Primary vs. Secondary Sources for Evidence-Based Medicine<br />SohailBajammal<br />October13, 2011<br />
Objectives<br />Differences between primary & secondary sources of evidence<br />Overview of popular secondary sources<br />
5A<br />
5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 <br />Computerized decision support system<br />Evidence...
Searching for evidence<br />Case report, Case series, Case-Control, Cohort, Randomized Trial<br />DiCenso A, Bayley L, Hay...
Studies(Primary Sources)<br />
Primary Sources<br />Original articles<br />Through databases: MEDLINE, EMBASE<br />Using: PubMed, OVID<br />You have to r...
MeSH (Medical Subject Headings)<br />
It is a “strategy”<br />Low Back Pain<br />Treatment<br />OR<br />OR<br />Low Back Ache<br />Management<br />Acute<br />OR...
We will talk more aboutSEARCH STRATEGYin Research Methodology<br />
PubMed Tutorials<br />16<br />
In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. B...
In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. B...
Pyramid of Evidence<br />http://library.downstate.edu/EBM2/2100.htm <br />
Tough Job<br />If you have to do the critical appraisal for every single article you read  Tough<br />BUT You need to lea...
Don’t say there is “no evidence”<br />Instead Weak evidence<br />You might not have looked thorough enough<br />
Absence of evidence is <br />not <br />the evidence of absence<br />
Satisficing<br />‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing...
Usefulness of information<br />Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-b...
Secondary Sources<br />
Syntheses(Systematic Reviews)<br />
Syntheses<br />The authors have done the work for you<br />Hopefully:<br />They asked a good question<br />They searched t...
How to search for “Syntheses”?<br />Same databases: MEDLINE, EMBASE<br />Cochrane Library<br />
PubMed<br />
Available at UQU<br />
Are all syntheses good?<br />You still have to appraise the quality of these systematic reviews and meta-analyses<br />
Synopses(Critically Appraised Abstracts)<br />
Synopses<br />Physicians with training in research methodology:<br />Read the articles<br />Assess their quality<br />Summ...
DAREDatabase of Abstracts of Reviews of Effects<br />
SummariesEBM TextbooksEBM Guidelines<br />
EBM Textbooks<br />UpToDate<br />
Guidelines<br />Types of guidelines:<br />Consensus<br />Evidence-based<br /> Use the limiting features in the website<br />
Guidelines<br />NICE: National Institute for Health & Clinical Excellence<br />SIGN: Scottish Intercollegiate Guidelines N...
Are all guidelines good quality?<br />
Systems<br />
Systems<br />This is the ultimate goal<br />Computerized decision support<br />Too sophisticated for us to think about now...
Paid Services<br />DynaMed<br />EvidenceMatters<br />EssentialEvidence Plus<br />
Available at UQU<br />DynaMed<br />
Evidence Matters<br />
EssentialEvidencePlus<br />
Meta Search (Many-in-one)<br />NHS Evidence<br />TripDatabase<br />Google Scholar<br />
NHS Evidence<br />
TRIPDatabase<br />
Google Scholar<br />
Broad Term  Lots of irrelevant results<br />
They will email you when new article cites this article<br />
Searching for evidence<br />DiCenso A, Bayley L, Haynes RB.  Accessing preappraised evidence: fine-tuning the 5S model int...
Next Weeks<br />Critical Appraisal of:<br />Therapy<br />Systematic Review<br />Diagnosis<br />Prognosis<br />
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Primary versus Secondary Sources for Evidence-Based Medicine

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Primary versus Secondary Sources for Evidence-Based Medicine

