400 medical journals, the Cochrane
Collection, POEMS, AHRQ, the National Guideline Clearinghouse, the
Medical Letter, ACP Journal Club, etc.
Essential Evidence
Plus (formerly InfoRetriever) (Clinical Research Critiques)
The only database system of filtered, synopsized, evidence-based
information. This integrated search engine allows you to simultaneously
search, via keyword, the following databases:
POEMs (Patient Oriented Evidence that Matters): 2,461 (the full
collection)
Cochrane Database abstracts: 1,964 (the full collection)
Evidence-based guideline summaries: 738
Clinical Decision Rules: 207
Diagnostic test calculators (unique combinations of symptom -> disease
-> test): 1116
H&PE calculators (unique combinations of symptom -> disease -> test):
1087
The complete 5-Minute Clinical Consult (1,036 summaries and 542 photos)
ICD-9 lookup tool including the 1,500 most-commonly needed codes
FPIN (Evidence Guidelines Summaries)
The Family Practice Inquiries Network (FPIN) is a national,
not-for-profit consortium of academic family physicians, family medicine
residency programs and departments, medical librarians, informaticians,
computer scientists, other primary-care providers and consultants
dedicated to using information technology to improve healthcare. Initial
Founding Member Departments of FPIN include: University of Chicago,
University of Colorado, Michigan State University, University of
Missouri - Columbia, University of North Carolina - Chapel Hill SUNY -
Upstate Medical University, University of Washington, University of
Wisconsin
InfoRetriever - Poems
(now called Essential Evidence Plus) (Clinical Research Critiques)
The only database system of filtered, synopsized, evidence-based
information. This integrated search engine allows you to simultaneously
search, via keyword, the following databases:
POEMs (Patient Oriented Evidence that Matters): 2,461 (the full
collection)
Cochrane Database abstracts: 1,964 (the full collection)
Evidence-based guideline summaries: 738
Clinical Decision Rules: 207
Diagnostic test calculators (unique combinations of symptom -> disease
-> test): 1116
H&PE calculators (unique combinations of symptom -> disease -> test):
1087
The complete 5-Minute Clinical Consult (1,036 summaries and 542 photos)
ICD-9 lookup tool including the 1,500 most-commonly needed codes
National Guideline Clearinghouse
(Practice Guidelines)
A public resource for evidence-based clinical practice guidelines, aimed
primarily at health professionals. Users can search the database, or
browse by disease/condition or treatment/intervention, or organization.
Medical Subject Headings (MeSH) are used to index the guidelines, and
are used in browsing. The guidelines can be viewed as a brief summary,
complete summary, with a link to the full text where available.
Guidelines can be compared side by side, and there are also syntheses of
guidelines on similar topics. The summaries produced in the NGC are
based on a Guideline Summary Sheet that has been reviewed by the
guideline developer. A discussion group is available to discuss the
development, implementation and use of guidelines. NGC is sponsored by
the Agency for Healthcare Research and Quality in partnership with the
American Medical Association and the American Association of Health
Plans.
PubMed - Medline (RCTs, Case Cohorts, Control Studies, other
Systematic Reviews, Meta-Analysis)
MEDLINE provides authoritative medical information on medicine, nursing,
dentistry, veterinary medicine, the health care system, pre-clinical
sciences, and much more. Created by the National Library of Medicine,
MEDLINE allows users to search abstracts from over 4,600 current
biomedical journals.
TRIP Meta-Search Engine
The TRIP Database was first created in 1997, and this third version of
the TRIP database has 15,000 links from 61 publishers of high quality
health related information on the internet. TRIP is compiled by hand and
is primarily aimed at primary health care workers interested in getting
research into practice. The site provides information on searching
strategies, how results are displayed, and a list of publications is
provided. There is also access to the Virtual Learning Centre which
offers several learning packs via PGEA exam or portfolio routes. This
site is updated monthly and maintained by Jon Brassey.
The TRIP Database started in 1997 as a small search engine with a focus
on medical articles considered evidence-based. Typically 300-400 new
articles are added monthly.
Content:
Evidence-based articles, includes Cochrane, ACP Journal Club, POEMS,
Bandolier, CRD Databases, Therapeutics Letter, AHRQ, NHS, Effective
Healthcare Bulletins.
Clinical guidelines, National Guideline Clearinghouse
Query-answering
Medical Images (80,000)
ETextbooks
Patient Information Leaflets
Peer-reviewed journals
PubMed (the world's largest searchable source of primary research
articles.)
