Internet Resources for Evidence-Based Medicine


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The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data

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Internet Resources for Evidence-Based Medicine

  1. 1. Internet R esources F or E vidence B ased M edicine
  2. 2. <ul><li>Prof. Dr. </li></ul><ul><li>A hmed- R efat K ashmery </li></ul><ul><li>2007 </li></ul> @ WWW
  3. 3.  @ WWW اقسم بالله العظيم أن ّّّّ ,,,,,,,,,,,,,,,,,,, وأن ,,,,,,,,,,,,,,,,,,, و أن أثابر علي طلب العلم و أسخره لنفع الإنسان لا لآذاه و أن أوقر من علمني و أعلم من يصغرني  من قسم الأطباء : المادة الأولى من لائحة آداب مهنة الطب - 2003  أ د / أحمد رفعت عبد الغفار الكشميري
  4. 4. Finding the Best Evidence <ul><li>Identify PICO terms </li></ul><ul><li>Look for Secondary sources </li></ul><ul><li>Search for Primary sources </li></ul><ul><li>www.CEBM.NET/ </li></ul>
  5. 5. Resources for Practicing EBM <ul><li>What is the ideal resource? </li></ul><ul><li>Located in the clinical setting </li></ul><ul><li>Easy to use </li></ul><ul><li>Fast, reliable connection </li></ul><ul><li>Comprehensive /Full Text </li></ul><ul><li>Provides primary data </li></ul><ul><li> </li></ul>
  6. 6. Resources for Practicing EBM <ul><li>Summaries of the primary evidence ACP Journal Club | Clinical Evidence | eMedicine | FPIN Clinical Inquiries | InfoPOEMs | UpToDate </li></ul><ul><li>Databases MEDLINE | Cochrane Library </li></ul><ul><li>Electronic textbooks and libraries ACP Medicine | Harrisons | MD Consult | Stat!Ref </li></ul><ul><li>Meta-Search Engines SUMSearch | TRIP Plus: Turning Research into Practice </li></ul><ul><li> </li></ul>
  7. 7. <ul><li>ACP Journal Club : </li></ul><ul><li>started in 1991, it contains abstracts of articles from about 100 journals of relevance to internal medicine, the articles being selected according to critical appraisal criteria. It is provided with Annals of Internal Medicine [ restricted to internal medicine topics?? ]. </li></ul>2 Look for secondary sources
  8. 8. Summaries of the primary evidence <ul><li>ACP Journal Club </li></ul><ul><li>ACP J-C's general purpose is to select published articles according to explicit criteria and to abstract those studies and reviews that warrant immediate attention by physicians attempting to keep pace with important advances in the treatment, prevention, diagnosis, cause, prognosis, or economics of the disorders managed by internists. These articles are summarized in &quot;value-added&quot; abstracts and commented on by clinical experts. </li></ul>
  9. 9. Summaries of the primary evidence <ul><li>ACP Journal Club </li></ul><ul><li>Abstracts and commentaries are reviewed at 5 year intervals and are either archived or updated. ACP Journal Club is available in print and electronic. </li></ul><ul><li>: http://www. acpjc .org/ </li></ul>
  10. 10. Summaries of the primary evidence <ul><li>Clinical Evidence </li></ul><ul><li>is a textbook and database of clinical questions designed to help clinicians make evidence–based medicine part of their everyday practice. Hundreds of clinical questions, representing nearly every clinical specialty, cover the effects of treatments and interventions based on the best available research. Topics include commonly encountered or important conditions seen in primary care or ambulatory settings. http://www. clinicalevidence .com/ </li></ul>
  11. 11. Summaries of the primary evidence <ul><li>eMedicine </li></ul><ul><li>is an online, peer-reviewed medical reference that provides access to information on diseases, including background, differential diagnosis, work-up, treatment, medications, and follow-up . Contributors include physicians and faculty from medical schools and medical societies. Additional resources include clinical calculators, images, CME, decision rules, and drug information. eMedicine is in electronic format and is available free. </li></ul><ul><li>http://www. emedicine .com </li></ul>
