Evidence Based Medicine (EBM) Resources

How to find the evidence
Resources available through our Library
How to keep up with the evidence
How to evaluate the evidence
Learn more about the EBM process
Nursing resources
To suggest changes in this webpage

How to find the evidence

Do you need the best evidence for use in patient care? If you are generally familiar with the disease process affecting your patient, but are not an expert in current care recommendations, experts recommend that you begin by using resources that review, grade, and summarize available evidence.

If these sources don’t provide current information or don't provide the general overview you need, go on to read information available through peer-reviewed, frequently updated resources or recent, review articles in medical journals. These resources may not comment on the quality of the evidence supporting their statements but are, at least, relatively current. If you find that you need more background information, you may wish to review the more dated information available through standard textbooks.

You can then go on to research more specific questions or the latest findings on a topic by searching the journal literature, grading the evidence you acquire and determining the significance of this evidence yourself.

In the end, you must always make decisions about the importance of the evidence in your patient’s case. Your experience and the patient’s preferences must be taken into account.

Resources available through our Library

Resources that review, grade, and summarize the available evidence

Advantages -- grade the evidence for you, condense a great deal of information making quick review of a topic possible

Disadvantages -- not all resources are updated on a continual basis, bias is possible and may be difficult to detect.

Resource Name	Location	Update Frequency	Characteristics
ACP's PIER	"Quick Links," To "eBooks," To "StatRef."	Continuous. Check “date posted” in bibliographic information.	1. outlines and provides strength of evidence information for each prevention, work-up and treatment option. 2. provides list of recent FDA alerts and recent articles of interest for each condition
Cochrane Library	“Online Resources,” To “C.”	Check “date of most recent substantive amendment”	1. covers therapeutic efficacy and cost-effectiveness of a wide-range of pharmaceutical, rehabilitative, educational, behavioral interventions. 2. will soon cover diagnostic test accuracy and usefulness as well 3. provides systematic reviews that include meta-analyses of good quality data and comments on quality of all the available data.
Drug Effectiveness Review Project	DERP Website . A freely available resource.	Check “current report date ”	1. covers therapeutic efficacy and cost-effectiveness of an ever increasing number of pharmacologic therapies. 2. available studies are evaluated. Meta-analysis is performed on data from studies meeting inclusion quality standards.
Systematic Reviews and Meta-Analyses	Find journal name, volume, etc. by searching literature databases	Check each article’s publication and/or submission date	1. to find systematic reviews in PubMed, add the following to your search statement: AND ("Cochrane Database Syst Rev"[ta] OR "systematic review"[tiab] OR "meta analysis"[tiab] OR meta-analysis[tiab] OR "meta analysis"[Publication Type]) 2. In CINAHL or PsycINFO, use appropriate publication type limits in "Refine Search" screen
Practice Guidelines	Search or browse: 1. ngc.gov, or 2. another guideline resource, or 3. "Resources" section of First Consult files	Check date of most recent update on each guideline	1. Check to see if the guideline grades or discusses the quality of the available evidence. 2. Consider the possibility of bias.
BestBETs (Best Evidence Topics)	Browse at BESTBETs website.	Check "Date Completed" and "Date Modified"	1. covers topics of interest to Emergency Medicine specialists. 2. attempts to provide systematic reviews with comments on quality of evidence available.

Peer-reviewed, Frequently Updated Resources

Advantages -- condense a great deal of information making quick review of a topic possible

Disadvantages -- for some of these resources updating is less frequent than would be optimal, most of these resources do not discuss the quality of the evidence for the prevention, diagnosis and treatment recommendations they make.

Standard Textbooks

Advantages -- condense a great deal of information making quick review of a topic possible

Disadvantages -- most are one to 5 years out-of-date when published, most do not discuss the quality of the evidence for the prevention, diagnosis and treatment recommendations made.

Journal Literature

Advantages -- current articles should reflect the most up-to-date information available

Disadvantages -- you must search vast literature databases for records that cite the few articles of interest. You must review and evaluate many articles from the primary journal literature (non-review articles) before you gain a sense of the extent and quality of the available evidence.

