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Evidence-Based Guidelines
Lynn Kysh, [email protected]
Information Services LibrarianNorris Medical Library
Evidence Pyramid – Publication Types
Evidence-Based Guidelines
Systematic Review & Meta-
analysis
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Case Series, Case Reports
S y n t he s e s
St
ud
ie
sHigher Quality of Information
Lower Quality of Information
Fewer Articles
More Articles
Agenda•A note about guidelines•Clinical Scenario: Prostate Cancer Screening•Ask• PICO
• Acquire• PubMed• National Guidelines Clearinghouse
•What about clinical information tools?
Evidence (research)
Patient values
Clinical expertise
Guide to formulate a question
•Problem/Patient• Intervention•Comparison (if any)•Outcome
Clinical Scenario
Your patient is a 50 year old African-American Chief Executive Officer for a Los Angeles company presents for his executive physical. His friend was recently diagnosed with prostate cancer and he wants to know if he should have a digital rectal examination and/or PSA. How would you respond?
Using PICO
•P 50 y/o African American man•I Digital rectal exam or PSA•C No screening•O Decrease morbidity and mortality related to prostate cancer
Finding guidelines:Use “Article Type” filter
National Guidelines Clearinghouse
• Guidelines Information• Organization• Process• Evidence used• Disclosures
• Comparison feature
But what about clinical information tools?
Are these EBM Resources?
•Opinions vary (and that’s okay!)
•Appraise the information• Check evidence ratings• Follow links to evidence• Check author information
Examined from UpToDate & Dynamed articles on:• erectile dysfunction• fibromyalgia• hypogonadism • Psoriasis• rheumatoid arthritis • Crohn's disease
All articles from the UpToDate articles demonstrated a conflict of interest. At times, the editor and author would have a financial relationship with a company whose drug was mentioned within the article.
Agenda•A note about guidelines•Clinical Scenario: Prostate Cancer Screening•Ask• PICO
• Acquire• PubMed• National Guidelines Clearinghouse
•What about clinical information tools?