  1. 1. Primary vs. Secondary Sources for Evidence-Based Medicine<br />SohailBajammal<br />October13, 2011<br />
  2. 2. Objectives<br />Differences between primary & secondary sources of evidence<br />Overview of popular secondary sources<br />
  3. 3. 5A<br />
  4. 4. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 <br />Computerized decision support system<br />Evidence-Based <br />Guidelines & Textbooks<br />Secondary<br />Critically-Appraised <br />Journal Articles & Abstracts<br />Systematic Reviews<br />RCTs, Cohort, Case control, Case series<br />Primary<br />Expert Opinion: Classical Textbooks<br />
  5. 5. Searching for evidence<br />Case report, Case series, Case-Control, Cohort, Randomized Trial<br />DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009<br />
  6. 6. Studies(Primary Sources)<br />
  7. 7. Primary Sources<br />Original articles<br />Through databases: MEDLINE, EMBASE<br />Using: PubMed, OVID<br />You have to retrieve and appraise the articles<br />Strength (pyramid) of evidence<br />
  8. 8.
  9. 9.
  10. 10. MeSH (Medical Subject Headings)<br />
  11. 11. It is a “strategy”<br />Low Back Pain<br />Treatment<br />OR<br />OR<br />Low Back Ache<br />Management<br />Acute<br />OR<br />OR<br />Low Backache<br />Therapy<br />AND<br />AND<br />OR<br />OR<br />"Low Back Pain"[Mesh]<br />Surgery<br />
  12. 12.
  13. 13.
  14. 14.
  15. 15. We will talk more aboutSEARCH STRATEGYin Research Methodology<br />
  16. 16. PubMed Tutorials<br />16<br />
  17. 17.
  18. 18.
  19. 19. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13<br />
  20. 20. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13<br />
  21. 21. Pyramid of Evidence<br />http://library.downstate.edu/EBM2/2100.htm <br />
  22. 22.
  23. 23.
  24. 24.
  25. 25. Tough Job<br />If you have to do the critical appraisal for every single article you read  Tough<br />BUT You need to learn about it in details for the sake of research<br />
  26. 26. Don’t say there is “no evidence”<br />Instead Weak evidence<br />You might not have looked thorough enough<br />
  27. 27. Absence of evidence is <br />not <br />the evidence of absence<br />
  28. 28. Satisficing<br />‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience”<br />Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.<br />
  29. 29. Usefulness of information<br />Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.<br />
  30. 30.
  31. 31. Secondary Sources<br />
  32. 32. Syntheses(Systematic Reviews)<br />
  33. 33. Syntheses<br />The authors have done the work for you<br />Hopefully:<br />They asked a good question<br />They searched the literature systematically (keywords & MeSH)<br />They identified the studies and assessed their quality<br />This is called Systematic Review<br />If they did statistical combination of results, this is called Meta-analysis<br />
  34. 34. How to search for “Syntheses”?<br />Same databases: MEDLINE, EMBASE<br />Cochrane Library<br />
  35. 35. PubMed<br />
  36. 36.
  37. 37. Available at UQU<br />
  38. 38.
  39. 39.
  40. 40.
  41. 41.
  42. 42. Are all syntheses good?<br />You still have to appraise the quality of these systematic reviews and meta-analyses<br />
  43. 43.
  44. 44. Synopses(Critically Appraised Abstracts)<br />
  45. 45. Synopses<br />Physicians with training in research methodology:<br />Read the articles<br />Assess their quality<br />Summarize them for you<br />Many sources: <br />Database of Abstracts of Reviews of Effects (DARE)<br />ACP Journal Club<br />Evidence-based sections in many journals<br />Others: DynaMed, EvidenceMatters, EssentialEvidence<br />
  46. 46.
  47. 47.
  48. 48.
  49. 49.
  50. 50.
  51. 51.
  52. 52.
  53. 53.
  54. 54. DAREDatabase of Abstracts of Reviews of Effects<br />
  55. 55.
  56. 56.
  57. 57.
  58. 58.
  59. 59. SummariesEBM TextbooksEBM Guidelines<br />
  60. 60. EBM Textbooks<br />UpToDate<br />
  61. 61.
  62. 62.
  63. 63.
  64. 64.
  65. 65.
  66. 66. Guidelines<br />Types of guidelines:<br />Consensus<br />Evidence-based<br /> Use the limiting features in the website<br />
  67. 67. Guidelines<br />NICE: National Institute for Health & Clinical Excellence<br />SIGN: Scottish Intercollegiate Guidelines Network<br />NGC: National Guideline Clearinghouse<br />
  68. 68.
  69. 69.
  70. 70.
  71. 71.
  72. 72.
  73. 73.
  74. 74.
  75. 75.
  76. 76.
  77. 77. Are all guidelines good quality?<br />
  78. 78.
  79. 79.
  80. 80.
  81. 81.
  82. 82.
  83. 83.
  84. 84.
  85. 85.
  86. 86. Systems<br />
  87. 87. Systems<br />This is the ultimate goal<br />Computerized decision support<br />Too sophisticated for us to think about now<br />
  88. 88.
  89. 89.
  90. 90.
  91. 91.
  92. 92.
  93. 93. Paid Services<br />DynaMed<br />EvidenceMatters<br />EssentialEvidence Plus<br />
  94. 94. Available at UQU<br />DynaMed<br />
  95. 95.
  96. 96.
  97. 97.
  98. 98.
  99. 99.
  100. 100.
  101. 101.
  102. 102.
  103. 103.
  104. 104.
  105. 105. Evidence Matters<br />
  106. 106.
  107. 107.
  108. 108.
  109. 109.
  110. 110.
  111. 111.
  112. 112.
  113. 113.
  114. 114.
  115. 115.
  116. 116.
  117. 117.
  118. 118.
  119. 119.
  120. 120.
  121. 121. EssentialEvidencePlus<br />
  122. 122.
  123. 123.
  124. 124.
  125. 125.
  126. 126.
  127. 127.
  128. 128.
  129. 129.
  130. 130.
  131. 131. Meta Search (Many-in-one)<br />NHS Evidence<br />TripDatabase<br />Google Scholar<br />
  132. 132. NHS Evidence<br />
  133. 133.
  134. 134.
  135. 135.
  136. 136.
  137. 137. TRIPDatabase<br />
  138. 138.
  139. 139.
  140. 140.
  141. 141.
  142. 142.
  143. 143.
  144. 144.
  145. 145.
  146. 146. Google Scholar<br />
  147. 147.
  148. 148. Broad Term  Lots of irrelevant results<br />
  149. 149.
  150. 150. They will email you when new article cites this article<br />
  151. 151. Searching for evidence<br />DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009<br />
  152. 152. Next Weeks<br />Critical Appraisal of:<br />Therapy<br />Systematic Review<br />Diagnosis<br />Prognosis<br />

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