HealthLinks Tutorial: Evidence-Based Practice

What Is Evidence-Based Medicine?

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2.

User Guides to Evidence-Based Practice, developed by McMaster University's Evidence-Based Medicine Working Group, are disseminated on the Internet by the Canadian Centre for Health Evidence.

Evidence-Based Practice Terminology

Evidence-Based Medicine Glossary from the Centre for Evidence-Based Medicine, Oxford, United Kingdom.

Types of Evidence-Based Practice Resources

Research Articles

Research articles are published results of research studies.
Research studies are the primary means of developing new clinical knowledge, but ...
Research articles vary in the level of detail given about the study. You may need to do your own evaluation.
Locate research articles using:
- PubMed | Search Tips
  Hint: you can limit with Publication Types, such as Randomized Controlled Trial or Clinical Trial
- PubMed Clinical Queries | Search Tips |
- CINAHL Plus | Search Tips
  Hint: Click on Research Article in the Limit Section; or limit with Publication Types, such as Clinical Trial or Research; or use the Clinical Queries limit
- More databases ...
Check availability of journals using:
- HealthLinks: eJournals for electronic journals
- UW Libraries Catalog for print journals

Clinical Practice Guidelines

Guidelines are systematically developed statements of appropriate care designed to assist the practitioner and patient make decisions about appropriate health care for specific clinical circumstances.
Guidelines from reputable, authoritative organizations are usually based on the most current, relevant research, but ...
Guidelines are developed using widely varying standards. Cost may be considered as well as health outcomes.
Locate clinical practice guidelines using:
- National Guideline Clearinghouse
  The National Guideline Clearinghouse (NGC) is a comprehensive database of evidence-based clinical practice guidelines sponsored by the Agency for Healthcare Research and Quality. The database includes structured abstracts, links to full-text guidelines (where available), ordering information for print copies, and a guideline comparison utility.
- PubMed | Search Tips
  Hint: you can limit with Publication Types: Practice Guideline
- CINAHL Plus | Search Tips
  Hint: you can limit to Publication Types: Practice Guidelines
- MD Consult | Search Tips
  MD Consult Practice Guidelines section contains peer-reviewed clinical practice guidelines. MD Consult is an online medical information service containing full-text reference books, guidelines, full-text journals, patient information, and drug information.
- AccessMedicine
  Current Practice Guidelines in Primary Care (2008) includes guidelines on disease diagnosis, prevention, and management.
- Web search engines or subject directories
  - Google
  - Google Scholar
- Remember to evaluate anything you locate on the web using the Criteria for Evaluating Web Sites.

Structured Abstracts and Evidence Summaries

It is difficult for a clinician to analyze all the information in a field.
Resources such as UpToDate and Clinical Evidence offer summaries of evidence-based information on a topic.
Locate summaries using:
- UpToDate
  The most current, extensive electronic textbook for medicine. Recommendations are based on the available evidence and the author's clinical experience. Continuously updated, not by any specific time schedule.
- Nursing Reference Center Point-of-care resource. Includes Evidence-based Care Sheets and Quick Lessons on procedures, diseases and conditions, legal cases, research instruments and clinical assessment tools.
- Clinical Evidence
  Updated compendium of evidence on the effects of clinical interventions. Summarizes the best available evidence and the current state of knowledge, including knowns and unknowns, based on thorough searches. Categorizes interventions as beneficial, likely beneficial, no known benefit, harmful... Covers more than 570 conditions.
- DynaMed
  Provides the evidence to help clinicians make patient care decisions.
- Clin-eguide : Clinical Decision Support
  Disease management, drug therapy, laboratory results, in a single resource. Provides a course of action with options.
- AccessMedicine
  Clinical reference library includes guidelines, images, drug information, and patient handouts.
- Essential Evidence Plus
  Includes InfoPOEMs (summaries on recent research from a defined set of journals that address questions clinicians face using measures of symptoms, morbidity, quality of life, and mortality outcomes), EBM Guidelines, and e-Essential Evidence.
- ACP Journal Club
  Value-added abstracts to research and systematic review journal articles selected according to explicit criteria from over 100 major peer-reviewed medical journals.
- AHRQ Evidence-Based Practice
  Evidence reports and technical reviews from the Agency for Healthcare Research and Quality.
- Bandolier
  1994-. Short evaluations of individual articles dealing with evidence-based clinical practice.
- Evidence Based Nursing
  Summarizes research articles with value-added abstracts including comments on methodology, preceding research, and recommendations for clinical practice.
- FPIN Clinical Inquiries
  Family Practice Inquiry Network's evidence answers to questions posed by primary care physicians, published in Journal of Family Practice.
- Natural Medicines Comprehensive Database
  Assesses available evidence for herbal medicines and dietary supplements used in the western world.
- Natural Standard (available through MedlinePlus)
  Evidence-based reviews of herbal medicines and supplements.