A. Search Literature Databases.

To find journal articles of interest, you must begin by searching databases that index the medical literature.

1. Begin by stating your clinical or research question and determining what terms can be used to express the central concepts.

a. Sometimes this is simple.

E.g. You're asked to research current recommendations regarding the diagnosis of gingivitis?

Terms: recommendations or guidelines, diagnosis, and gingivitis

b. Sometimes this is more complex. Perhaps you've been told to read literature relevant to your patient's case but don't have a specific question. Outlining the clinical situation using the PICO accronym may be helpful.

P -- patient characteristics, disease/condition, race, age, etc.

I -- intervention/s

C -- compared (alternate) intervention

O -- outcome of interest

After outlining the situation using PICO, it's often possible to state a clinical question worthy of research. Central terms in this question can then be listed.

2. Separate your terms/concepts into a list of limits and a list of search terms.

Did your list of terms/concepts include terms describing age or gender or a term describing a type of publication (guidelines, etc.)? These terms/concepts should probably be used as limits. Most databases indexing the journal literature allow you to apply limits to your search. You can usually limit retrieval to records that describe experimental or clinical subjects of a particular age group or gender, and you're typically allowed to limit retrieval to records corresponding to a specific type of publication (review, clinical trial, etc.), publications in a specific language, or articles published within a specified range of publication dates. A database's "limits" screen is usually reached by clicking a "limits" or a "refine search," tab, link or button.

3. Now that you've separated the limit terms from your list of search terms/concepts, you can use the search terms to compose your search strategy. After you retrieve your initial search results, go to the "limits" or "refine search" screen and apply your limits.

If you need help formulating a search strategy see the "Guides for Specific Databases " at http://www.unmc.edu/library/guides. These guides includes web-based handouts and online movies.

An online tutorial describing keyword searching methods can be viewed at http://www.unmc.edu/library/pharm/ipatutorial/ipaFrameset.htm. This tutorial was designed for use with the International Pharmaceutical Abstracts database but the keyword searching techniques described will be useful in any database. You must have a UNMC username and ID to use the tutorial from off-campus.

An online tutorial describing the use of Medical Subject Heading search strategies in PubMed is available at http://www.unmc.edu/library/pharm/medlinetutorial/MEDLINEframeset.htm. You must have a UNMC username and ID to use the tutorial from off-campus.

If you are using PubMed to look for an overview article or to find an article that focuses on a therapeutic intervention, an adverse effect, the diagnosis or the prognosis of a condition you may wish to use a search filter. Click here to learn more.

Databases Available Through our Library or Available Free Through the Internet:

B. Determine whether or not the database records you've retrieved cite peer-reviewed articles.

Not all indexed journals use a peer-review process. Since content appearing in a peer-reviewed journal is more likely to be accurate, you may wish to determine which of the database records you've retrieved cite peer-reviewed articles. To determine which journals are peer-reviewed, use one of the methods listed below:

• Limit your search to peer-reviewed journals, when the database you're using (CINAHL, for example) provides this option.
• Visit each journal's website. The "About" and "Instructions for Authors" sections of a journal's website usually mention any peer-review process used by the journal.
• Locate the journal's title in the title index of Ulrich's International Periodicals Directory. If the journal's title is preceded by an arrowhead the journal is peer-reviewed. Ulrich's International Periodicals Directory is housed on the 6th floor of Wittson Hall, in the bookcase behind the reference desk, at Z 6941 U5.

C. Determine which of the records you've retrieved correspond to articles available in electronic or print form through our Library.

The Electronic Journal Finder: Use the "Quick Links" menu on the Library's home page to access the "Electronic Journal Finder" and search for the journal title (using either the official abbreviation or several complete words from the journal title). Links to the various online sources for a journal are listed below the journal's title. Some journals are available through 5 different sources. Check the dates of full-text availability for the various sources. Are any of the sources available "on-campus" only (indicated by an "i" icon). Is there a "pw" next to the full-text checkmark for any of the sources? If so, a journal-specific username and password are required for that source. Click on the "pw" icon to see a pop-up box containing the username and password. When you've found a source that should contain the issue you need and have any needed pw info, click on the source link. You may need to search for an "archive," "browse," or "past issues" link.

