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Evidence Based Medicine Resources

Evidence Based Medicine Resources. Nancy Clark FSU College of Medicine. Objectives. Attendees will Formulate a clinical question Utilize EBM online resources to answer their questions EBM Databases Guidelines Apply rules for levels of evidence to make clinical decisions. The EBM Process.

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Evidence Based Medicine Resources

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  1. Evidence Based Medicine Resources Nancy Clark FSU College of Medicine EBM Resources

  2. Objectives • Attendees will • Formulate a clinical question • Utilize EBM online resources to answer their questions • EBM Databases • Guidelines • Apply rules for levels of evidence to make clinical decisions EBM Resources

  3. The EBM Process EBM = LLL EBM Resources

  4. The EBM Process with Patients EBM Resources

  5. The EBM Process with Students EBM Resources

  6. Types of Questions • Therapy/prevention Question • Prognosis Question • Diagnosis Question • Harm Question EBM Resources

  7. Who? What? Alternately? Outcome? Write the question Type of question? Type of Study? Elements of a Good Question EBM Resources

  8. Levels of Evidence • Level 1: Randomized Clinical Trials • Level 2: Head to Head Trial or Systematic Review of Cohort Studies • Level 3: Case-Control Studies • Level 4: Case-series • Level 5: Expert Opinion EBM Resources

  9. Long Process • Formulate clinical question • Do MEDLINE search • Limit by population • Limit to types of studies • Find articles • Read and critically appraise articles EBM Resources

  10. Purpose-specific resources • CDC Travel • Drug information resources • Patient Education handouts • Diagnostic Testing – ARUP • Medical Search engines • Textbooks • Journals EBM Resources

  11. EBM Databases Systematic Literature Searches • Cochrane Library (OVID) • Clinical Evidence Systematic Literature Surveillance • ACP Journal Club (OVID) • DynaMed * • Medical InfoRetriever EBM Search Engine • TRIP Database EBM Resources

  12. Today • National Guidelines Clearinghouse (AHRQ) • Clinical Trials.gov • Cochrane • ACP Journal Club • Dynamed • InfoRetriever • PDxMD EBM Databases EBM Resources

  13. Guidelines • Clinical Practice Guidelines may be • Explicit evidence-based • Evidence-based • Research-based (highly referenced) • Opinion-based • “expert consensus” EBM Resources

  14. National Guideline Clearinghouse Primary Care Clinical Practice Guidelines Agency/Association sites AAFP APA AAP ACS AGS RCOG Guidelines EBM Resources

  15. ClinicalTrials.gov • NIH, NLM, FDA sponsored • Studies in progress • February 2000 • 7400 studies • US and CA – 80 countries EBM Resources

  16. Cochrane Library • The current resource with the highest methodological rigor • For each clinical question, all of the English literature meticulously searched for randomized trials • Large systematic reviews with valid methods + collaborative effort • Conclusions are based on all the evidence from valid randomized trials EBM Resources

  17. Cochrane Library • Included in OVID subscription • Limitations • limited to English • only addresses questions amenable to randomized trials • most of medicine has not been studied enough to allow for conclusions • $235/year or abstracts only EBM Resources

  18. ACP Journal Club • About 100 journals systematically surveyed • Highest-validity articles abstracted • Structured abstracts to guide critical appraisal • Clinical commentary • Included in our OVID subscription EBM Resources

  19. ACP Journal Club • Limitations • individual article summaries may not account for the “big picture” • may have to read multiple items • No “control” over what is covered • $78/year ? EBM Resources

  20. DynaMed • Designed as entry point to information • Textbooks and Medline not efficient • Intuitive clinical organization • Brief summarized information presented • Links and references if more details needed • ICD-9 codes and links to patient information handouts EBM Resources

  21. Description Etiology Increased Risks Associated Conditions Complications History (cc, HPI, etc.) Physical Diagnostic (including Rule out, Tests to order) Prognosis Treatment Prevention Screening References Patient Information DynaMed format EBM Resources

  22. DynaMed Sources • 18 primary journals – e.g. BMJ, JAMA, Lancet, NEJM, Pediatrics • 12 secondary literature sources – e.g. Alternative Therapies, ACP Journal Club, Cochrane Library, InfoPOEMs • 4 drug info sources – e.g. The Medical Letter, FDA MedWatch EBM Resources

  23. DynaMed • Limitations • variable quality • online only • areas with a lot of research can get hard to navigate • $200/year or effort EBM Resources

  24. Medical InfoRetriever • 104 journals surveyed for Evidence-Based Practice Newsletter • Over 1300 article synopses • Cochrane abstracts • Selected evidence-based guidelines • Basic drug info • Clinical calculators/prediction rules • 5 Minute Clinical Consult EBM Resources

  25. InfoRetriever • Comes in web, desktop and PDA (30M) versions • Limitations • individual article summaries may not account for the “big picture” • may have to read multiple items • $249/year EBM Resources

  26. PDxMD • Online and PDA (10M) versions • By MDConsult • Differential Diagnosis • Disease Information • Patient Education Handouts EBM Resources

  27. PDxMD EBM Resources

  28. PDxMD EBM Resources

  29. Hands-On Experience EBM Resources

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