Evidence Based Medicine UF HSCL Databases,

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EvidenceBasedMedicine UF HSCL Databases,

• Internet Tools, and Resources

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• gtRead Sackets Quote
• Evidence -based medicine is the integration of
  best research evidence with clinical expertise
  and patient values.
• From David L. Sackett Evidence-Based Medicine
  How to Practice and teach EBM

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The EBM Process in Short
gt Convert the information into a focused
question gt Track down the best evidence to
answer the question
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University of Chicago, Library of the Health
Sciences, Peoria http//www.uic.edu/depts/lib/lhsp
/resources/pico.shtml
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Read Pauline Story Pauline is a new patient and
she came for a routine physical exam today. You
have her medical records from her previous
physician. Pauline is in good health although
she has had hypertension for many years. You note
that there is a family history of stroke. She is
76 years old, she walks 3-4 miles several times a
week, although she lives alone, her family
lives nearby. She is active in church and the
garden club. Pauline's hypertension has been
successfully controlled by Beta-blockers and she
expressed satisfaction with this therapy.
However, Pauline's son, who sees another
physician, has recently been diagnosed with
hypertension and was given Captopril ACE
Inhibitor. Pauline's son asked her to ask you
whether or not Captopril would be a better
medication for her.
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Sample of a Well-Constructed Question
P- I- C- O-
In elderly patients with hypertension Are ACE
inhibitors more effective than Beta blockers
in Controlling high blood pressure and
minimizing adverse effects?
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A Question of? Then Look for.
Therapy Diagnosis Prognosis Etiology/Harm
Prevention Clinical Exam Cost
RCTgt Cohortgt Case Controlgt Case Series
Blind comparison to a gold standard Cohort
Studygt Case Controlgt Case Series RCTgt
Cohortgt Case Controlgt Case Series RCTgt
Cohortgt Case Controlgt Case Series Blind
comparison to a gold standard Economic
analysis
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So, for Pauline, it is a Therapy Question and
best evidence would be Randomized Control Trial
comparing the 2 drugs Gold Standard Test
Surest way to diagnose but usually expensive and
invasive. Example -Lung Biopsy to
diagnose lunc cancer (instead of an
MRI).
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THE PYRAMID Shows the hierarchy of evidence
available. You may not always be able to find
information at the best level of evidence.
You then need to consider moving down the
pyramid to other types of studies. MEDLINE
certainly has most of just about
everything Cochrane deals mainly with systematic
and meta reviews Meta Analysis is a subset oif
Systematic Reviews and uses statistics.
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Where to Look
From Searching For the Evidence A Search
Protocol University of Virginia Health
Center http//www.healthsystem.virginia.edu/intern
et/library/collections/ebm/overview.cfm
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HSCL Databases
www.library.health.ufl.edu
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Ovids EBMR (Evidence Based Medicine
Reviews Authors email addressPoint out HELP
button 3 full-text components 1. (CDSR)
Cochrane Database of Systematic Reviews
-Current, no archives, protocols for current
studies 2. (DARE) Database of Abstracts of
Reviews of Effects -Structured abstracts
of critical assessments of SRs not
covered by Cochranes DSR 3. ACP Journal
Club -2 journals CDSR DARE only
most recent updated PICO Is coiling or clipping
better for treating aneurysms? Keywords only
- aneurysm vs aneurysms OR - clip or coil
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Ovids Evidence Based Medicine Reviews (EBMR)
Full Text
gt ACP Journal Club gt Cochrane Controlled Trials
Register gt Cochranes Database of Systematic
Reviews (CDSR) gt Database of Abstracts of
Reviews of Effects (DARE)
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Ovids EBMR (Evidence Based Medicine
Reviews Authors email addressPoint out HELP
button 3 full-text components 1. (CDSR)
Cochrane Database of Systematic Reviews
-Current, no archives, protocols for current
studies 2. (DARE) Database of Abstracts of
Reviews of Effects -Structured abstracts
of critical assessments of SRs not
covered by Cochranes DSR 3. ACP Journal
Club -2 journals CDSR DARE only
most recent updated PICO Is coiling or clipping
better for treating aneurysms? Keywords only
- aneurysm vs aneurysms OR - clip or coil
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(No Transcript)
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MEDLINE via PubMed andPubMeds
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Internet Tools and Resources
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EBM Filters for PubMed-
From Yale University "Best Terms" PubMed
filters for gtTherapy gtDiagnosis gtEtiology gtPr
ognosis
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SUMSearch
From the University of Texas gt Selects the best
resources for question gt Formats your question
for each resource gt Makes additional searches
based on results
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Merck Medicus -Free for many licensed
healthcare providers
gt Best Practice of Medicine is free to anyone
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National Guideline Clearinghouse (NGC)
-Browse by gtdisease/condition
gttreatment/intervention gtorganization -Citati
ons provide gtstructured abstracts gtlinks
to full-text guidelines gtside-by-side
comparisons
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Risk Calculators
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AHCPRGuide to Clinical Preventive Services, 3rd
Edition, 2000-2003
gt Evaluates clinical research to weigh the
merits of preventive measures
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Thank You.