The Library's Catalog: Use the "Helix -- Library Catalog" link on the Library's homepage to reach the catalog. Click on the "Journal Title" link. Enter the full journal title or an official MEDLINE or CINAHL abbreviation for the title. Check all the records that correspond to the journal of interest before giving up on the journal's availability. Both print and electronic journals are listed in the catalog.

Call or e-mail the library's reference desk if you have questions or problems. 559-6221, 1-866-800-5209 (toll free outside of Omaha), askus@unmc.edu

D. Request copies of articles that are not available through our Library by using the Interlibrary Loan Department's Online Form.

How to keep up with the evidence

Do weeks fly by when you are unaware of new publications in your field?

If you request Current Awareness Service, a librarian will set up a search tailored to your individual needs and will e-mail you a list of newly indexed articles every week. We can provide updates of searches run in the following databases:

• MEDLINE/PREMEDLINE
• CINAHL
• PsycINFO

You may pick the format in which you recieve MEDLINE/PREMEDLINE updates

• through a Refworks account
• in plain text, .html, or as a file ready for import into EndNote or Reference Manager (MEDLINE only)

To request Current Awareness Service, call Cindy Schmidt at 559-7077 or e-mail her at cmschmidt@unmc.edu.

How to evaluate the evidence

Users' Guides Interactive: An online tool to guide clinicians in the appraisal and application of evidence into their everyday practice

--NOTE: access restricted to UNMC-affiliated users only. UNMC users click here for user name and password.

Centre for Evidence-Based Dentistry
http://www.cebd.org/

The main objective of the Centre is to promote the teaching, learning, practice, and evaluation of Evidence-Based Dentistry. Evidence-based links and tools are maintained.

How to Read a Paper
http://www.bmj.com/collections/read.dtl

Links to specific articles by Trish Greenhalgh which were published in BMJ. The articles provide information on evaluating the quality of various types of research articles, such as drug trials, diagnostic screening test reports, qualitative research, etc.

Clinical Practice Guideline - Introduction
http://medicine.ucsf.edu/resources/guidelines/intro.html

Aimed a primary care providers. Provides a discussion of what makes a good clinical practice guideline with links to additional readings. Personal site of Peter Sam, MD; hosted by the University of California San Francisco.

Learn more about the Evidence Based Medicine process

Canadian Centres for Health Evidence
http://www.cche.net/che/home.asp

Extensive website on EBM. Includes background information, Users' Guides and information on teaching EBM.

NHS Centre for Evidence-Based Medicine
http://www.cebm.net/

Website from the National Health Service ( UK). See the "EBM Toolbox" of analytical tools for an
EBM glossary and statistics definitions and calculators.

Netting the Evidence A ScHARR Introduction to Evidence Based Practice on the Internet
http://www.shef.ac.uk/~scharr/ir/netting/

Extensive collection of links to websites related to EBM. Resources include articles, tutorials, statistical software, etc. Produced by Andrew Booth, School of Health and Related Research (ScHARR), University of Sheffield.

MLANET Evidence-Based Health Care Resources on the Internet
http://www.mlanet.org/education/telecon/ebhc/resource.html

From the Medical Library Association. Includes links under these headings: Master Lists, Tutorials/How-to Sites, Search Filters, Practice Guidelines/Systematic Reviews, Organizations, Journals.

Nursing Resources

Evidence Based Nursing
http://www.unmc.edu/library/education/class/ebn/

This guide, created by McGoogan Library of Medicine Faculty, contains nursing-specific information on how to search the literature for the best evidence

This page is maintained by Cindy Schmidt, M.D., M.L.S. If you would like to suggest additions to, deletions from, or other changes to this page, please contact Cindy at 402-559-7077, 1-866-800-5209 (toll-free outside of Omaha), cmschmidt@unmc.edu.