•…an approach to practicing medicine in which
the clinician is aware of the evidence in support
of clinical practice, and ...
•Improves patient care.
•Hydroxyurea therapy associated with declining serum levels of magnesium in
children with sickle c...
•Converting clinical questions into a
searchable format.
•Efficient searching skills.
•Critically assessing the informatio...
•Evaluating the performance of the
information in clinical practice.
•Discovering areas where more research is
needed.
•Ap...
Convert a clinical situation into a searchable, (and
hopefully answerable) question using
PICO
•PATIENT
•INTERVENTION
•COM...
atient or Problem
ntervention
omparison
utcome
“Patient” refers to the
person presenting
with the problem, or
more simply,...
atient or Problem
ntervention
omparison
utcome
“Intervention” refers
to the action taken in
response to the
problem. This ...
atient or Problem
ntervention
omparison
utcome
“Comparison” refers to
the benchmark against
which the intervention
is meas...
atient or Problem
ntervention
omparison
utcome
“Outcome” refers
to the anticipated
result of the
intervention.
You are seeing a child with acute diarrhea and a lower
respiratory infection. You know that zinc supplementation will
impr...
• Opinion papers, editorials
• Case studies, case reports
• Laboratory Testing
• Animal Experiments
• Early Human Experime...
• Systematic v. Narrative Reviews
• Systematic Review:
• CLEAR CLINICAL QUESTION
• CONCLUSION BASED ON DATA
• Narrative Re...
• Medline
• Both PubMed and Ovid are often refered to as
Medline. They contain the same information.
• PubMed Clinical Que...
OVID PubMed
PROS
•Related articles
•Clinical
Queries
•Book links
•Links to other
NCBI databases
•Clipboard
•Free!
Same Med...
•Keyword search
not so good
•To many steps to
do a complicated
search
•Sophisticated
searcher may be
frustrated
•Very expe...
Applies research methodology filters
• Categories:
• Therapy
• Double-blind randomized controlled trials
• Diagnosis
• Com...
• Emphasis
• Different than the diagnostic meaning of the
words
• Sensitivity
• Broad-based
• Specificity
• Targeted, Narr...
• Cochrane Collection
• Systematic Reviews; Database of Reviews of
Systematic Reviews; Cochcrane Controlled
Trials Registe...
•The Cochrane Database of Systematic Reviews (COCH) includes the full text of
the regularly updated systematic reviews pre...
•The Database of Abstracts of Reviews of Effectiveness (DARE) includes the
Cochrane Database of Systematic Reviews and ACP...
•The ACP Journal Club Collection consists of two journals ACP Journal Club, a
publication of the American College of Physi...
•CCTR is a bibliographic database of definitive controlled trials. These
controlled trials have been identified by the dis...
Medline vs Reviews
•Goes back
further
•Bigger
•Sometimes too
many citations
•Clinical focus
•Keyword
searching is
better
•...
Evidence Based Medicine: An Introduction
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Evidence Based Medicine: An Introduction

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  • To be covered in this class
  • Evidence Based Medicine: An Introduction

