Evidence-Based Medicine Reviews - Biomedical Library

Overview from Sackett, D.L. et al. (1996) "Evidence based medicine: what it is and what it isn't." BMJ 312 (7023), 13 January, 71-72 What is Evidence-Based Medicine? EBM has been defined as the conscientious, explicit, and judicious application of the current best evidence in making decisions about the care of individual patients.
EBM is the integration of: Individual clinical expertise: your ability as clinician to make an accurate diagnosis of the patient's case, as well as to identify and utilize the individual patient's needs, rights and preferences. Best available external clinical evidence: clinically relevant research, usually patient-centered, to determine the accuracy and precision of diagnostic tests (including the clinical examination, the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative and preventive regimens. New evidence from clinical research both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.	an excellent overview of EBM prepared by Jo Dorsch, Library of the Health Sciences-Peoria, University of Illinois at Chicago.
The bad news EBM is not a "Cook-book" of medicine: by no means can EBM replace individual clinical expertise. Should this happen, practice risks would become tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. EBM will not tell you what to do! Ultimately, it is YOU, the clinician, who will have to keep up-to-date with the current research findings, appraise them, and then select those findings that you think are applicable to the case of an individual patient. The practice of EBM is a life-long process of tracking, evaluating and selecting medical information, and then using this information to alter your behavior and practice in light of what you have found.	Ask a Librarian!
The good news keeping up-to-date with evidence in the era of information explosion is not an easy task. However, keep in mind that you have a strong ally in this battle: your librarian! We suggest that you take advantage of this ally. Whenever in doubt, ask your librarian to assist you with your search strategy and to suggest the best resources for your research. Overview \| EBM Reviews \| Searching EBMR \| Links \| Workshop Evaluation	a concise overview of systematic reviews from University of Leeds
Evidence-Based Medicine Reviews (EBMR) An Evidence-Based Medicine Review is secondary research written by reviewers who use explicit and rigorous methods to identify, critically appraise, and synthesize relevant studies from the published medical research. Reviews may cover one type of research method or a combination of different research methods. Generally, the most reliable are considered the systematic reviews because they are more scientifically structured than traditional reviews. As such, they describe the authors' search strategy in detail, judge the scientific quality of each study, and weigh the evidence from multiple studies with conflicting results using validated methods. Systematic reviews also cover a broader range of published as well as unpublished literature. However, as systematic reviews can vary in quality, each one must be carefully appraised. Do not attempt to apply evidence from a systematic review to the care of your patients unless you have carefully evaluated this review for quality. from Gray, J.A. Muir. (1997) Evidence-based healthcare. New York : Churchill Livingstone	validity criteria for evaluating systematic reviews from the Evidence Based Medicine Working Group, University of Alberta
Evidence-Based Medicine Reviews from OVID Reflecting the current practice in medicine to base clinical decisions on accumulated evidence from the primary medical literature Ovid has created a collection of resources called Evidence-Based Medicine Reviews which is designed for use by clinicians, researchers and students. The Database of Abstracts of Reviews of Effectiveness (DARE) is one of the databases in Ovid's evidence-based medicine collection, which also includes the Cochrane Database of Systematic Reviews and ACP Journal Club (which consists of the publications ACP Journal Club from the American College of Physicians-American Society for Internal Medicine [ACP-ASIM] and Evidence Based Medicine from the BMJ Publishing Group).	Access Restrictions OVID allows only a certain amount of concurrent users. If you receive the message "the database is currently unavailable" do not be discouraged, but try again later.
Database of Abstracts of Reviews of Effectiveness (DARE) DARE is the latest addition to a growing collection of Ovid's Evidence Based Medicine Reviews collection. It consists of structured abstracts of systematic reviews from all over the world. These reviews have been critically appraised by an expert group of reviewers at the NHS Centre for Reviews and Dissemination (CRD) at the University of York, England. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment. Cochrane Database of Systematic Reviews (COCH) COCH includes the full text of the regularly updated systematic reviews of the effects of healthcare prepared by The Cochrane Collaboration. Cochrane Groups in various subject areas choose topics for review. Volunteers scan the world's literature, select articles on the topic, and decide which meet criteria for study design. Volunteers then create a systematic review, synthesizing the results of relevant studies (many of which are randomized controlled trials) and performing a meta-analysis on the data from the articles. 