Evidence-Based Medicine

Evidence-Based Medicine

Introduction

Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. From Sackett DL et al. Evidence-Based Medicine: What it is and what it isn't  BMJ. 1996 Jan 13; 312 (7023):71-2.

This is a basic introduction to evidence-based practice resources including books, guides, media, tools, and tutorials. The term evidence-based practice (EBP) is also used interchangeably with evidence-based medicine (EBM), since many health professions have adopted evidence-based principles into their practice. 

Evidence-Based Medicine: An Oral History

EBM and Study Design

EBM Parody

EBM Practice Tools Summary

Best evidence pyramid diagram; the elements of the diagram are explained belowMeta-search engines; TRIP, SUMSearch Cochrane Systematic ReviewsOther Systematic Reviews and Meta-analysesEvidence GuidelinesRCTs, Case Cohorts, Control StudiesClinical Research CritiquesOther Reviews of the LiteratureCase Reports, Case Series, Other Articles, Practice Guidelines, etc.Clinical Reference Texts  
 Meta-search engines; TRIP, SUMSearch

pyramid modified from: Navigating the Maze, University of Virginia, Health Sciences Library

The EBM Pyramid is a visual representation of the different kinds of clinical/biomedical information. Sources are ranked hierarchically from bottom to top according to their level of evidence. Sources at the bottom are numerous but provide less evidence. As one progresses up the pyramid, the strength of the evidence increases.

Cochrane Sytematic Reviews

Cochrane Systematic Reviews

  • Cochrane Library | http://jabsom.hawaii.libguides.com/go.php?c=5094504
    The Cochrane Collaboration. Oxford: Update Software; 1996-. Updated quarterly.

  • Cochrane Database of Systematic Reviews (Cochrane Reviews)

    • 'Gold Standard' for high-quality systematic reviews

    • Full-text included in Cochrane Library

    • Cochrane Reviews includes complete reviews and protocols (reviews that are still in progress)

    • Cochrane Reviews abstracts are in PubMed

  • Database of Abstracts of Reviews of Effects (Other Reviews - DARE)

    • prepared by the National Health Service Centre for Reviews and Dissemination, University of York, England

    • Complements the Cochrane Reviews by offering a selection of quality assessed reviews in those subjects where there is currently no Cochrane review

    • Brief critical appraisals of previously published reviews of the effects of health care

    • Structured abstracts, not full-text

    • DARE not indexed in PubMed, but original research articles may be

    • Also available at no charge on the web from University of York | www.crd.york.ac.uk/crdweb/

Other Systematic Reviews & Meta-analyses

Other Systematic Reviews and Meta-analyses

  • PubMed MEDLINE - Systematic Reviews | www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml

    • access: part of PubMed's Clinical Queries (linked on PubMed Home and Advanced Search pages)
      UH access for more full-text links

    • Identifies systematic reviews and other similar types of studies found in biomedical journals included in PubMed database

    • No evaluation of comparative quality of different reviews on a topic

    • Abstracts supplied by authors/journals. No separate evaluation of quality of research

    • Identify systematic reviews in the biomedical area - gathers together much larger collection than other evidence-based practice resources

Evidence Guidelines/Summaries

Evidence Guidelines/Summaries

RCTs, Case Cohorts, Control Studies

RCTs, Case Cohorts, Control Studies

  • PubMed | http://jabsom.hawaii.libguides.com/go.php?c=5082003 (pubmed.gov if you are not a UH faculty, staff, or student)

    • note: Filtered by publication type, but not quality

    • Clinical Queries - Uses preconfigured search strategies to retrieve research-based citations on clinical topics in the areas of therapy, diagnosis, etiology, or diagnosis

    • Use Limits to search by specific publication type (e.g. meta-analysis, randomized controlled trial, review)

  • Cochrane Library | http://jabsom.hawaii.libguides.com/go.php?c=5094504
    The Cochrane Collaboration. Oxford: Update Software; 1996-. Updated quarterly.

    • Cochrane Central Register of Controlled Trials (Clinical Trials)

      • Bibliography of controlled trials as part of an international effort to hand search the world's journals

      • Includes reports published in conference proceedings and in many other sources not in PubMed or other bibliographic databases

  • Other Resources

    • Check HSL Databases for other databases that may be appropriate.

Clinical Research Critiques

Clinical Research Critiques

Reviews of patient care relevant studies.

  • ACP Journal Club | www.acpjc.org

    • American College of Physicians - American Society of Internal Medicine (ACP-ASIM)

    • Internal medicine focus

    • Abstracts to journal articles selected according to explicit criteria from major peer-reviewed medical journals

    • Available in print

  • POEMS (Patient Oriented Evidence that Matters) | www.essentialevidenceplus.com/inforetriever/results.cfm?resource=E

    • Structured abstracts by Journal of Family Practice editors

    • Reviews over 90 journals monthly; identifies eight articles to abstract

    • Focus on the patient

    • Subset available in Journal of Family Practice

    • All POEMS included in Essential Evidence Plus

Other Reviews of Literature

Other Reviews of the Literature

  • Natural Medicines Comprehensive Database | http://jabsom.hawaii.libguides.com/az.php?q=natural%20medicine

    • Subject-specific database of evidence-based information.

    • Compiled by publishers of Pharmacist's Letter and Prescriber's Letter

    • Herbal medicines, and dietary supplements used in the western world

    • Assesses available evidence; check references for quality of source

  • Check HSL Databases for other subjects.

Case Reports, Case Series, Other Articles, Practice Guidelines, etc.

Case Reports, Case Series, Other Articles, Practice Guidelines, etc.

  • PubMed | http://jabsom.hawaii.libguides.com/go.php?c=5082003

    • Use Limits to search by specific publication type(s)

  • National Guideline Clearinghouse | www.guideline.gov/

    • Initiative of the Agency for Healthcare Research and Quality (AHRQ)

    • Available at no charge

    • Updated weekly with new and changed guidelines

    • Comprehensive database of evidence-based clinical practice guidelines and related documents. Voluntary participation

Clinical Reference Texts

Clinical Reference Texts

Meta-search Engines

Meta-Search Engines

  • TRIP (Turning Research Into Practice) | www.tripdatabase.com

    • Meta-search from the UK

    • Searches over 55 sites of evidence-based information

    • Includes links to peer-reviewed journals and other publications

  • SUMSearch | sumsearch.org

    • Produced by University of Texas Health Sciences Center, San Antonio

    • Simultaneously searches few free-access sources - PubMed Cochrane Systematic Reviews (within PubMed), National Guideline Clearinghouse and Merck Index

    • Results grouped by reviews, practice guidelines, systematic reviews and research-based articles

Additional Resources

Additional Resources

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Updated 20Oct2015

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