  12. 12. Summaries of the primary evidence <ul><li>FPIN Clinical Inquiries </li></ul><ul><li>Clinical Inquiries are produced by the Family Practitioners Inquiries Network (FPIN). Clinical Inquiries are a series of answers to practicing physicians' questions that help FPIN achieve its goal to provide rapid, evidence based answers to family physicians.  </li></ul><ul><li>http://www. fpin .org </li></ul>
  13. 13. Finding the Best Evidence <ul><li>Identify PICO terms </li></ul><ul><li>Look for Secondary sources </li></ul><ul><li>Search for Primary sources </li></ul><ul><li>www.CEBM.NET/ </li></ul>
  14. 14. Finding the Best Evidence <ul><li>Identify PICO terms </li></ul><ul><li>Formulating a well-focused question is the first and the most important step in the EBM process. </li></ul><ul><li>Without a well-focused question, it can be very difficult and time consuming to identify appropriate resources and search for relevant evidence </li></ul>
  15. 15. Finding the Best Evidence <ul><li>1- Secondary Sources </li></ul><ul><li>Authors take data from previously published or unpublished studies, they summarize, analyze, critically appraise and draw conclusion to it: </li></ul>
  16. 16. Ready Made Evidence <ul><li>Search for Secondary Sources </li></ul>
  17. 17. Secondary Sources <ul><li>Guidelines: </li></ul><ul><li>CATs: </li></ul><ul><li>Evidence-Based Summaries: Bandolier , </li></ul><ul><li>Structured Abstracts: EBM Online , ACP Journal Club </li></ul><ul><li>Systematic Reviews: Cochrane Library </li></ul><ul><li>To search several of the databases simultaneously you can use: http://www. tripdatabase .com/ </li></ul>
  18. 18. Secondary Sources <ul><li>4- Practice Guidelines : Recommendations designed by a group of experts for the purpose of influencing medical interventions to improve quality of care.  They are broader in scope than systematic reviews, and provide an overview of the management of a condition or the use of an intervention.  </li></ul>
  19. 19. Secondary Sources <ul><li>validity of guidelines </li></ul><ul><li>Did its developers carry out a comprehensive reproducible literature review within the past 12 months? </li></ul><ul><li>Is each of its recommendations both tagged by the level of evidence upon which it is based and linked to a specific citation? </li></ul>
  20. 20. 2 Look for secondary sources <ul><li>Examples of Guidelines: </li></ul><ul><li>National Library for Health , </li></ul><ul><li>NICE , </li></ul><ul><li>SIGN </li></ul>
  21. 21. 2 Look for secondary sources <ul><li>Examples of Guidelines: </li></ul><ul><li>http://medicine. ucsf . edu /resources/guidelines http://www. ahcpr . gov / http://www. /ClinicalGuidelines.htm http://www http://www. ngc . gov http://text. nlm . nih . gov http://www. cdc . gov </li></ul>
  22. 22. 2 Look for secondary sources <ul><li>Examples of Guidelines: </li></ul><ul><li>Canadian Medical Association ; </li></ul><ul><li>New Zealand Guidelines Group. </li></ul>
  23. 23. <ul><li>CATs </li></ul><ul><li>CAT Crawler </li></ul>2 Look for secondary sources
  24. 24. <ul><li>Evidence-Based Summaries: </li></ul><ul><li>Bandolier , </li></ul><ul><li>Clinical Evidence </li></ul>2 Look for secondary sources
  25. 25. <ul><li>Systematic Reviews </li></ul><ul><li>Cochrane Library </li></ul>2 Look for secondary sources
  26. 26. <ul><li>Evidence Based Medicine     </li></ul><ul><li>   http://www. acponline .org/journals/ ebm Provides summaries to 50 journals in all subjects.  Now it is merged with ACP journal club to produce best evidence </li></ul>2 Look for secondary sources
