SELECTED FREE EVIDENCE BASED RESOURCES

Carolyn Klatt, MLIS

Health Sciences Library

Mercer University School of Medicine -- SavannahMemorial University Medical Center4700 Waters AvenueP.O. Box 23089Savannah, GA 31404

Phone: 912-350-3546

FAX: 912-350-8685

Email:

klatt_ca@mercer.edu

klattca1@memorialhealth.com

WHAT IS “EVIDENCE BASED”?

Definition from:(Straus, Sharon E., Richardson, W.S., Glasziou,

P., and Haynes, R.B. Evidence-based medicine: how to practice and teach EBM. London: Churchill-Livingstone, 2005)

“Evidence based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.”

WHAT IS “EVIDENCE BASED?

Best Research Evidence

Clinical Expertise

Patient Values

EBM

HOW EVIDENCE IS APPLIED

Prevention Diagnosis Therapy and Treatment Prognosis Etiology Harm

PYRAMID OF EVIDENCE

Medical literature is immense. Only a small portion is immediately useful in

answering clinical questions. Literature reports the whole spectrum of the

scientific research process. Journey from in-vitro studies to double-blind

randomized control trials is called the “wedge of evidence” or the “pyramid of evidence.”

PYRAMID OF EVIDENCE

TYPES OF STUDIES

Meta-analysis Systematic Reviews Evidence Guidelines Evidence Summaries Randomized Controlled Trials (RCT) Cohort Studies Case Control Studies Clinical Research Critiques Case series and Case reports

LEVELS OF EVIDENCE (LOE)

“Evidence-based” involves tracking down the available evidence, assessing its validity and then using the “best” evidence to inform decisions regarding care.

Rules of evidence have been established to grade evidence according to its strength.

The terms "levels of evidence" or "strength of evidence" refer to systems for classifying the evidence in a body of literature through a hierarchy of scientific rigor and quality.

Several dozen of these hierarchies exist. Some systems comprise three levels and

others eight or more.

EXAMPLE 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

Centre for Evidence-Based Medicine, Oxford

EXAMPLE LEVELS OF EVIDENCEA: There is good research-based evidence to

support the recommendation.B: There is fair research-based evidence to support

the recommendation.C: The recommendation is based on expert opinion

and panel consensus.X: There is evidence of harm from this intervention.

Agency for Healthcare Research and Quality (AHRQ)

EXAMPLE LEVELS OF EVIDENCE

Beneficial Likely to be beneficial Trade off between benefits and harms Unknown effectiveness Unlikely to be beneficial Likely to be ineffective or harmful

British Medical Journal’s Clinical Evidence

EVIDENCE BASED TUTORIALS

Evidence Based Practicehttp://www.biomed.lib.umn.edu/learn/ebp/

From the University of Minnesota Bio-Medical Library.

Introduction to EBMhttp://ktclearinghouse.ca/cebm/intro

From the Centre for Evidence Based Medicine Toronto.

FREE RESOURCES Cochrane Collaboration

http://www.cochrane.org/index.htmContains high-quality, independent evidence to inform healthcare decision-making. Cochrane systematic reviews represent the highest level of evidence on which to base clinical treatment decisions. In addition to Cochrane reviews, the Cochrane Library provides other sources of reliable information:

from other systematic review abstracts technology assessments economic evaluations individual clinical trials Abstracts are free

FREE RESOURCES PubMed (Medline) Clinical Queries

http://www.ncbi.nlm.nih.gov/pubmed/clinical

Search by a clinical study category such as etiology, diagnosis, therapy, prognosis Find systematic reviews , meta-analysis, reviews of

clinical trials, evidence-based medicine, consensus development conferences, and guidelines.

FREE RESOURCES TRIP (Turning Research Into Practice) http://www.tripdatabase.com/

A meta-search engine of many Evidence Based resources, including the Cochrane Library, e-journals, practice guidelines, e-textbooks, and PubMed.

FREE RESOURCES

SumSearchhttp://sumsearch.org/

From the University of Texas Health Sciences Center at San Antonio - Simultaneously searches MEDLINE, DARE, the National Guideline Clearinghouse, the Merck Manual, and other resources.

FREE RESOURCES Bandolier

http://www.medicine.ox.ac.uk/bandolier/Bandolier is an independent journal about evidence-based

healthcare published in the UK. It includes “information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.”.

FREE RESOURCES

AHRQ (Agency for Healthcare Research and Quality)

http://www.ahrq.govThe lead Federal agency charged with improving

the quality, safety, efficiency, and effectiveness of health care for all Americans .

The AHRQ website includes access to research findings, fact sheets, data and surveys on various health topics as well as reports on specific populations, quality and patient safety, Health IT, and clinical information.

ePSS (elctronic Preventative Services Selector) tool on web and PDA

FREE RESOURCES National Guidelines Clearinghouse

http://www.guideline.gov A comprehensive database of evidence-based

clinical practice guidelines and related documents.

An initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.

FREE RESOURCES ClinicalTrials.govhttp://clinicaltrials.gov

Provides regularly updated information about federally and privately supported clinical research in human volunteers.

Gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details.

FREE RESOURCES eMedicine

http://www.emedicine.com Has over 7,000 physician authors and editors who

create thousands of peer-reviewed, disease specific articles.

Publishes over 400 new review articles monthly. Each article incorporates 4 levels of physician peer-review.

Includes over 100 useful medical tools and calculators, as well as a clinical image case, radiograph and ECG of the week, and over 30,000 images.

FREE RESOURCES Evidence Updates

http://plus.mcmaster.ca/EvidenceUpdates

A collaboration between BMJ Group and McMasterUniversity's Health Information Research Unit Email alerting service Searchable database of articles that are pre-screened

for quality and given a clinical relevancy rating Links to selected evidence-based resources

KNOWLEDGE IS: KNOWING WHERE TO FIND IT