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 (all include an expected date of completion). Protocols are the background, objectives and methods of reviews in preparation. Cochrane Controlled Trials Register (CCTR) CCTR is a bibliographic database of definitive controlled trials. These controlled trials have been identified by the distinguished contributors to the Cochrane Collaboration. CCTR contains over 300,000 bibliographic references to controlled trials in health care. ACP Journal Club ACP Journal Club (ACP) is the second component in Ovid's growing collection of Evidence Based Medicine Reviews collection. The ACP Journal Club Collection consists of two journals: the ACP Journal Club, a publication of the American College of Physicians, and Evidence-Based Medicine, a joint publication with the British Medical Journal Group. ACP Journal Club contains the complete contents of the database dating back to 1991. Overview \| EBM Reviews \| Searching EBMR \| Links \| Workshop Evaluation Browsing & Searching Evidence-Based Medicine Reviews Browsing the contents of EBMR Each database from the EBMR collection is a separate file and must be browsed individually. Search for either Dare, COCH, ACP, or CCTR in the Databases menu. Click on the Browse Topics (Cochrane) or Browse Journals (ACP Journal) icon from the Main Search Screen. Searching There are 4 ways to search for Evidence-Based Medicine Reviews in Ovid: Search each database separately. Search for either Dare, COCH, ACP, or CCTR in the Databases menu. Link to EBMR from MEDLINE. On the MEDLINE Main Search Screen there is an option to limit to EBM Reviews. Clicking this will limit your search to those articles that are either: a) reviewed in a Best Evidence review, or b) meta-analyzed as part of a Cochrane review, c) as Dare review or d) as an ACP Journal review. Links to ACP Journal, Dare and Best Evidence are indicated by the link Article Review . Links to Cochrane are indicated by Topic Review links. Clicking on the hypertext will link you to the full text of the review. Note that more references are often retrieved when you search an EBMR file directly as opposed to linking to EBMR from MEDLINE. This is due to: The increased size of a full text file increases the opportunity for "hits" on your term and therefore retrieval. The Cochrane Protocols (reviews currently being prepared) are not linked to MEDLINE. Searching all four EBMR components simultaneously through Ovid's Multifile interface In Ovid, you have the option of selecting several databases to search at once. To do this, click on the "Change Database" icon and select any or all of the databases related to EBM. The link to Evidence-Based Medicine Reviews Multifile from the Health Sciences Libraries Database Menu will take you to a search screen where the EBM databases have already been selected. PubMed Systematic Reviews This feature combines your search term(s) with citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Citations from journals specializing in clinical review studies are also included. The systematic reviews subset is NOT available on the PubMed Limits screen. It is available on the Clinical Queries screen. Make sure the Systematic Reviews button is checked. Note: while OVID is accessible only to individual or library subscribers, PubMed is free to the public Overview \| EBM Reviews \| Searching EBMR \| Links \| Workshop Evaluation	A sample PubMed systematic reviews search with a detailed view of the search strategy behind it A video tutorial on Clinical Queries from the University of Washington (note: to view the video, RealOne Player is required)
Additional Information on EBM Basic Introduction to Evidence-Based Practice Video - University of Washington (http://healthlinks.washington.edu/howto/videos/ebphelp.ram) Note: some of the resources discussed are NOT available through Penn libraries. Introduction to Evidence-Based Medicine. - Duke University, University of North Carolina at Chapel Hill (http://www.hsl.unc.edu/services/tutorials/ebm/index.htm). This site provides an overview of EBM, as well as an excellent step-by-step tutorial on the EBM process and a bibliography. Evidence-Based Practice Center - McMaster University (http://hiru.mcmaster.ca/epc/) This site is dedicated to Evidence-Based Health Informatics. Centres for Health Evidence.net (www.cche.net/) This site has links to various tools and resources. For the Users' Guides to Evidence-Based Practice articles, under Principles, click on Content, then at the Principles: content dialog box, choose All to see the full listing of the articles. State University of New York (SUNY) Health Science Center at Brooklyn (servers.medlib.hscbklyn.edu/ebm/toc.html) The web site is a self-guided, well-organized course on Evidence-Based Medicine. Centre for Evidence-Based Medicine, Oxford University (http://www.cebm.net/) Contains more information about the principles, strategies and tactics of evidence-based medicine. The EBM Toolbox contains topics such as Asking Focused Clinical Questions, Glossary of EBM Terms, Comparison of Study Designs, Quality Filters, and Specific Tools and Data. The Trent Institute Information Service, ScHARR Library - School of Health and Related Research, University of Sheffield (http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/corelist.html) An extensive bibliography on Evidence-based Practice.
Send mail concerning this page to the Health Sciences Libraries at: libref@mail.med.upenn.edu

Overview

from Sackett, D.L. et al. (1996) "Evidence based medicine: what it is and what it isn't." BMJ 312 (7023), 13 January, 71-72

What is Evidence-Based Medicine?