Additional Resources:
BestBets (Clinical Research Critiques)
BestBets is a resource providing access to a range of topics in
evidence-based emergency medicine. BETs (Best-Evidence Topics) were
developed in the Emergency Department of the Manchester Royal Infirmary
and aim to provide "rapid evidence-based answers to real-life clinical
questions, using a systematic approach to reviewing the literature".
Background information on the development and structure of BETs, the
difference between BETs and CATs (Critically Appraised Topics) and links
to other EBM resources are provided. The online database allows users to
either browse or search for topics, and currently there are over 600
BETs accessible from this site. The status of each BET is easily
identifiable in the database (ie whether it has been completed, reviewed
or incomplete) and each BET is peer-reviewed at regular intervals. Key
people behind the concept of BETs and this Web site include Kevin
Mackway-Jones, Consultant in Emergency Medicine; Rosemary Morton,
Consultant in Emergency Medicine; and Simon Carley, Specialist Registrar
in Emergency Medicine. Interested professionals may submit a BET online.
CATbank
The CATbank is a storage and retrieval facility for a collection of CATs
(Critically Appraised Topics). Aimed at practitioners of Evidence-Based
Medicine (EBM), this resource had been developed by the Centre for
Evidence-Based Medicine, Oxford. This resource contains documentation on
what a CAT is and the value of CATs for clinical practice. Available
CATs and NNTs (numbers needed to treat) can be browsed or searched for,
currently there are 63 CATs and 57 NNTs. CATmaker is a software tool
that allows the creation of CATs for key articles about therapy,
diagnosis, prognosis, etiology/harm and systematic reviews of therapy.
A demonstration version (CATnipper) is freely available for downloading.
CEBM Centre for Evidence-Based Medicine
The Centre for Evidence-Based Medicine, funded by the Mount Sinai
Hospital and the University of Health Network at the University of
Toronto, Canada, is an organization aimed at lecturers, undergraduates,
postgraduates and any health professionals engaged in continuing
education. It aims to "develop, disseminate, and evaluate resources that
can be used to practice and teach evidence-based medicine (EBM)". This
Web site provides information about the centre's activities, definitions
of EBM, syllabus plans, lists of EBM teaching resources and links to
Web-based materials, a glossary of EBM terms. It also provides
supporting materials to the textbook "Evidence-based medicine: how to
teach and practice EBM" by David L. Sacket et al.
EBM online
The journal "Evidence-Based Medicine" (EBM Online) is published jointly
by the BMJ Publishing Group and the American College of Physicians -
American Society of Internal Medicine. Tables of contents and abstracts
are freely available from Volume 5 (1) January 2000 to the present.
Full-text articles are available for subscribers (personal and
institutional). Information is provided on the free access provided to
the countries defined by the World Bank as "Low Income Economies" and
"Lower Middle Income Economies". EBM Online is published with assistance
from Stanford University's HighWire Press.
EBM toolbox
The EBM Toolbox is a collection of clinical tools for practitioners of
Evidence-Based Medicine (EBM). The EBM Toolbox has been developed by the
Centre for Evidence-Based Medicine, Oxford and contains generic EBM
resources, specific tools and data. Samples of NNTs, SpPINS, SnNouts,
likelihood ratios, prognosis, and pre-test probabilities are provided.
Evidence-based nursing
A Web site that gives an introduction to evidence based practice in
nursing. It is part of a series of resources developed and funded by
the Centre for Evidence-based Medicine at Mount Sinai Hospital in
Toronto, Canada. These resources are intended to be used to practice and
teach EBM for undergraduate, postgraduate and continuing education for
health care professionals from a variety of disciplines including
nursing. The section on evidence-based nursing includes an introduction,
resource list and sample scenarios. The scenarios are appended by a
completed "worksheet" showing the types of questions and answers that
critical appraisal involves.
Evidence based medicine toolkit
The Evidence Based Medicine Toolkit contains a collection of tools for
identifying, assessing and applying relevant evidence for better health
care decision making. These tools are based on the work of the "Evidence
Based Medicine Working Group" based at the University of Alberta. This
resource includes sections on finding and using articles about
therapy/prevention, diagnostic tests, prognosis, and harm. Also covered
is finding and using clinical guidelines, how to use a systematic
review, and economic analysis. Glossaries for both clinical
epidemiological terminology and MEDLINE terminology are provided.
Provided on the Web by the University of Alberta.
