Embed Size (px)
Citation preview
Payam Kabiri, MD. PhD.Clinical EpidemiologistTehran University of Medical Sciences
Evidence Based Medicine Resources
Finding resources for practicing EBM The widespread practice of Evidence
Based Medicine requires that we get the right information to the right person at the right time.
Current systems frequently fail: important information is missing, presented inappropriately, distorted in reporting, never gathered, hard to search, and hard to find.
3
Objectives
You will:Formulate a clinical question Identify and utilize EBM online resources to
answer your questions EBM Databases & Resources Guidelines
Apply rules for levels of evidence to make clinical decisions
Information Mastery
Usefulness of medical information
Relevance x Validity
work=
Creating a culture of inquiry
Medical Sources Types A primary source is firsthand testimony or direct evidence
concerning a topic under investigation not interpreted. Primary resources are generally articles that appear in peer-reviewed journals and are found primarily by searching Medline.
Secondary sources describe or analyze the primary sources. are summaries and analyses of the evidence derived from and based on primary sources. A secondary source is a work that appraises, interprets or analyzes. Secondary resources available as Clinical Evidence, ACP Journal Club, and Cochrane Library, EBMR.
Tertiary resources list, compile, digest or index primary or secondary sources. Examples of tertiary resources include UpToDate, DynaMed, TripDatabase.
04/19/23 EBM Resources6
Systematic Literature Searches Cochrane Library (OVID) Clinical Evidence
Systematic Literature Surveillance ACP Journal Club (OVID) DARE DynaMed Medical InfoRetriever
EMB Search Engine TRIP Database
EBM Resources
04/19/23 EBM Resources7
Guidelines
What is a guideline? Guidelines may be
Explicit evidence-basedEvidence-basedResearch-based (highly referenced)Opinion-based“expert consensus”
Levels of Evidence
Level 1: Randomized Clinical Trials
Level 2: Head to Head Trial or
Systematic Review of Cohort
Studies
Level 3: Case-Control Studies
Level 4: Case-series
Level 5: Expert Opinion
Levels of Evidence
Level of Evidence
Type of Study
1a Systematic reviews of randomized clinical trials (RCTs)
1b Individual RCTs
2a Systematic reviews of cohort studies
2b Individual cohort studies and low-quality RCTs
3a Systematic reviews of case-controlled studies
3b Individual case-controlled studies
4 Case series and poor-quality cohort and case-control studies
5 Expert opinion based on clinical experience
Adapted from: Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Churchill Livingstone; 2000.
Guidelines Resources
www.guideline.gov (AHRQ) www.mdconsult.com (MD Consult) www.nice.org.uk/Guidance/ (NICE) www.sign.ac.uk/guidelines (SIGN clinical
guidelines) www.g-i-n.net (Guidelines International
Network (G-I-N)
04/19/23 EBM Resources11
Included in OVID subscription Limitations
limited to English only addresses questions amenable to randomized
trials most of medicine has not been studied enough to
allow for conclusions
Cochrane Database
The Cochrane Library is a collection of 6 main databases and 1 additional databases that describe Cochrane as an organization. These are:
1. The Cochrane Database of Systematic Reviews (CDSR)2. The Cochrane Database of Reviews of Effects (DARE)3. The Cochrane Central Register of Controlled Trials
(CENTRAL)4. The Cochrane Database of Methodology Reviews (CDMR)5. Health Technology Assessment Database (HTA)6. NHS Economic Evaluation Database (NHS EED)7. THE COCHRANE METHODOLOGY REGISTER (CMR)8. About The Cochrane Collaboration and the Cochrane
Collaborative Review Groups
Cochrane Databases
The Cochrane Library 2007, Issue 4
Database Total Records
The Cochrane Database of Systematic Reviews (Cochrane Reviews) 5053
Database of Abstracts of Reviews of Effects (DARE) 6761
The Cochrane Central Register of Controlled Trials (CENTRAL) 522,340
The Cochrane Database of Methodology Reviews (Methodology Reviews) 20
The Cochrane Methodology Register (Methodology Register) 10,008
Health Technology Assessment Database (HTA) 7078
NHS Economic Evaluation Database (NHS EED) 22,731
About The Cochrane Collaboration and the Cochrane Collaborative Review Groups (About)
92
04/19/23 EBM Resources14
ACP Journal Club
About 100 journals systematically surveyed Highest-validity articles abstracted Structured abstracts to guide critical appraisal Clinical commentary Included in our OVID subscription
04/19/23 EBM Resources15
& you know UpToDate …. !
