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  • 1. Evidence-Based Health Care: A Tutorial Joyce Condon, MLS, AHIP Reference Librarian Exempla Saint Joseph Hospital Denver, Colorado USA Medical Library
  • 2. Part Three This section will cover selecting appropriate evidence resources
  • 3. Resources 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.
  • 4. Resources 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.
  • 5. Appraised 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.
  • 6. RESOURCES ACCESS DESCRIPTION Cochrane Database of Internet access via Produced by Cochrane Systematic Reviews OVID Web Gateway. Collaboration. Systematic reviews of controlled trials of Link on Exempla Library Page. 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 Internet access via Produced by NHS Centre for of Reviews of Effects OVID Web Gateway. Reviews and Dissemination at Link on Exempla Library Page. the University of York, England. Also available for FREE 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.
  • 7. RESOURCES ACCESS DESCRIPTION Cochrane Central Register of Internet access via Produced by cooperative effort of The Controlled Trials OVID Web Gateway. Cochrane Collaboration, the National Link on Exempla Library of Medicine, and Elsevier LibraryPage. 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 Produced by American Full text database of structured (ACP Journal Club and Evidence- College of Physicians. abstracts of studies. Comments on based Medicine combined into one Available in print, online via the value of the study for clinical journal, ACP Journal Club, in publisher’s website, or practice. Coverage: 1991-present. North and South America in internet access via OVID version links to MEDLINE and January 2000) [ISSN: 1056-8751] OVID Web Gateway. full text articles in Journals@OVID. Link on Evidence for foreground questions. Exempla Library Page. InfoRetriever/POEMs Access is from Collection of evidence and reference (Patient Oriented Evidence that Exempla Intranet material including the POEMs Matters) database, Cochrane abstracts, 5- POEMs identify and critically Minute Clinical Consult, a variety of review articles related to primary proprietary clinical decision rules and care. support tools, and clinical guidelines. Evidence for foreground questions.
  • 8. SAM – Scientific American Produced by WebMD Corp. Online electronic textbook for Medicine Scientific American Medicine. answering background questions. Available in print and online. Fee- Current, comprehensive and based. Must enter userid and extensively referenced medical password. information resource covering internal medicine. Clinical Evidence Produced by BMJ Publishing Compendium of evidence on Group. effectiveness of clinical Available in print, online via interventions specifying benefits publisher's website, or internet and harms. Updated monthly with access via OVID Web Gateway. new topics. Topic revisions occur on 8-month cycle. Evidence for background questions. UpToDate Produced by UpToDate, Inc. Electronic clinical reference for Available on CD-ROM and on internists and medicine ExemplaWeb 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.
  • 9. TRIP Plus – Created in 1997 to bring together A meta-search engine that searches Transforming Research evidence-based resources available across the Internet for high-quality into Practice on the internet. TRIP Plus 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 Any group or organization can EBM Web sites with a collection of Appraised Topics produce a collection of CATs. View evidence-based answers to clinical current CATS at questions. CATs provide a quick way to Birmingham Women's Hospital. See summarize evidence on common clinical additional CATs at the questions with a “hard copy” for future University of Western Ontario Evidence-Based Neurology CATs can be used as reference. Existing page. starting points for seeking and appraising updates in the relevant evidence. Use for foreground questions Bandolier Bandolier is produced by Andrew Bandolier is a print and Internet journal Moore (RAM) as executive editor, about health care, using evidence-based with Henry McQuay (HJM) running medicine techniques to provide advice the web production. The selection of about particular treatments or diseases material and the content are for healthcare professionals and determined by RAM and HJM, with consumers. The content is 'tertiary' neither control nor direction from publishing, distilling the information from any other body. (secondary) reviews of (primary) trials Access to the web version is free. and making it comprehensible. Evidence for focused questions.
  • 10. MD Consult Services Produced by MD Consult, a division of Elsevier An online clinical information service Science. Userid and password required. 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 Sponsored by Agency for Healthcare Research and Provides structured guideline Clearinghouse Quality, the American Medical Association, and the summaries, comparison of guidelines, American Association of Health Plans. and syntheses of selected guidelines. Access via the Internet Also provides a utility for side-by-side comparison of guidelines. Use for guideline development.
  • 11. This is the end of Part Three