Evidence-Based On-Call : EBOC
Evidence-based On-call, (created by the Centre for Evidence-based
Medicine, Oxford) is a database which has been designed for hospital
clinicians, 'who want to integrate the best available evidence with
their own personal skills and expertise to improve the care of their
patients.' The database has Critically Appraised Topics, (CATS) with a
series of recommendations for issues to consider when caring for
patients. The Web site covers; Evidence-based Medicine, how to use the
database, the EBOC process, levels of evidence, glossary, definitions,
and links to useful Web sites.
Knowledgeshare
The home page for "Knowledgeshare" a Brighton based knowledge management
service attached to the Library, Sussex Postgraduate Medical Centre,
Brighton. The service supports the information needs of local health
care professionals for information on evidence based practice (EBP) and
clinical governance. The site provides access to the Knowledgeshare
current awareness e- bulletin - Alert, an EBP discussion group and to
two interactive pathways to resources supporting quality assurance for
local NHS staff. The site also provides links to a variety of EBP online
resources.
Locating and Appraising Systematic Reviews
This article from the journal Annals of Internal Medicine looks at ways
of locating systematic reviews, covering their strengths and weaknesses.
The methods of finding these reviews include electronic databases such
as MEDLINE, Best Evidence and the Cochrane Library. It also present
steps used to critically appraise review articles. The article is
provided by the American College of Physicians for medical professionals
and is dated April 1997.
National Quality Measures Clearinghouse
The National Quality Measures Clearinghouse (NQMC) is sponsored by the
Agency for Healthcare Research and Quality (AHRQ), U.S Department of
Health and Human Services, and provides public access for evidence-based
quality measures and measure sets. NQMC is sponsored by AHRQ to promote
'widespread access to quality measures by the health care community and
other interested individuals'. Other services include a discussion list,
what's new, update service, detailed search, links to full-text quality
measures and a glossary.
NIHR Centre for Reviews and Dissemination :
The NIHR Centre for Reviews and Dissemination (CRD) was established in
January 1994 to "provide the NIHR with important information on the
effectiveness of treatments and the delivery and organization of health
care". The CRD undertakes systematic reviews on selected topics,
maintains a database of reviews, provides a dissemination and an
information service, and promotes research-based practice within the
NHS. The Web site provides information about these activities, and
provides links to the resources, including: CRD Reports, Effectiveness
Matters, Effective Health Care Bulletins, Database of Abstracts of
Reviews of Effectiveness (DARE), NIHR Economic Evaluations Database
(NHSEED), HTA Database, and completed and in progress systematic
reviews.
Pedro Physiotherapy
PEDro is the Physiotherapy Evidence Database. It has been developed to
give rapid access to bibliographic details and abstracts of randomized
controlled trials, systematic reviews and evidence-based clinical
practice guidelines in physiotherapy. Most trials on the database have
been rated for quality to help you quickly discriminate between trials
which are likely to be valid and interpretable and those which are not.
ScHARR Netting the Evidence
Scharr Netting the Evidence is intended to facilitate evidence-based
healthcare by providing support and access to helpful organizations and
useful learning resources, such as an evidence-based virtual library,
software and journals
SUMSearch (Meta-Search Engine)
SUMSearch is an Internet meta-search tool developed by the Health
Science Center San Antonio, University of Texas. SUMSearch
simultaneously searches databases such as the National Library of
Medicine PubMed, DARE (Database of Abstracts of Reviews of
Effectiveness), the National Guideline Clearinghouse, and the Merck
Manual. There is also the facility to perform contingency searching.
SUMSearch has been designed to provide the most valid medical
information, and only searches Internet resources which have been
authored by qualified medical professionals. Additional features of this
site include the facility to focus a search by treatment, prognosis,
diagnosis, etiology/causation, physical findings, adverse treatment
affects, and screening and prevention. There are helpful hints on using
this tool available on this site, and on how to formulate a search
strategy. Published on the Web by the University of Texas, SUMSearch is
a free resource and receives no sponsorship.
Trent research information access gateway : TRIAGE
This is the home page of TRIAGE, a gateway to Internet resources for
health services research, health economics and evidence based practice.
This is an initiative of the Trent Institute for Health Services
Research. Developed by staff based at the School of Health and Related
Research (ScHARR), TRIAGE provides links to Web-based teaching
materials, tutorials and articles, and other research tools. Broad
subject areas covered presently include clinical effectiveness, critical
appraisal, diagnostic instruments, evidence based medicine,
epidemiology, ethics, health economics, literature searching,
presentation and writing, qualitative research, reference management,
research, software, statistics, systematic reviews, and trials. This
prototype is funded by the Trent NHS Executive R&D and is published on
the Web by the University of Sheffield.
U of Washington EBP
EBM Glossary
