Evidence-Based Health Care:Evidence-Based Health Care:A TutorialA Tutorial

  Joyce Condon, MLS, AHIP

Reference Librarian

Exempla Saint Joseph HospitalDenver, Colorado USA

Medical Library

Part Three

This section will cover

selecting appropriate evidence resources

Resources StrategyResources Strategy

First search appraised resources that offer smaller numbers of high-quality materials. For example, the Cochrane Library offers the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and the Cochrane Central Register of Controlled Trials.

Other EBM resources include the ACP Journal Club and Clinical Evidence. These are “prefiltered” resources that apply explicit critical appraising techniques to evaluate studies. The focus is on methodologically sound and clinically important studies. They are regularly updated. These are small full text databases wherein every word of the document text is searchable. Keep the strategy simple for these databases. Use single terms, short phrases and synonyms as text words.

Resources StrategyResources Strategy

Next search for original studies indexed in large databases like MEDLINE (over 12 million citations from over 4,600 biomedicine or life sciences journals). MEDLINE contains the full spectrum of literature reports. The methodological quality of these studies may be excellent or poor. Only a small portion of the studies will be immediately useful in answering clinical questions.

To retrieve the highest level of evidence for a particular question you may need to add methodology terms and EBM filters to subject terms. This means you must create a more complex search strategy to replace the simple text word strategy appropriate for a small appraised resource.

Finally, check Web EBM sites like TRIP+, Bandolier, POEMs, National Guideline Clearinghouse. For these resources keep the strategy simple. Use single terms, short phrases and synonyms.

Appraised ResourcesAppraised Resources

These resources identify, analyze, evaluate and synthesize existing information. Such value-added resources require much time and effort to create. Consequently, they are small databases compared to MEDLINE. The table below lists some of the important appraised information resources.

Note: For access to OVID Web Gateway resources from home userid and password are required.

RESOURCES ACCESS DESCRIPTIONCochrane Database of Systematic Reviews

Internet access via OVID Web Gateway.

Link on Exempla Library Page.

Produced by Cochrane Collaboration. Systematic reviews of controlled trials of therapeutic interventions. Full text database. Evidence for answering foreground questions. Coverage: 1991-present. Updated quarterly. Links to MEDLINE and full text articles in Journals@OVID

DARE – Database of Abstracts of Reviews of Effects

Internet access via OVID Web Gateway. Link on Exempla Library Page.Also available for FREE

Produced by NHS Centre for Reviews and Dissemination at the University of York, England. Identifies and evaluates the best quality systematic reviews. Offers reviews of some topics not included in Cochrane Review database. Full text database updated quarterly. Coverage: 1994-present. OVID version links to MEDLINE and full text articles in Journals@OVID. Evidence for answering foreground questions.

RESOURCES ACCESS DESCRIPTION

Cochrane Central Register of Controlled Trials

Internet access via OVID Web Gateway. Link on Exempla LibraryPage.

Produced by cooperative effort of The Cochrane Collaboration, the National Library of Medicine, and Elsevier Science. Bibliographic database of over 300,000 definitive controlled trials in health care. Source of data for systematic reviews of controlled trials – no analysis or commentary. Use for foreground questions.

ACP Journal Club(ACP Journal Club and Evidence-based Medicine combined into one journal, ACP Journal Club, in North and South America in January 2000) [ISSN: 1056-8751]

Produced by American College of Physicians. Available in print, online via publisher’s website, or internet access via OVID Web Gateway. Link on Exempla Library Page.

Full text database of structured abstracts of studies. Comments on the value of the study for clinical practice. Coverage: 1991-present. OVID version links to MEDLINE and full text articles in Journals@OVID. Evidence for foreground questions.

InfoRetriever/POEMs(Patient Oriented Evidence that Matters)POEMs identify and critically review articles related to primary care.

Access is from Exempla Intranet

Collection of evidence and reference material including the POEMs database, Cochrane abstracts, 5-Minute Clinical Consult, a variety of proprietary clinical decision rules and support tools, and clinical guidelines. Evidence for foreground questions.

SAM – Scientific American Medicine

Produced by WebMD Corp.Scientific American Medicine.Available in print and online. Fee-based. Must enter userid and password.

Online electronic textbook for answering background questions. Current, comprehensive and extensively referenced medical information resource covering internal medicine.

Clinical Evidence Produced by BMJ Publishing Group. Available in print, online via publisher's website, or internet access via OVID Web Gateway.

Compendium of evidence on effectiveness of clinical interventions specifying benefits and harms. Updated monthly with new topics. Topic revisions occur on 8-month cycle. Evidence for background questions.

UpToDate Produced by UpToDate, Inc. Available on CD-ROM and on ExemplaWeb

Electronic clinical reference for internists and medicine subspecialists. Comprised of thousands of original topic reviews written by a recognized faculty of experts and based on a synthesis of evidence-based findings and the authors’ clinical experience. Updated quarterly. Good resource for background questions.

TRIP Plus – Transforming Research into Practice

Created in 1997 to bring together evidence-based resources available on the internet. TRIP Plus

A meta-search engine that searches across the Internet for high-quality information. Provides direct, hyperlinked access to EBM literature. Links to the latest evidence by clinical area, peer-reviewed journals, guidelines, e-Textbooks, medical images, and patient information. Also hyperlinks to “Clinical Queries” in PubMed.

CATs – Critically Appraised Topics

Any group or organization can produce a collection of CATs. View current CATS at Birmingham Women's Hospital. See additional CATs at the University of Western Ontario Evidence-Based Neurology page.

EBM Web sites with a collection of evidence-based answers to clinical questions. CATs provide a quick way to summarize evidence on common clinical questions with a “hard copy” for future reference. Existing CATs can be used as starting points for seeking and appraising updates in the relevant evidence. Use for foreground questions

Bandolier Bandolier is produced by Andrew Moore (RAM) as executive editor, with Henry McQuay (HJM) running the web production. The selection of material and the content are determined by RAM and HJM, with neither control nor direction from any other body. Access to the web version is free.

Bandolier is a print and Internet journal about health care, using evidence-based medicine techniques to provide advice about particular treatments or diseases for healthcare professionals and consumers. The content is 'tertiary' publishing, distilling the information from (secondary) reviews of (primary) trials and making it comprehensible. Evidence for focused questions.

MD Consult Services Produced by MD Consult, a division of Elsevier Science. Userid and password required.

An online clinical information service providing access to information on clinical care. Provides access to continuously updated reference books, daily updates in medicine, drug information, practice guidelines, and a collection of full text journals including: Evidence-based Cardiovascular Medicine, Evidence-based Health Policy & Management, Evidence-based Healthcare, Evidence-based Obstetrics & Gynecology, and Evidence-based Oncology. Use to answer focused or background questions.

National Guideline Clearinghouse

Sponsored by Agency for Healthcare Research and Quality, the American Medical Association, and the American Association of Health Plans. Access via the Internet

Provides structured guideline summaries, comparison of guidelines, and syntheses of selected guidelines. Also provides a utility for side-by-side comparison of guidelines. Use for guideline development.

This is the end of

Part Three