EBM has been defined as the conscientious, explicit, and judicious application of the current best evidence in making decisions about the care of individual patients.

EBM is the integration of:

Individual clinical expertise: your ability as clinician to make an accurate diagnosis of the patient's case, as well as to identify and utilize the individual patient's needs, rights and preferences.
Best available external clinical evidence: clinically relevant research, usually patient-centered, to determine the accuracy and precision of diagnostic tests (including the clinical examination, the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative and preventive regimens. New evidence from clinical research both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.

an excellent overview of EBM prepared by Jo Dorsch, Library of the Health Sciences-Peoria, University of Illinois at Chicago.

The bad news

EBM is not a "Cook-book" of medicine: by no means can EBM replace individual clinical expertise. Should this happen, practice risks would become tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.
EBM will not tell you what to do! Ultimately, it is YOU, the clinician, who will have to keep up-to-date with the current research findings, appraise them, and then select those findings that you think are applicable to the case of an individual patient.
The practice of EBM is a life-long process of tracking, evaluating and selecting medical information, and then using this information to alter your behavior and practice in light of what you have found.

Ask a Librarian!

The good news

keeping up-to-date with evidence in the era of information explosion is not an easy task. However, keep in mind that you have a strong ally in this battle: your librarian!

We suggest that you take advantage of this ally. Whenever in doubt, ask your librarian to assist you with your search strategy and to suggest the best resources for your research.

Overview | EBM Reviews | Searching EBMR | Links | Workshop Evaluation

a concise overview of systematic reviews from University of Leeds

Evidence-Based Medicine Reviews (EBMR)

An Evidence-Based Medicine Review is secondary research written by reviewers who use explicit and rigorous methods to identify, critically appraise, and synthesize relevant studies from the published medical research. Reviews may cover one type of research method or a combination of different research methods. Generally, the most reliable are considered the systematic reviews because they are more scientifically structured than traditional reviews. As such, they describe the authors' search strategy in detail, judge the scientific quality of each study, and weigh the evidence from multiple studies with conflicting results using validated methods. Systematic reviews also cover a broader range of published as well as unpublished literature.

However, as systematic reviews can vary in quality, each one must be carefully appraised. Do not attempt to apply evidence from a systematic review to the care of your patients unless you have carefully evaluated this review for quality.

from Gray, J.A. Muir. (1997) Evidence-based healthcare. New York : Churchill Livingstone

validity criteria for evaluating systematic reviews from the Evidence Based Medicine Working Group, University of Alberta

Evidence-Based Medicine Reviews from OVID

Reflecting the current practice in medicine to base clinical decisions on accumulated evidence from the primary medical literature Ovid has created a collection of resources called Evidence-Based Medicine Reviews which is designed for use by clinicians, researchers and students. The Database of Abstracts of Reviews of Effectiveness (DARE) is one of the databases in Ovid's evidence-based medicine collection, which also includes the Cochrane Database of Systematic Reviews and ACP Journal Club (which consists of the publications ACP Journal Club from the American College of Physicians-American Society for Internal Medicine [ACP-ASIM] and Evidence Based Medicine from the BMJ Publishing Group).

Access Restrictions

OVID allows only a certain amount of concurrent users. If you receive the message "the database is currently unavailable" do not be discouraged, but try again later.

Database of Abstracts of Reviews of Effectiveness (DARE)
DARE is the latest addition to a growing collection of Ovid's Evidence Based Medicine Reviews collection. It consists of structured abstracts of systematic reviews from all over the world. These reviews have been critically appraised by an expert group of reviewers at the NHS Centre for Reviews and Dissemination (CRD) at the University of York, England. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.
Cochrane Database of Systematic Reviews (COCH)
COCH includes the full text of the regularly updated systematic reviews of the effects of healthcare prepared by The Cochrane Collaboration. Cochrane Groups in various subject areas choose topics for review. Volunteers scan the world's literature, select articles on the topic, and decide which meet criteria for study design. Volunteers then create a systematic review, synthesizing the results of relevant studies (many of which are randomized controlled trials) and performing a meta-analysis on the data from the articles. 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 (all include an expected date of completion). Protocols are the background, objectives and methods of reviews in preparation.
Cochrane Controlled Trials Register (CCTR)
CCTR is a bibliographic database of definitive controlled trials. These controlled trials have been identified by the distinguished contributors to the Cochrane Collaboration. CCTR contains over 300,000 bibliographic references to controlled trials in health care.
ACP Journal Club
ACP Journal Club (ACP) is the second component in Ovid's growing collection of Evidence Based Medicine Reviews collection. The ACP Journal Club Collection consists of two journals: the ACP Journal Club, a publication of the American College of Physicians, and Evidence-Based Medicine, a joint publication with the British Medical Journal Group. ACP Journal Club contains the complete contents of the database dating back to 1991.

