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Sparrow Health Sciences Library Guide to Evidence-Based Medicine (EBM) Resources

Evidence-based medicine is the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients" (Sackett, DL. BMJ. 1996 Jan 13;312(7023):71-2).

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TRIP (Turning Research Into Practice) Database Plus

Welcome to the TRIP Database, the Internet's leading resources for Evidence-Based Practice. Allowing users to easily and rapidly identify the highest quality evidence from a wide range of sources. Simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.

The TRIP Database is free and readily accessible from any computer connected to the Internet.

Filtered Resources

Filtered resources appraise the quality of studies and often make recommendations for practice.

Systematic Reviews / Meta-Analyses
Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. A meta-analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results.
The Cochrane Database of Systematic Reviews
Consists of detailed, structured topic reviews of hundreds of articles. Teams of experts complete comprehensive literature reviews, evaluate the literature, and present summaries of the findings of the best studies. Published by the International Cochrane Collaboration.
The Database of Abstracts of Reviews of Effect (DARE)
Full-text database containing structured abstracts of systematic reviews from a variety of medical journals. DARE is produced by the National Health Services' Centre for Reviews and Dissemination (NHS CRD) at the University of York. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.
Also available directly from the Centre for Reviews and Dissemination at York.
Systematic Reviews are also searchable in MEDLINE:

Ovid MEDLINE: Enter your search query. Click on the “Limits” icon; select “Systematic Reviews” under “Subject Subsets.”

PubMed Clinical Queries: Select: “Find Systematic Reviews” and enter your search query.
Sparrow Library Associates can assist you with fine-tuning of your searching skills.
Critically-Appraised Topics
Authors of critically-appraised topics evaluate and synthesize multiple research studies.
Clinical Evidence
Summarizes the current state of knowledge about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so.
National Guideline Clearinghouse
A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Updated weekly.
Note: Guideline evidence varies from expert opinion to high levels of evidence. NOT ALL guidelines are evidence-based.
InfoPOEMS
Clinical awareness system that highlights important new evidence via DailyPOEMs™ ("Patient-Oriented Evidence that Matters"), synopses of new, valid evidence relevant to patient care originating from critical appraisal of studies published in more than 100 journals.
The PDA version of this product is available from Sparrow Medical Education.
PIER - Physicians' Information and Education Resource
Evidence-based clinical guidance designed for rapid access to clinical information at the point of care. PIER is peer-reviewed, updated continually and includes recommendations based on all levels of medical evidence. Recommendations also include strength-of-recommendation ratings based on the quality of the underlying evidence. From the American College of Physicians.
Critically-Appraised Individual Articles
Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
The ACP Journal Club
The editors of this journal screen the top 100+ clinical journals and identify studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine.
Bandolier
Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes “information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.”
bmjupdates
Quality articles from over 110 clinical journals are selected by research staff, and then rated for clinical relevance and interest by an international group of physicians. Includes a searchable database of the best evidence from the medical literature and an email alerting system. From BMJ Publishing Group and McMaster University's Health Information Research Unit.

Unfiltered Resources

Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use specific search strategies in MEDLINE and other databases to achieve the highest possible level of evidence. A randomized controlled trial (RCT) is a research study in which participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest. A cohort study is a research study that compares two groups (cohorts) of patients, one that received the exposure of interest and one that did not, and follows these cohorts forward for the outcome of interest. A case-controlled study is a research study which identifies patients with the outcome of interest (cases) and patients without the same outcome (controls), and looks back to see if they had the exposure of interest. A case series is a report on a series of patients with an outcome of interest. No control group is involved. A case report is a report of a patient with an exposure or an outcome of interest. [Adapted from Centre for Evidence Based Medicine, Toronto]

PubMed
To limit your PubMed search to the best evidence-producing studies: Click on "clinical queries" (on the left side of the screen). This specialized search is intended for clinicians and has built-in search "filters." Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you may indicate whether you wish your search to be more sensitive (i.e., include most relevant articles but probably including some less relevant ones) or more specific (i.e., including mostly relevant articles but probably omit a few).
Ovid Medline
This premier interface to MEDLINE may at first appear daunting, but once the searching techniques are learned a highly focused list of results can be retrieved. OVID makes the searcher "think" about their question constantly applying critical analysis skills during the search process.
Consult with a Sparrow Library Associate to learn the best searching skills and many of the value-added enhancements that OVID provides.
CINAHL
Cumulative Index to Nursing and Allied Health Literature
To limit your CINAHL search to the best evidence-producing studies: Click on the ‘Limits’ icon to use ‘Clinical Queries’ or limit to ‘Research’ or other ‘publication’ types (i.e., systematic review).

Background Information/Expert Opinion

Note: Evidence varies from expert opinion to high levels of evidence.

UpToDate
A clinical information resource, which offers up-to-date, fully referenced expert answers to patient-care, diagnosis, and treatment questions. Topic reviews are written by recognized authorities who review the topic, synthesize the evidence, summarize key findings, and provide specific recommendations.
Access to UpToDate is available only from a single workstation in the Sparrow Health Sciences Library.
eMedicine
Physician authors and editors contribute to the eMedicine Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content provides the latest practice guidelines in 62 medical specialties. eMedicine's professional content undergoes multiple levels of physician peer review.
Personal registration may be required and will provide enhancement.
Harrison's Online
A classic: Principles of Internal Medicine dynamically kept current with frequent updates.

Evidence-Based Medicine Information Sites

Centre for Evidence-Based Medicine (Oxford University)
The Centre promotes evidence-based health care and provide support and resources to anyone who wants to make use of them. Includes the EBM Toolbox, an assortment of materials which are very useful for practitioners of EBM, and EBM Teaching Materials, including PowerPoint presentations.
Centre for Evidence-Based Medicine (Toronto)
Includes many resources for practicing and teaching EBM.
Evidence-Based Medicine
A selective list of additional EBM websites developed and maintained by Duke University Medical Center Library.
Netting the Evidence
From the School of Health and Related Research (ScHARR) at the University of Sheffield, UK. Includes a comprehensive list of EBM databases, journals, articles, and other information sources.
Users' Guides to Evidence-Based Practice
From the University of Alberta's Centre for Health Evidence. Includes the complete set of EBM Users' Guides originally published as a series in the Journal of the American Medical Association (JAMA).

Evidence-Based Medicine Tutorials

Introduction to Evidence-Based Medicine
From Duke University Medical Center Library and University of North Carolina at Chapel Hill Health Sciences Library.
SUNY Health Sciences Evidence-Based Medicine Course

Evidence-Based Medicine Resources for PDA

Evidence-Based Medicine Resources for the PDA
A list of resources from the Dartmouth Biomedical Libraries.