Evidence-Based Medicine
(EBM) Resources at the Mercer School of Medicine
Evidence-Based Medicine is the
integration of best research evidence with clinical expertise and patient
values. (Sackett DL, Straus SE, Richardson WS, et al. Evidence-based
medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill
Livingstone, 2000.)
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| Definitions of Types of Studies
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Meta-analysis
A meta-analysis will thoroughly examine a number of valid studies on
a topic and combine the results using accepted statistical methodology as if
they were from one large study. Some clinicians put meta-analysis at the top of
the pyramid because part of the methodology includes critical appraisal of the
selected RCTs for analysis. PubMed's Clinical Queries is a good place to
start.
Systematic Reviews
Systematic reviews usually focus on a clinical topic and answer a
specific question. An extensive literature search is conducted to identify all
studies with sound methodology. The studies are reviewed, assessed, and the
results are summarized according to the predetermined criteria of the review
question. The Cochrane Collaboration has done a lot of work in the area
of systematic review.
Evidence
Syntheses
Authors of critically-appraised topics evaluate and synthesize
multiple research studies, so that practioners may more readily determine if
the evidence is valid and reliable, and whether they can apply it to their own
practice. Bandolier is an example of a resource that contains evidence
syntheses.
Article
synopses
Authors of critically-appraised individual articles
evaluate and synopsize individual research studies so that practioners may more
readily determine if the evidence is valid and reliable, and whether they can
apply it to their own practice. The ACP Journal Club is an example of a
resource that contains article synopses.
Randomized
Controlled Trials
Randomized controlled trials are carefully planned projects that
study the effect of a therapy on real patients. They include methodologies that
reduce the potential for bias (randomizing and blinding) and that allow for
comparison between intervention groups and control groups (no intervention).
PubMed's Clinical Queries and the Cochrane Library are resource
tools. |
Cohort
Studies
Cohort Studies take a large population and follow
patients who have a specific condition or receive a particular treatment over
time and compare them with another group that has not been affected by the
condition or treatment being studied. Cohort studies are observational and not
as reliable as randomized controlled studies, since the two groups differ in
ways other than in the variable under study. PubMed's Clinical Queries
and the Cochrane Library are resource tools.
Case Controlled
Studies
Case controlled studies are studies in which patients
who already have a specific condition are compared with people who do not. They
often rely on medical reports and patient recall for data collection. These
types of studes are often less reliable than randomized controlled trials and
cohort studies because showing a statistical relationship does not mean that
one factor necessarily caused the other. PubMed's Clinical Queries and
the Cochrane Library are resource tools.
Case Series/Case
Reports
Case series and case reports consist of collections of
reports on the treatment of individual patients or a report on a single
patient. Because they are reports of cases and use no control groups with which
to compare outcomes, they have no statistical validity.
Background
Information/Expert Opinion
Evidence in these resources may vary from expert opinion
to high levels of evidence. |
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Foraging Tools
Examples
include:
Foraging is keeping up with the new literatue and finding
information/research that is relevant.
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Hunting Tools
Examples
include:
Hunting is answereing a specific, well-formed question in a
timely, efficient manner to include at patient point of care.
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TRIP (Turning
Research Into Practice) Database Plus
Simultaneously searches
evidence-based sources of systematic reviews, practice guidelines, and
critically-appraised topics and articles -- including most of those listed
above and many more. Also searches MEDLINE’s Clinical Queries, medical
image databases, e-textbooks, and patient information leaflets.
Access is
free.
Filtered Resources
Filtered resources appraise the quality of studies and often
make recommendations for practice.
Systematic Reviews /
Meta-Analyses
Authors of a systematic review ask a specific clinical
question, perform a comprehensive literature search, eliminate the poorly done
studies and attempt to make practice recommendations based on the well-done
studies. A meta-analysis is a systematic review that combines all the
results of all the studies into a single statistical analysis of
results.
The
Cochrane Library This
resource is a regularly updated collection of evidence-based medicine
databases. It includes abstracts and full reviews of controlled trials,
methodologies, economic evaluation, and health technology assessment.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
Systematic Reviews are also searchable in
MEDLINE:
- PubMed:
Click on “Clinical Queries” on the left side of the screen; select
“Find Systematic Reviews” and enter your search query.
- PICO
searching from NLM is a specialty interface where Patient/Problem,
Intervention, Compare to, and Outcome factors are entered to search MEDLINE.
Choose "Meta-Analysis" from the "Select Publication Type" pull-down menu. Not
geting any results? Don't select any publication type.
