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Evidence Based Medicine Resources. Nancy Clark FSU College of Medicine. Objectives. Attendees will Formulate a clinical question Utilize EBM online resources to answer their questions EBM Databases Guidelines Apply rules for levels of evidence to make clinical decisions. The EBM Process.

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Evidence based medicine resources

Evidence Based Medicine Resources

Nancy Clark

FSU College of Medicine

EBM Resources


Objectives
Objectives

  • Attendees will

    • Formulate a clinical question

    • Utilize EBM online resources to answer their questions

      • EBM Databases

      • Guidelines

    • Apply rules for levels of evidence to make clinical decisions

EBM Resources


The ebm process
The EBM Process

EBM = LLL

EBM Resources




Types of questions
Types of Questions

  • Therapy/prevention Question

  • Prognosis Question

  • Diagnosis Question

  • Harm Question

EBM Resources


Elements of a good question

Who?

What?

Alternately?

Outcome?

Write the question

Type of question?

Type of Study?

Elements of a Good Question

EBM Resources


Levels of evidence
Levels of Evidence

  • Level 1: Randomized Clinical Trials

  • Level 2: Head to Head Trial or Systematic Review of Cohort Studies

  • Level 3: Case-Control Studies

  • Level 4: Case-series

  • Level 5: Expert Opinion

EBM Resources


Long process
Long Process

  • Formulate clinical question

  • Do MEDLINE search

    • Limit by population

    • Limit to types of studies

  • Find articles

  • Read and critically appraise articles

EBM Resources


Purpose specific resources
Purpose-specific resources

  • CDC Travel

  • Drug information resources

  • Patient Education handouts

  • Diagnostic Testing – ARUP

  • Medical Search engines

  • Textbooks

  • Journals

EBM Resources


Ebm databases
EBM Databases

Systematic Literature Searches

  • Cochrane Library (OVID)

  • Clinical Evidence

    Systematic Literature Surveillance

  • ACP Journal Club (OVID)

  • DynaMed *

  • Medical InfoRetriever

    EBM Search Engine

  • TRIP Database

EBM Resources


Today
Today

  • National Guidelines Clearinghouse (AHRQ)

  • Clinical Trials.gov

  • Cochrane

  • ACP Journal Club

  • Dynamed

  • InfoRetriever

  • PDxMD

EBM Databases

EBM Resources


Guidelines
Guidelines

  • Clinical Practice Guidelines may be

    • Explicit evidence-based

    • Evidence-based

    • Research-based (highly referenced)

    • Opinion-based

    • “expert consensus”

EBM Resources


Guidelines1

National Guideline Clearinghouse

Primary Care Clinical Practice Guidelines

Agency/Association sites

AAFP

APA

AAP

ACS

AGS

RCOG

Guidelines

EBM Resources


Clinicaltrials gov
ClinicalTrials.gov

  • NIH, NLM, FDA sponsored

  • Studies in progress

  • February 2000

  • 7400 studies

  • US and CA – 80 countries

EBM Resources


Cochrane library
Cochrane Library

  • The current resource with the highest methodological rigor

  • For each clinical question, all of the English literature meticulously searched for randomized trials

  • Large systematic reviews with valid methods + collaborative effort

  • Conclusions are based on all the evidence from valid randomized trials

EBM Resources


Cochrane library1
Cochrane Library

  • Included in OVID subscription

  • Limitations

    • limited to English

    • only addresses questions amenable to randomized trials

    • most of medicine has not been studied enough to allow for conclusions

    • $235/year or abstracts only

EBM Resources


Acp journal club
ACP Journal Club

  • About 100 journals systematically surveyed

  • Highest-validity articles abstracted

  • Structured abstracts to guide critical appraisal

  • Clinical commentary

  • Included in our OVID subscription

EBM Resources


Acp journal club1
ACP Journal Club

  • Limitations

    • individual article summaries may not account for the “big picture”

    • may have to read multiple items

    • No “control” over what is covered

    • $78/year ?

EBM Resources


Dynamed
DynaMed

  • Designed as entry point to information

  • Textbooks and Medline not efficient

  • Intuitive clinical organization

  • Brief summarized information presented

  • Links and references if more details needed

  • ICD-9 codes and links to patient information handouts

EBM Resources


Dynamed format

Description

Etiology

Increased Risks

Associated Conditions

Complications

History (cc, HPI, etc.)

Physical

Diagnostic (including Rule out, Tests to order)

Prognosis

Treatment

Prevention

Screening

References

Patient Information

DynaMed format

EBM Resources


Dynamed sources
DynaMed Sources

  • 18 primary journals – e.g. BMJ, JAMA, Lancet, NEJM, Pediatrics

  • 12 secondary literature sources – e.g. Alternative Therapies, ACP Journal Club, Cochrane Library, InfoPOEMs

  • 4 drug info sources – e.g. The Medical Letter, FDA MedWatch

EBM Resources


Dynamed1
DynaMed

  • Limitations

    • variable quality

    • online only

    • areas with a lot of research can get hard to navigate

    • $200/year or effort

EBM Resources


Medical inforetriever
Medical InfoRetriever

  • 104 journals surveyed for Evidence-Based Practice Newsletter

  • Over 1300 article synopses

  • Cochrane abstracts

  • Selected evidence-based guidelines

  • Basic drug info

  • Clinical calculators/prediction rules

  • 5 Minute Clinical Consult

EBM Resources


Inforetriever
InfoRetriever

  • Comes in web, desktop and PDA (30M) versions

  • Limitations

    • individual article summaries may not account for the “big picture”

    • may have to read multiple items

    • $249/year

EBM Resources


Pdxmd
PDxMD

  • Online and PDA (10M) versions

  • By MDConsult

  • Differential Diagnosis

  • Disease Information

  • Patient Education Handouts

EBM Resources


Pdxmd1
PDxMD

EBM Resources


Pdxmd2
PDxMD

EBM Resources


Hands on experience

Hands-On Experience

EBM Resources


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