Evidence-Based Health Care:
Joyce Condon, MLS, AHIP
Exempla Saint Joseph Hospital
Denver, Colorado USA
This section will cover
selecting appropriate evidence resources
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.
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.
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
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.
Updated quarterly. Links to
MEDLINE and full text articles in
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.
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.
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
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
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.
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
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.
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:
Medicine, Evidence-based Health
Policy & Management, Evidence-based
Healthcare, Evidence-based Obstetrics
& Gynecology, and Evidence-based
Oncology. Use to answer focused or
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