MetaSearch Engines

A metasearch engine is a search engine that searches multiple other search engines simultaneously and combines the results.
Locate evidence-based sources using a metasearch engine:
- TRIP Database
  TRIP (Turning Research Into Practice) Database performs a simple search of more than 75 databases, including CDSR Abstracts, NGC, Bandolier, Evidence-Based Medicine, DARE, POEMs, etc. for access to evidence-based material as well as articles from peer-reviewed journals.
- SUMSearch
  Simultaneously searches a few free-access sources: PubMed, NGC, Merck Index, DARE, etc. Results grouped by reviews, practice guidelines, systematic reviews, and research-based articles. May be extremely slow.

Systematic Reviews and Meta-Analyses

A Systematic Review is a literature review focused on a single question which tries to identify, appraise, select and synthesis all high quality research evidence relevant to that question. Systematic reviews use explicit methods to identify, select, and critically evaluate relevant research.
Meta-analyses are systematic reviews that combine the results of several studies using quantitative statistics.
Systematic reviews minimize the possibility of bias by using explicit criteria, and expand the relevance of individual studies with limited scope, but ...
Only a small number of clinical topics are covered by systematic reviews, because they require years of effort to develop.
Locate systematic reviews using:
- Cochrane Database of Systematic Reviews (CDSR)
  The CDSR is a full-text database containing systematic reviews and protocols (reviews still in progress) of the effects of health care interventions; mainly randomized controlled trials. "Gold Standard" for high quality, systematic reviews.
- Database of Abstracts of Reviews of Effects (DARE)
  Structured abstracts of good quality systematic reviews from around the world. Complements CDSR by offering a selection of quality assessed reviews in subjects with no Cochrane review. Also part of the Cochrane Library.
- PubMed Systematic Reviews
  PubMed Clinical Queries: Systematic Reviews 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. No evaluation of comparative quality of different reviews on a topic.
- PubMed | Search Tips
  Hint: you can limit to Publication Type: Meta-Analysis
- CINAHL Plus | Search Tips
  Hint: you can limit with Publication Types: Systematic Review

For more information on Evidence-Based Practice, see:

DNP Toolkit
http://healthlinks.washington.edu/nurse/dnp/

Evidence-Based Practice Tools Summary
http://healthlinks.washington.edu/ebp/ebptools.html

Find the Evidence, in the Care Provider Toolkit
http://healthlinks.washington.edu/care_provider/

Evidence-Based Practice
http://healthlinks.washington.edu/ebp

APA Style Guide Examples
http://healthlinks.washington.edu/hsl/styleguides/apa.html

Basic Introduction to Evidence-Based Practice Video presentation based on this tutorial [59 minutes]. Flash required

Revised June 18, 2009

Janet G. Schnall, MS, AHIP
Information Management Librarian
schnall@u.washington.edu
http://healthlinks.washington.edu/hsl/liaisons/schnall/

Joanne Rich, MLIS, BS (Pharm)
Information Management Librarian
jrich@u.washington.edu
http://healthlinks.washington.edu/hsl/liaisons/rich/

Basic Introduction to Evidence-Based Practice Resources