  27. 27. <ul><li>Bandolier : Evidence-Based Health Care uk /Bandolier This publication (1994-) uses EBM techniques to provide advice about diseases for health-care professionals and consumers. </li></ul>2 Look for secondary sources
  28. 28. <ul><li>InfoPOEMS: </li></ul><ul><li>(Patient-Oriented-Evidence That Matters) </li></ul><ul><li>prepared by editors of the Journal of Family Practice that review over 100 journals and select those articles of high relevance to primary care physicians , then write a structured critical appraisal to these articles. </li></ul>2 Look for secondary sources
  29. 29. <ul><li>To search several of the databases simultaneously you can use: http://www. tripdatabase .com / </li></ul>2 Look for secondary sources
  30. 30. Do It Yourself <ul><li>Search for Primary Sources </li></ul>
  31. 31. 3 Search for Primary Sources <ul><li>PubMED – MEDLINE </li></ul>
  32. 32. PubMED - MEDLINE <ul><li>PubMed is a service of the U.S. National Library of Medicine (NLM) that provides access to over 16 million citations from MEDLINE and other life science journals dating back to the 1950s </li></ul>
  33. 33. <ul><li>Since 1997, PubMed has been freely available to physicians, researchers, and the public. The information obtained from literature searches in PubMed can have a significant impact on patient care and clinical outcomes </li></ul>PubMED - MEDLINE
  34. 34. <ul><li>Crowley et al reported on a study of 625 clinical questions asked by residents during an in-hospital general medicine rotation. Seventy-seven percent of the answers to these questions came from MEDLINE and the information from the articles changed patient management 47% of the time </li></ul>PubMED - MEDLINE
  35. 35. <ul><li>Klein et al. showed that conducting a MEDLINE search early in the hospitalization of a patient could significantly lower costs, charges, and lengths of stay . </li></ul><ul><li>Westbrook et al reported that the use of an online information retrieval system improved the quality of clinicians' answers to clinical questions by 21% </li></ul>PubMED - MEDLINE
  36. 36. <ul><li>( http:// pubmed . gov ) </li></ul><ul><li>May be searched to retrieve EBM.  </li></ul><ul><li>This is done by either of the following two ways: </li></ul><ul><li>~ ??? ~ Three Ways …. </li></ul>PubMED - MEDLINE
  37. 37. <ul><li>1- Do a search on PubMed in the usual manner, < ACTION-BAR , FEATURE-BAR?> </li></ul><ul><li>then apply “ Limits&quot; and select a Publication Types category such as &quot; Clinical Trial&quot;, &quot;Meta-Analysis&quot;,&quot;Practice  Guideline&quot;, &quot;Randomized Controlled Trial&quot;, or &quot;Review&quot;.  >>CCZEEESTYPES???????? </li></ul><ul><li>These limits would filter out and retrieve hits that follow EBM principles . !!! Skill_ ONE Use KW ~PICO formate </li></ul><ul><li> Go To An illustration </li></ul>PubMED - MEDLINE
  38. 38. <ul><li>2- Go directly to the &quot;Clinical Queries&quot; .  </li></ul><ul><li>!!! SKILL _ TWO ::: Just select & CHECK……. not type PICO words !!!!!!! </li></ul><ul><li>Clinical Queries have built in search filters that retrieve EBM   citations. Two options are available, first one is through searching using methodology filters for searching for a therapy, etiology, diagnosis or prognosis, with either emphasis on specificity or sensitivity options .  The second option is to search for systematic reviews . !!! SKILL _ THERR </li></ul><ul><li>Select~~~~~ not type PICO words </li></ul><ul><li>  </li></ul>PubMED - MEDLINE
  39. 39. P.I.C.O + T.T
  40. 40. <ul><li>Combining the P.I.C.O with the Clinical Queries of the PubMed </li></ul><ul><li>PICO + CQ = All You Want </li></ul><ul><li>!!!! ???? !!!! !!! SKILL _ FOUR,5,6 & 7 </li></ul><ul><li>المعضلة خلصت خالص </li></ul>PubMED – MEDLINE The Third Method : !!!!!!!
