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What is Evidence-Based Medicine?

• Evidence-Based Medicine: What it is and what it isn't
• Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine

Evidence-Based Practice is a five-step process:

1. Construct a relevant, answerable question from a clinical case.
2. Plan and carry out a search of the literature for the best external evidence.
3. Critically appraise the literature for validity and applicability.
4. Apply the evidence to your clinical practice.
5. Evaluate your performance.

Step 1: Constructing a relevant, answerable question

• Flemming K. EBN notebook. Asking answerable questions. Evidence-Based Nursing 1998;1:36-37.
• Formulating Answerable Clinical Questions (Centre for Evidence-Based Medicine, Mount Sinai Hospital) Including: Educational prescription
• The Well-Built Clinical Question (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill
• Asking Focused Questions (Centre for Evidence-Based Medicine, Oxford)

Hierarchy of pre-processed evidence

[ [Adapted from DiCenso, Bayley and Haynes (2009). ACP Journal Club. Editorial: Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3.]

Systems

“An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

Summaries

"These include clinical pathways or textbook summaries that
integrate evidence-based information about specific clinical
problems and provide regular updating."

Syntheses: Systematic Reviews

"A synthesis or systematic review is a comprehensive summary of all the research evidence related to a focused clinical question."
[More information on systematic reviews]

Synopses

“...a synopsis that summarizes the findings of a high-quality systematic review can often provide sufficient information to support clinical action... the synopsis of a single study provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice."

Tips for Searching for the Evidence

Databases

Medline	PubMed PubMed Clinical Queries PubMed Health Services Research (HSR) Queries Ovid MEDLINE (Use the "Limit" feature to add Clinical Queries) MeSH (Medical Subject Headings) Browser
Cochrane Database	Cochrane Library Podcasts from the Cochrane Library Cochrane Summaries [plain language abstracts and summaries by topic] Informed Health Online (includes consumer summaries of Cochrane reviews) Cochrane Neonatal Reviews from the National Institute of Child Health & Human Development
Other databases	EvidenceUpdates OVID (Access to the Library's Ovid databases, including Medline and Embase) National Institute for Health Research (UK) Centre for Reviews and Dissemination (CRD) Databases, including: Database of Abstracts of Reviews of Effectiveness (DARE) NHS Economic Evaluation Database (NHS EED) Health Technology Assessment (HTA) Database Web of Science (including Science Citation Index) PEDro : Physiotherapy Evidence Database health-evidence.ca (Public Health) TRIP Database (Turning Research Into Practice) Campbell Collaboration (social, behavioral and educational arenas) Public Health +

Evidence-Based Abstract Journals

• Evidence-Based Nursing (before 2010)
• ACP Journal Club
• Evidence-Based Medicine (before 2010)
• Evidence-Based Mental Health
• Current Cancer Treatment Reviews (Incorporating Evidence-Based Oncology)

Evidence-Based Texts

• BMJ Clinical Evidence
• DynaMed
• FirstCONSULT
• PIER: the Physicians' Information and Education Resource
• UpToDate (On-campus access only)

Evidence-Based Clinical Practice Guidelines

• Best Practice Guidelines (Registered Nurses Association of Ontario)
• AGREE (Appraisal of Guidelines Research & Evaluation)
• CMA Infobase: clinical practice guidelines -- Canadian Medical Association
• National Guideline Clearinghouse (United States)
• National Institute for Health and Clinical Evidence (NICE - UK)
• Evidence-Based Guidelines (Program in Evidence-Based Care) (Cancer Care Ontario) Practice Guidelines (Program in Evidence-Based Care)

Critically Appraised Topics

• CATmaker (Centre for Evidence-Based Medicine, Oxford University)
• CATwalk: a guided walk through the process of doing a CAT (University of Alberta Libraries)

Meta-Searches

• MacPLUS FS (McMaster Health Knowledge Refinery)
  Only available to McMaster affiliates, please register or login via MedPortal
• TRIP (Turning Research Into Practice) Database (Clinical Effectiveness Initiative for Wales)
• SUM Search

Consumer Resources

• MEDLINEplus
• Informed Health Online

Tools

• Users' guide to the Medical Literature
• EBM Toolbox
• Glossaries and other resources for understanding health care statistics terminology
• Clinical Epidemiology & Evidence-Based Medicine Glossary

Other Resources

• ClinicalTrials.gov
• Bandolier Evidence-Based Health Care
• Cancer Care Ontario Program in Evidence-Based Care (PEBC)
• Therapeutics Initiative: Evidence-Based Drug Therapy
• Tutorials:
  • Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, University of North Carolina at Chapel Hill)
• Directories
  • Evidence-Based Healthcare (University of Rochester, Edward G. Miner Library)
  • Evidence-Based Resources (University of Alberta Libraries)
  • Evidence-Based Practice (Canadian Virtual Health Library)
• Clinical Skills
  • JAMA Rational Clinical Examination series
  • EBONCALL (Evidence-Based On-Call) database

Resources for Surgery

• Evidence-based Surgery (SOURCE: Surgical Outcomes Research Centre):
  • Incudes the Evidence-Based Surgery articles from the Canadian Journal of Surgery
• OrthoEvidence

Evidence-Based Practice Organizations

• The Canadian Cochrane Centre / Centre de Cochrane Canadien
• Centre for Evidence-based Medicine (Mount Sinai Hospital, University of Toronto)
  • Centre for Evidence-Based Medicine (Oxford, England)
• Cochrane Collaboration
• Agency for Healthcare Research and Quality

 

Need some help? Contact: Liz Bayley
Health Sciences Library, HSC-2B28
Tel: (905)525-9140, ext. 22545
Email: bayleyl@mcmaster.ca