Overview | EBM Reviews | Searching EBMR | Links | Workshop Evaluation

Browsing & Searching Evidence-Based Medicine Reviews

Browsing the contents of EBMR

Each database from the EBMR collection is a separate file and must be browsed individually.

Search for either Dare, COCH, ACP, or CCTR in the Databases menu. Click on the Browse Topics (Cochrane) or Browse Journals (ACP Journal) icon from the Main Search Screen.

Searching

There are 4 ways to search for Evidence-Based Medicine Reviews in Ovid:

Search each database separately.
Search for either Dare, COCH, ACP, or CCTR in the Databases menu.
Link to EBMR from MEDLINE.
On the MEDLINE Main Search Screen there is an option to limit to EBM Reviews. Clicking this will limit your search to those articles that are either: a) reviewed in a Best Evidence review, or b) meta-analyzed as part of a Cochrane review, c) as Dare review or d) as an ACP Journal review.

Links to ACP Journal, Dare and Best Evidence are indicated by the link Article Review . Links to Cochrane are indicated by Topic Review links. Clicking on the hypertext will link you to the full text of the review.

Note that more references are often retrieved when you search an EBMR file directly as opposed to linking to EBMR from MEDLINE. This is due to:
1. The increased size of a full text file increases the opportunity for "hits" on your term and therefore retrieval.
2. The Cochrane Protocols (reviews currently being prepared) are not linked to MEDLINE.

Searching all four EBMR components simultaneously through Ovid's Multifile interface
In Ovid, you have the option of selecting several databases to search at once. To do this, click on the "Change Database" icon and select any or all of the databases related to EBM.
The link to Evidence-Based Medicine Reviews Multifile from the Health Sciences Libraries Database Menu will take you to a search screen where the EBM databases have already been selected.
PubMed Systematic Reviews
This feature combines your search term(s) with citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Citations from journals specializing in clinical review studies are also included.

The systematic reviews subset is NOT available on the PubMed Limits screen. It is available on the Clinical Queries screen. Make sure the Systematic Reviews button is checked.

Note: while OVID is accessible only to individual or library subscribers, PubMed is free to the public

Overview | EBM Reviews | Searching EBMR | Links | Workshop Evaluation

A sample PubMed systematic reviews search with a detailed view of the search strategy behind it

A video tutorial on Clinical Queries from the University of Washington (note: to view the video, RealOne Player is required)

Additional Information on EBM

Basic Introduction to Evidence-Based Practice Video - University of Washington (http://healthlinks.washington.edu/howto/videos/ebphelp.ram): Note: some of the resources discussed are NOT available through Penn libraries.
Introduction to Evidence-Based Medicine. - Duke University, University of North Carolina at Chapel Hill (http://www.hsl.unc.edu/services/tutorials/ebm/index.htm).: This site provides an overview of EBM, as well as an excellent step-by-step tutorial on the EBM process and a bibliography.
Evidence-Based Practice Center - McMaster University (http://hiru.mcmaster.ca/epc/): This site is dedicated to Evidence-Based Health Informatics.
Centres for Health Evidence.net (www.cche.net/): This site has links to various tools and resources. For the Users' Guides to Evidence-Based Practice articles, under Principles, click on Content, then at the Principles: content dialog box, choose All to see the full listing of the articles.
State University of New York (SUNY) Health Science Center at Brooklyn (servers.medlib.hscbklyn.edu/ebm/toc.html): The web site is a self-guided, well-organized course on Evidence-Based Medicine.
Centre for Evidence-Based Medicine, Oxford University (http://www.cebm.net/): Contains more information about the principles, strategies and tactics of evidence-based medicine. The EBM Toolbox contains topics such as Asking Focused Clinical Questions, Glossary of EBM Terms, Comparison of Study Designs, Quality Filters, and Specific Tools and Data.
The Trent Institute Information Service, ScHARR Library - School of Health and Related Research, University of Sheffield (http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/corelist.html): An extensive bibliography on Evidence-based Practice.

Send mail concerning this page to the Health Sciences Libraries at: libref@mail.med.upenn.edu