  41. 41. <ul><li>Combining the PICO framework with the PubMed Clinical Queries has the potential to improve the efficiency of literature searching. </li></ul>PubMED - MEDLINE
  42. 42. PICO + PubMed CQ <ul><li>questions with at least a defined intervention (I) and outcome (O) were more likely to be answered than questions with one or none of these parameters </li></ul>
  43. 43. <ul><li>PubMed for Handhelds </li></ul><ul><li>MEDLINE/PubMed      Search MEDLINE/ PubMed      Read Journal Abstracts </li></ul><ul><li>PICO search      Patient, Intervention, Comparison, Outcome </li></ul><ul><li>ask MEDLINE      free-text, natural language search </li></ul>
  44. 44. Ask…..Medline <ul><li>Ask </li></ul><ul><li>? </li></ul><ul><li>Medline </li></ul><ul><li>Type Your Question </li></ul>
  45. 45. <ul><li>. </li></ul>
  46. 46.
  47. 47. Or Type Your PICO
  48. 48.
  49. 49.
  50. 50. <ul><li>ask MEDLINE is intended for the clinician, researcher, or the general public who want to simply ask a question and to skip the challenge of learning how to format it in manner that will make the searching MEDLINE/PubMed efficient. It is a tool that allows the user to search MEDLINE/PubMed using free-text, natural language query, just like one would in a clinical setting, or in a conversation. </li></ul>
  51. 51. <ul><li>A simple, handheld-friendly search interface was created where users can enter free-text, natural language searches (Figure 1 .) The results are also provided in text-only mode, optimised for use by the mobile health care personnel using handheld devices. Links to abstracts, related citations in MEDLINE and full-text articles are provided. Full-text links to journal publishers are not text-based, and may require journal subscription or fees for viewing. </li></ul>
  52. 52. <ul><li>Overall, ask MEDLINE retrieved 72/95 exact matches of cited references (gold standard) in POEMs, an accuracy of 75.8%, while Entrez' accuracy was 22% (21/95.) If citations that are not the same as those cited in POEMs, but are relevant and considered satisfactory for answering the clinical question are included, ask MEDLINE's total efficiency is 96.8%. Entrez' total efficiency for finding specific and relevant citations for BMJ POEMs is 38.9% (21 specific and 16 relevant citations found.) </li></ul>
  53. 53. <ul><li>PubMed for Handhelds </li></ul><ul><li>MEDLINE/PubMed      Search MEDLINE/ PubMed      Read Journal Abstracts </li></ul><ul><li>PICO search      Patient, Intervention, Comparison, Outcome </li></ul><ul><li>ask MEDLINE      free-text, natural language search </li></ul>
  54. 54. <ul><li>PubMed for Handhelds </li></ul><ul><li>MEDLINE/PubMed      Search MEDLINE/ PubMed      </li></ul>
  55. 55.
  56. 56. <ul><li>Searches performed on a PICO-formatted screen retrieved a higher percentage of relevant citations than searches performed on the standard PubMed search interface. </li></ul>
  57. 57.
  58. 58. Cochrane Collaboration
  59. 59. Cochrane Collaboration <ul><li>It is an international organization </li></ul><ul><li>that started in 1993.  </li></ul><ul><li>It was developed after Archie Cochrane, an epidemiologist in UK noticed that health-care is not always based on good evidence.  </li></ul>
  60. 60. Cochrane Collaboration <ul><li>It prepares, maintains and promotes the accessibility of systematic reviews of the effects of health care intervention.   </li></ul><ul><li>It has 15 centers worldwide, with 7000 members.  </li></ul><ul><li>Each subject area in health care is covered by a specialized Cochrane review group. </li></ul>
  61. 61. <ul><li>Cochrane collaboration aims for information to be: </li></ul><ul><ul><li>Evidence -based, </li></ul></ul><ul><ul><li>Easily accessible, </li></ul></ul><ul><ul><li>Internationally developed, </li></ul></ul><ul><ul><li>Quality controlled, </li></ul></ul><ul><ul><li>Clinically useful and </li></ul></ul><ul><ul><li>Periodically updated </li></ul></ul>Cochrane Collaboration