UpToDate
04/19/23 EBM Resources16
Designed as entry point to information Textbooks and Medline not efficient Intuitive clinical organization Brief summarized information presented Links and references if more details needed ICD-9 codes and links to patient information
handouts
DynaMed
E-Books
MD Consulthttp://www.mdconsult.com
Free Books 4 Doctorshttp://www.freebooks4doctors.com/
Gigapediahttp://gigapedia.com/
EBM Calculators
Statistics for Diagnostic, Prospective, Case Control & Randomized studies
Can graph pre- and post test probability with likelihood ratio for Diagnostic Studies.
Can save results and view at another time EBM Calculator – Centre for EBM – University Health Network
EBM Online Calculators
Some Examplses:http://www.graphpad.com/quickcalcs/NNT1.cfm
http://www.ebem.org/nntcalculator.html
http://www.cebm.net/index.aspx?o=1160
Selected Electronic Health Information Resources
Resource Internet Address
ACP Journal Club www.acpjc.org
Cochrane Library www.update-software.com
UpToDate www.uptodate.com
PubMED www.pubmed.com
eMedicine www.emedicine.com
Clinical practice guidelines www.guidelines.gov
MD Consult www.mdconsult.com
EBMR Reviews (OVID) www.ovid.com/site/catalog
Bandolierhttp://www.medicine.ox.ac.uk/bandolier/
A monthly newsletter about evidence-based health care; top source for such information on the net.
Evidence-Based Medicinehttp://www.evidence-basedmedicine.com
Bi-monthly journal which summarises important recent
articles from major clinical fields (family medicine,
internal medicine, obstetrics and gynecology, pediatrics,
psychiatry, public health, surgery). (Note: Best Evidence
is the cumulated contents of ACP Journal Club (since
1991) and Evidence-Based Medicine (since 1995) in an
annual CD.
BestBETShttp://www.bestbets.org
Provides rapid evidence-based answers to reallife
clinical questions in emergency medicine, using a systematic approach to reviewing the literature.
BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is. Developed in the Emergency Department of Manchester Royal Infirmary, UK.
Clinical Evidencehttp://www.clinicalevidence.com
Clinical Evidence is an updated directory of evidence on the effects of clinical interventions.
It summarises the current state of knowledge, ignorance, and uncertainty about the prevention
and treatment of clinical conditions, based on
thorough searches and appraisal of the literature. It covers 20 specialties and includes 134 conditions. Updated/expanded coverage every six months in print and CD.
TRIP Databasehttp://www.tripdatabase.com
Searches several different evidence-based
resources including PubMed, Bandolier,
and the ATTRACT question-answering
service. Only allows title searches, but
does allow AND, OR, NOT
How to Search?
Use the components of the PICO to
direct your search
• (Population OR synonym1 OR synonym2…) AND
• (Intervention OR synonym1 OR synonym2…) AND
• (Comparator OR synonym1 OR synonym2…) AND
• (Outcome OR synonym1 OR synonym2…)
EBM “Systems” vs Traditional Textbook Model
Traditional textbook: Author is an “authority” Author selects, reports on own One-year production line from
manuscript to bookstand Three-year production schedule
Updating in EBM Systems
Authors are provided with new studies and reviews that are:
• Assessed for validity• Rated by clinicians for relevance • Rated by clinicians for newsworthiness• Within a month of original publication
Studies
Syntheses
Synopses
Systems
Original published Articles like Medline
Evidence-based Journals
Cochrane reviews
Computerized Decision Support System (CDSS)
Evidence-based textbook