- Already have your PICO Question formulated, use
askMEDLINE,
a free-text, natural language search tool for MEDLINE/PubMed.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
Critically-Appraised Topics
Authors of critically-appraised topics evaluate and synthesize
multiple research studies.
National
Guideline Clearinghouse
A comprehensive
database of evidence-based clinical practice guidelines and related documents
produced by the Agency for Health Care Research and Quality, in partnership
with the American Medical Association and the American Association of Health
Plans. Updated weekly.
Note: Guideline
evidence varies from expert opinion to high levels of evidence.
Access is
free
ACP
PIER
Go here for evidence based
information about health conditions and interventions.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
Dynamed
DynaMed includes the
following information on disease entities: • Description (including ICD-9
Codes) • Causes and Risk Factors • Complications and Associated
Conditions • History • Physical • Diagnosis • Prognosis
• Treatment • Prevention and Screening • References •
Patient Information
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
Critically-Appraised Individual
Articles
Authors of critically-appraised individual articles evaluate
and synopsize individual research studies.
The
ACP Journal Club
The editors of this
journal screen the top 100+ clinical journals and identify studies that are
methodologically sound and clinically relevant. An enhanced abstract, with
conclusions clearly stated, and a commentary are provided for each selected
article. Published by the American College of Physicians-American Society of
Internal Medicine.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
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.”
Access is
free
Unfiltered Resources
Evidence is not always available via filtered resources. Searching
the primary literature may be required. It is possible to use specific search
strategies in PubMed and other databases to achieve the highest possible level
of evidence.
PubMed
To limit your PubMed
search to the best evidence-producing studies: Click on "clinical queries" (on
the left side of the screen). This specialized search is intended for
clinicians and has built-in search "filters." Four study categories--therapy,
diagnosis, etiology, prognosis--are provided, and you may indicate whether you
wish your search to be more sensitive (i.e., include most relevant articles but
probably including some less relevant ones) or more specific (i.e., including
mostly relevant articles but probably omit a few).
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
PsycINFO
International coverage
of the professional and academic literature in psychology, medicine,
psychiatry, nursing, sociology, education, pharmacology, physiology,
linguistics, and other areas.
To limit your PsycINFO
search to the best evidence-producing studies: Click on the "Limits" icon to
use "Clinical Queries" or limit to "methodology" types.
To access,
Students and Faculty,
please contact the library (912-350-8345 in Savannah and 478-301-4056 in Macon)
for the current password, which changes every few months.
Background Information/Expert
Opinion
Note: Evidence in
these resources may vary from expert opinion to high levels of
evidence.
eMedicine
Has over 10,000
physician authors and editors who create thousands of peer-reviewed, disease
specific articles. 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.
Access is
free.
eBooks
Full-text electronic
books from Ovid.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
AccessMedicine
It has 43 electronic
textbooks and reference books including: Harrison's Principles of Internal
Medicine; Hurst’s the Heart; Metabolic and Molecular Bases of Inherited
Diseases; the Lange series in the basic medical and clinical sciences; and
color atlases of cardiology, dermatology, microbiology, hematology, endoscopy
and others.
To access: On Campus, no login. Off Campus:
Students and Faculty,
use your Mercer email username (e.g. smith_ab) and password.
Evidence-Based Medicine Information
Sites
Centre for
Evidence-Based Medicine (Oxford University)
The Centre promotes
evidence-based health care and provide support and resources to anyone who
wants to make use of them. Includes the EBM Toolbox, an assortment of materials
which are very useful for practitioners of EBM, and EBM Teaching Materials,
including PowerPoint presentations.
Centre for Evidence-Based Medicine
(Toronto)
Includes many resources
for practicing and teaching EBM.
Evidence-Based
Medicine
A selective list of
additional EBM websites developed and maintained by Duke University Medical
Center Library.
Netting the
Evidence
From the School of
Health and Related Research (ScHARR) at the University of Sheffield, UK.
Includes a comprehensive list of EBM databases, journals, articles, and other
information sources.
Users' Guides to Evidence-Based
Practice
From the University of
Alberta's Centre for Health Evidence. Includes the complete set of EBM Users'
Guides originally published as a series in the Journal of the American Medical
Association (JAMA).
Evidence-Based Medicine
Tutorials
Introduction to
Evidence-Based Medicine
From Duke University
Medical Center Library and University of North Carolina at Chapel Hill Health
Sciences Library.
SUNY Health Sciences
Evidence-Based Medicine Course
EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of
Dartmouth College and Yale University. All Rights Reserved.
Produced by Jan
Glover, David Izzo, Karen Odato and Lei Wang.
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