  62. 62. <ul><li>Use the Cochrane Library to answer questions such as: -Is treatment effective? -Is accepted practice &quot;best&quot; practice? -What is the best treatment? </li></ul>Cochrane Collaboration
  63. 63. <ul><li>Do not use Cochrane Library : -To obtain general health care information -To answer queries on causation, prognosis & epidemiology.   -To search for clinical practice guidelines. </li></ul>Cochrane Collaboration
  64. 64. <ul><li>  Cochrane contains !!! SKILL_ 8 </li></ul><ul><li>Cochrane Database of Systematic Reviews (CDSR): </li></ul><ul><li>Database of Abstracts of Reviews of Effectiveness (DARE):. </li></ul><ul><li>Cochrane Central Register of Controlled Trials (CENTRAL) </li></ul><ul><li>Cochrane Database of Methodology Reviews contains articles on research synthesis and systematic reviews. </li></ul><ul><li>  </li></ul>Cochrane Collaboration
  65. 65. <ul><li>  - Cochrane Database of Systematic Reviews (CDSR): are full text documents reviewing effects of health care.  These reviews are highly structured and systematic. These are the main output of Cochrane Library. </li></ul>Cochrane Collaboration
  66. 66. <ul><li>  - Database of Abstracts of Reviews of Effectiveness (DARE): provides structured abstracts of Systematic reviews that have been initially appraised by reviewers giving comment on the quality of methodology of reviews.  </li></ul><ul><li>It actually complements the CDSR by offering a selection of high-quality assessed reviews in those subjects where there is currently no Cochrane review. </li></ul><ul><li>- </li></ul>Cochrane Collaboration
  67. 67. <ul><li>  -- Cochrane Central Register of Controlled Trials (CENTRAL) is a bibliography of controlled trials, it also includes reports published in conference proceedings and other sources not indexed in Medline or other bibliographic databases. </li></ul><ul><li>- Cochrane Database of Methodology Reviews contains articles on research synthesis and systematic reviews. </li></ul>Cochrane Collaboration
  68. 68. <ul><li>  Cochrane Logo: </li></ul><ul><li>-Illustrates a systematic review of data from 7 randomized controlled trials (RCT) comparing one health care treatment with a placebo.   Each horizontal line represents results of one trial.   The shorter the line means the more certain the result.  The diamond is the combined result, if it is to the left then treatment is beneficial.  </li></ul>Cochrane Collaboration
  69. 69. <ul><li>  Cochrane Collaboration Logo : </li></ul><ul><li>If a horizontal line touches the vertical one then the trial found no clear difference between the treatments.   If the horizontal line is to the right or the diamond is to the right of the vertical line then the treatment in not good, and may do harm more than good.                      </li></ul>Cochrane Collaboration
  70. 70. !!! TripDatabase SKILL_ 9
  71. 71. !!! SKILL_ TEN /
  72. 72. Other sites include : <ul><li>Canadian Centers for Health Evidence          http://www. cche .net </li></ul><ul><li>Medic8 EvidenceBasedMedicine . htm </li></ul><ul><li>Center for EBM        http:// cebm uk </li></ul><ul><li>Netting the Evidence http://www. shef .ac. uk / uni /academic/R-Z/ scharr / ir /netting.html </li></ul><ul><li>Trawling the Net http://www. shef .ac. uk / uni /academic/R-Z/ scharr / ir /trawling.html </li></ul>
  73. 73. <ul><li>Health Evidence Bulletin Wales    http:// hebw . uwcm .ac. uk </li></ul><ul><li>NHS Center for Reviews & Dissemination   http://www. york .ac. uk /inst/ crd / </li></ul><ul><li>Tufts University     http://www.library.tufts. edu / hsl / ebm .html </li></ul><ul><li>Glossary of EBM terms: http://www. cebm . utoronto .ca/glossary/ </li></ul>Other sites include :
  74. 74. <ul><li>http://www. hsl . unc . edu /Services/Tutorials/EBM/practice. htm </li></ul>Other sites include :
  75. 75. اشكر لكم Thank You~~ <ul><li>الصبر </li></ul><ul><li>و المتابعة </li></ul><ul><li>و المشاركة </li></ul><ul><li>و الدعم </li></ul><ul><li>و المحبة </li></ul>