Evidence-Based Medicine (EBM)
Because not all information is created equal.
formulate a question | first stop for ebm | medline searching | clinical ebm | guidelines | appraising the evidence | for consumers | more help | pda resources
Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values and circumstances.
Why Should You Care About Evidence-Based Practice?*
- Clinicians have a daily need for valid information about diagnosis, therapy, prevention, and prognosis.
- Inadequacy of traditional sources of information because they are out of date (textbooks), sometimes wrong (experts), ineffective (didactic continuing medical education), or too overwhelming or variable for practical clinical use (journals).
- Clinicians have limited time with each patient. Likewise it can be difficult to keep up with the literature.
How Do We Practice EBM?*
- Convert the need for information into an answerable question.
- Find the best evidence with which to answer that question.
- Critically appraise the evidence for validity, impact, and applicability.
- Integrate the appraisal with clinical expertise and with the patient’s biology, values, and circumstances.
- Evaluate the effectiveness and efficiency of the process for future improvements.
Formulating an Answerable Question
The Well Built Clinical Question (from UNC Chapel Hill and Duke University). http://www.hsl.unc.edu/services/tutorials/ebm/Question.htm
First Stop for the Evidence
PubMed (MEDLINE) Clinical Study Categories
Quickly use the search form to access high quality clinical trials on specific topics in biomedical journals. http://www.ncbi.nlm.nih.gov/entrez/clinicalx.cgi?holding=njclib
PubMed (MEDLINE) Systematic Reviews
Find citations for systematic reviews, meta-analyses, and reviews of clinical trials in biomedical journals. http://www.ncbi.nlm.nih.gov/entrez/clinicalx.cgi?holding=njclib#reviews
Ovid (MEDLINE)
Search for clinical trials or systematic reviews in biomedical journals. Also includes AMED, Clinical Evidence, EBM Reviews: ACP Journal Club, EBM Reviews: Cochrane Library, International Pharmaceutical Abstracts, PsychInfo, and Journals@Ovid. Go to http://gateway.ut.ovid.com/autologin.cgi or use Ovid with a password by linking from the library website http://www.nationaljewish.org/news/med-library/index.aspx
Point of Care Clinical Resources
Physician's Information and Education Resource (PIER) - via STAT!Ref
PIER provides authoritative evidence-based guidance for clinical care.
http://online.statref.com/Splash/Splash.aspx?SessionId=81B7D3FJOWLMTTYZ
Clinical Evidence – via Ovid
Compendium of evidence based information on a wide variety of conditions to search or browse by alphabet. Published by BMJ.http://gateway.ut.ovid.com/autologin.cgi
UpToDate
Comprehensive and concise point of care clinical information resource written by physician authors.http://www.utdol.com/enterprise.asp
eMedicine.com
A current clinical knowledge base for physicians and other healthcare professionals. The database contains articles on 7,000 diseases and disorders. Content is updated 24/7and undergoes 4 levels of physician peer review plus an additional review.
www.eMedicine.com
Databases of Guidelines
National Guideline Clearinghouse
A U.S. resource for evidence-based clinical practice guidelines. A display tool allows side by side comparison of guidelines.http://www.guideline.gov/
Guidelines International Network (G-I-N)
1. Guidelines organized my health topic.
http://www.g-i-n.net/index.cfm?fuseaction=membersarea&fusesubaction=docs&documentID=33
2. Links to worldwide sources of guidelines.
http://www.g-i-n.net/index.cfm?fuseaction=links&fusesubaction=index
National Institute for Clinical Evidence (NICE)
Evidence based guidance on technology use, clinical care, and interventional procedures.
http://www.nice.org.uk/page.aspx?o=ourguidance
Appraising the Evidence
AGREE Instrument for Appraising Guidelines
Use a worksheet to organize your critical appraisal of the literature.
http://www.agreecollaboration.org/pdf/agreeinstrumentfinal.pdf
Appraising the Evidence
Step by step guide to appraisal with examples from the major categories of clinical studies.
http://www.cebm.utoronto.ca/practise/ca/
How to Read a Paper
Guidance from a series of BMJ articles.http://bmj.bmjjournals.com/collections/read.shtml
CatMaker
Download a wizard that guides you through a critical appraisal, then calculates appropriate EBM values.http://www.cebm.net/catmaker.asp
EBM for Consumers
Ask NOAH About: Evidence-Based Medicine
Learn more about evidence based medicine at a site designed for health care consumers.
http://www.noah-health.org/en/ebm/index.html
eMedicineHealth.com
Current medical information is available in the Health Resource, First Aid and Emergencies, and Lifestyle and Wellness Centers. With more than 5500 pages of health content, the site contains articles written by physicians for patients and consumers.
www.eMedicineHealth.com
More Help with EBM
New York Academy of Medicine - EBM
This site is regularly updated and is considered one of the quality EBM websites available.
http://www.ebmny.org/teach.html
Centre for Evidence-Based Medicine
The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practise and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of clinical disciplines. http://www.cebm.net/index.asp
Introduction to Evidence-based Medicine (UNC Chapel Hill and Duke University)
This self-paced tutorial is intended for any health care practitioner or student who needs a basic introduction to the principles of Evidence-Based Medicine.
http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htm
CASP Guide to Statistical Terms
This brief guide explains and illustrates the use of measures of clinical effectiveness such as: Relative Risk (RR) and Number Needed to Treat (NNT) and also discusses Confidence Intervals (CI). http://www.phru.org/casp/statistics.html
SUNY Health Sciences Evidence Based Medicine Course
Easy to use tutorial outlining evidence based medicine. Excellent review for those seeking a quick refresher course on the basics. http://library.downstate.edu/EBM2/contents.htm
National electronic Library for Health (NeLH)
The UK NHS provides this guide for evidence based decision-making. http://www.nelh.nhs.uk/ebdm/
PDA Resources for EBM
Centre for Evidence-Based Medicine
Provides downloads for logbooks, calculators, and tables.http://www.cebm.utoronto.ca/
Clinical Practice Guidelines for Handheld Computers - National Guideline Clearinghouse
When you select a guideline at the National Guideline Clearinghouse website, click on "Palm Download" to obtain the PDA version. http://www.guideline.gov/resources/pda.aspx
PubMed for Handhelds
Use a "PICO" form to search wirelessly on your handheld. http://pubmedhh.nlm.nih.gov/nlm/
How to Use an Article About Prognosis
Centre for Health Evidence
The Centre has been established in Oxford to promote evidence-based health care and provide support and resources to anyone who wants to make use of them. The Toolbox provides valuable resources for learning and practice.
http://www.cche.net/usersguides/prognosis.asp
How to Use an Article on Economic Analysis of Clinical Practice
Centre for Health Evidence
The Centre has been established in Oxford to promote evidence-based health care and provide support and resources to anyone who wants to make use of them. The Toolbox provides valuable resources for learning and practice.
http://www.cche.net/usersguides/economic.asp
* Excerpted from Sharon E. Strauss et al. Evidence-Based Medicine: How to Practice and Teach EBM. 3rd ed. (Elsevier: New York ) 2005.
