The Evidence Based Medicine Database (EBM)

The Evidence Based Medicine Database
Agus Widiyatmoko
Introduction
The most current and widely accepted definition of evidencebased medicine is the integration of the best research evidence with clinical expertise and patient values This reflects a systematic approach to clinical problem solving.
Major Authoritative Web Sites

www.CDC.gov www.Guidelines.gov www.nlm.nih.gov http://epss.ahrq.gov/ http://www.ncbi.nlm.nih.gov/sites/entr ez?db=pubmed Professional medical organizations, associations and academies Avoid Wikipedia
systematic process for implementing evidence based medicine into clinical practice
Start with the patient -- a clinical problem or question arises out of the care of the patient Construct a well built (PICO) clinical question Select the appropriate resource Appraise that evidence Return to the patient Evaluate your performance
Select the appropriate resource
Major EBM DatabasesMajor EBM Databases

A high-quality foraging tool employs a transparent process that:
1. Systematically surveys or reviews the literature 2. filters out disease-oriented research and presents only patient-oriented research outcomes 3. demonstrates that a validity assessment has been performed using appropriate criteria 4. assigns levels of evidence, based on appropriate validity criteria, to individual studies 5. provides specific recommendations, when feasible, on how to apply the information, placing it into clinical context 6. comprehensively reviews the literature for a specific specialty or discipline 7. coordinates with a high-quality hunting tool
Cochrane Database of Systematic Reviews
Cochrane Database
Highest level of rigor, systematically reviews the entire English publications on a topic. Abstracts are free at their website. Full text is available through WileyInterscience. Cochrane Systematic Reviews on therapy topics only contain randomized clinical trials It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.
ACP Journal Club
ACP Journal Club

Critical appraisals of studies from two journals, the ACP Journal Club and Evidence Based Medicine. ACP Journal Club's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts.
Daily POEMS
Daily POEMS
Patient Oriented Evidence that Matters. Published daily, and ongoing since 1996, editors review more than 1,200 studies monthly from 100+ medical journals, presenting only the best as InfoPOEMs. The acclaimed POEMs process applies specific criteria for validity and relevance to clinical practice. About 1 in 40 studies qualifies.
Database of Abstracts of Reviews of Effectiveness
Database of Abstracts of Reviews of Effectiveness (DARE)

DARE contains summaries of systematic reviews which have met strict quality criteria. Included reviews have to be about the effects of interventions. Each summary also provides a critical commentary on the quality of the review. The database covers a broad range of health and social care topics and can be used for answering questions about the effects of interventions, as well as for developing guidelines and policy making. (DARE) is currently available through Ovid.
National Guideline Clearinghouse
National Guideline Clearinghouse

A public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans
US Preventative Services Task Force (USPSTF)
US Preventative Services Task Force (USPSTF)

The USPSTF is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.
ACP PIER
ACP PIER
PIER (Physicians' Information and Education Resource) is an evidence based, decisionsupport tool designed for rapid point-of-care delivery of up-to-date guidance for clinicians. PIER is an evidence-based "System" of actionable information about health conditions and interventions. Information in PIER is presented in a "drill down" format, in which the user clicks from an opening guidance statement through to more specific information.
Clinical Evidence
Clinical Evidence Clinical Evidence -- Web Version

Evidence-based evaluations of interventions for common clinical conditions developed in collaboration with the American College of Physicians, the American Society of Internal Medicine and BMJ. Summaries of evidence Specific clinical questions: treatment and preven-tion Makes specific recommen-dations States when there is a lack of evidence
Essential Evidence Plus
Essential Evidence Plus

104 journals surveyed for EvidenceBased Practice Newsletter Over 1300 article synopses/ POEMS Cochrane abstracts Selected evidence-based guidelines (USPSTF, CDC, JNC7,others) Basic drug info ICD-9 codes Clinical calculators/prediction rules
DynaMed
DynaMed
DynaMed is a huge, evidence based reference designed to pro-vide the most useful and current disease information at the point-of-care for health care profes-sionals. Where available, links are provided to full-text elec-tronic resources, including all FSU-available e-journals via a PubMed reference and patient education handouts.
Making EBM Databases Usable

EBM Hunting Tools Hunting tools combine many of the major EBM foraging tools into one tool that searches multiple resources, then organizes the results by category representing the type of question you have.
The Hunting Tools
Searching all EBM Resources Using WebFeat
WebFeat
WebFeat is a search engine developed specifically to search the vast subscription resources of the College of Medicine Maguire Medical Library. It has been in a constant state of revision and improvement. There are limitations, and the product should be considered in Beta testing for a while longer. However, it is getting better all the time, as the Beatles say. The link to WebFeat it at the top, center of the home page.
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The Evidence Based Medicine Database

Major Authoritative Web Sites

Select the appropriate resource

Major EBM DatabasesMajor EBM Databases

Cochrane Database of Systematic Reviews

ACP Journal Club

ACP Journal Club

Database of Abstracts of Reviews of Effectiveness

Database of Abstracts of Reviews of Effectiveness (DARE)

National Guideline Clearinghouse

National Guideline Clearinghouse

US Preventative Services Task Force (USPSTF)

US Preventative Services Task Force (USPSTF)

Clinical Evidence Clinical Evidence -- Web Version

Essential Evidence Plus

Essential Evidence Plus

Making EBM Databases Usable

The Hunting Tools

Searching all EBM Resources Using WebFeat

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