    1. 1. •…an approach to practicing medicine in which the clinician is aware of the evidence in support of clinical practice, and the strength of that evidence. •Combines your clinical knowledge with your knowledge of your patient, with evidence from the literature
    2. 2. •Improves patient care. •Hydroxyurea therapy associated with declining serum levels of magnesium in children with sickle cell anemia, J. Pediatrics 140(5):565-9, 2002 May. •It helps to avoid legal pitfalls. •Lawyer sued for missing a transected pancreas in injured child. •Medical school knowledge quickly becomes dated and/or forgotten •Children to get Viagra in lung disease trial, NewScientist.com, July 23, 2002.
    3. 3. •Converting clinical questions into a searchable format. •Efficient searching skills. •Critically assessing the information for validity and usefulness.
    4. 4. •Evaluating the performance of the information in clinical practice. •Discovering areas where more research is needed. •Applying the information in clinical practice with physicians.
    5. 5. Convert a clinical situation into a searchable, (and hopefully answerable) question using PICO •PATIENT •INTERVENTION •COMPARISON •OUTCOME
    6. 6. atient or Problem ntervention omparison utcome “Patient” refers to the person presenting with the problem, or more simply, to the problem itself. Both concepts are important in searching.
    7. 7. atient or Problem ntervention omparison utcome “Intervention” refers to the action taken in response to the problem. This is often a drug or surgical procedure, but it can take many forms
    8. 8. atient or Problem ntervention omparison utcome “Comparison” refers to the benchmark against which the intervention is measured. Often it refers to another treatment, no treatment, or a placebo.
    9. 9. atient or Problem ntervention omparison utcome “Outcome” refers to the anticipated result of the intervention.
    10. 10. You are seeing a child with acute diarrhea and a lower respiratory infection. You know that zinc supplementation will improve the diarrhea, but will it help the respiratory infection as well? Or is there something else that you can add that might work with the zinc? P I C O Child with diarrhea and respiratory infection Zinc supplementation Zinc supplementation plus something else Improvement in diarrhea and respiratory infection
    11. 11. • Opinion papers, editorials • Case studies, case reports • Laboratory Testing • Animal Experiments • Early Human Experiments-Phase I Trials • Case Series-Phase II Trials • Clinical Trials-Phase III Trials
    12. 12. • Systematic v. Narrative Reviews • Systematic Review: • CLEAR CLINICAL QUESTION • CONCLUSION BASED ON DATA • Narrative Review: • NO CLEAR QUESTION • NO EVIDENCE CITED
    13. 13. • Medline • Both PubMed and Ovid are often refered to as Medline. They contain the same information. • PubMed Clinical Queries • Ovid • Cochrane’s Database • Best Evidence
    14. 14. OVID PubMed PROS •Related articles •Clinical Queries •Book links •Links to other NCBI databases •Clipboard •Free! Same Medline, different interface •EBM Reviews limit •More limits •Links to fulltext •Can e-mail results •Search multiple databases •Links to catalog
    15. 15. •Keyword search not so good •To many steps to do a complicated search •Sophisticated searcher may be frustrated •Very expensive CONS OVID PubMed •Can’t e-mail results easily •Automatically explodes search •MESH browser does not map as well as the main search page •Interface not as intuitive
    16. 16. Applies research methodology filters • Categories: • Therapy • Double-blind randomized controlled trials • Diagnosis • Compares new test to the gold standard; controlled trials • Etiology • Longitudinal Studies • Prognosis • Cohort studies or survival analyses
    17. 17. • Emphasis • Different than the diagnostic meaning of the words • Sensitivity • Broad-based • Specificity • Targeted, Narrower
    18. 18. • Cochrane Collection • Systematic Reviews; Database of Reviews of Systematic Reviews; Cochcrane Controlled Trials Register • Best Evidence • Electronic version of ACP Journal Club • Most information contained in commentary
    19. 19. •The Cochrane Database of Systematic Reviews (COCH) includes the full text of the regularly updated systematic reviews prepared by The Cochrane Collaboration. •The reviews are presented in two types: •Complete reviews - Regularly updated Cochrane Reviews, prepared and maintained by Collaborative Review Groups •Protocols - Protocols for reviews currently being prepared. Protocols are the background, objectives and methods of reviews in preparation.
    20. 20. •The Database of Abstracts of Reviews of Effectiveness (DARE) includes the Cochrane Database of Systematic Reviews and ACP Journal Club •DARE is a Full Text database containing critical assessments of systematic reviews from a variety of medical journals. DARE consists of structured abstracts of systematic reviews from all over the world. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.
    21. 21. •The ACP Journal Club Collection consists of two journals ACP Journal Club, a publication of the American College of Physicians, and Evidence-Based Medicine, a joint publication with the British Medical Journal Group. •The editors of ACP Journal Club screen the top clinical journals on a regular basis and identify studies that are both methodologically sound and clinically relevant. They write an enhanced abstract of the chosen articles and provide a commentary on the value of the article for clinical practice. Using this source, clinicians can quickly understand and apply to their practice important changes in medical knowledge, without having to read and synthesize for themselves thousands of journal articles.
    22. 22. •CCTR is a bibliographic database of definitive controlled trials. These controlled trials have been identified by the distinguished contributors to the Cochrane Collaboration. They search the world's health care journals systematically, have combined results to create an unbiased source of data for systematic reviews. •CCTR contains over 300,000 bibliographic references to controlled trials in health care. Contributors to the Cochrane Collaboration follow quality control standards to ensure that only reports of definite randomized controlled trials or controlled clinical trials are included. •Although many reports of trials are included in MEDLINE, others are not easily identified as randomized controlled trials; and as such, researchers may overlook them in the search for relevant studies for systematic reviews.
    23. 23. Medline vs Reviews •Goes back further •Bigger •Sometimes too many citations •Clinical focus •Keyword searching is better •Smaller •Information gaps-topics not as well covered

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