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Sources of Evidence

Sources of Evidence. F. Hosseinpanah .MD. Agenda. Information mastery Systems Summaries Synopsis Synthesis Studies Alerting services. Five steps of EBM Practice. 1.Translation to an answerable question

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Sources of Evidence

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  1. Sources of Evidence F. Hosseinpanah .MD

  2. Agenda • Information mastery • Systems • Summaries • Synopsis • Synthesis • Studies • Alerting services

  3. Five steps of EBM Practice 1.Translation to an answerable question 2. Track down with maximum efficiency the best evidence with which to answer them[Finding the evidence ; Using electronic health information resources in evidence-based practice] 3.Critical appraisal of the evidence for its validity and clinical applicability 4.Integration of that critical appraisal with clinical expertise and the patient’s unique biology and beliefs 5.Evaluation of one’s performance.

  4. Information mastery Relevance × Validity Usefulness of medical information = Work

  5. All biomedical papers Clinical studies Relevant clinical studies Relevant and valid clinical studies Relevant, valid, new clinical studies How to hit the target?

  6. EBM Resources • Journals • Database • Textbooks • Evidence based medicine • ACP journal club • Bandolier • Cochrane • EBMR (ovid) • Trip database • Inforetriever • Up to date • Clinical evidence

  7. Haynes’5S Model • Systems • Summaries • Synopsis (selected individual studies or systematic reviews) • Synthesis • Studies Haynes RB. ACP J Club. 2006;145:A8.

  8. Systems • “A perfect evidence-based clinical information system would integrate and concisely summarize all relevant and important research evidence about a clinical problem and would automatically link, through an electronic medical record, a specific patient's circumstances to the relevant information." (Haynes, 2001)

  9. Summaries

  10. Summaries • Some information resources provide regularly updated clinical evidence, sometimes integrated with other types of health care information, and provide guidance or recommendations for patient management.

  11. Value added books • UpToDate • Clinical evidence

  12. UpToDate • UpToDate is a well-referenced online textbook that is carefully updated every 4 months. It exists in digital format because it is too large to print. • Although UpToDate, unlike Best Evidence and the Cochrane Database of Systematic Reviews, does not have a set of explicit methodologic quality criteria that included articles must meet, it does reference many high-quality studies chosen by its section authors

  13. UpToDate

  14. UpToDate

  15. UpToDate

  16. Up To Date • Search strategy? • Appraisal strategy? • Not multidisciplinary authorities, • Select facts instead of opinion • Appraise yourselves

  17. Clinical Evidence • Clinical Evidence, published by the BMJ Publishing Group and American College of Physicians/American Society of Internal Medicine, is similar to UpToDate • Although less oriented to provide bottom-line clinical advice from experts. • (http://www.clinicalevidence.com/).

  18. Clinical Evidence

  19. Synopses

  20. Synopses • "When no evidence-based information system exists for a clinical problem, then synopses of individual studies and reviews are the next best source....The perfect synopsis would provide exactly enough information to support a clinical action." (Haynes, 2001)

  21. Synopsis (Reappraised Resources) • ACP Journal Club(http://www.acpjc.org/) • Info-POEMs (http://www.infopoems.com/)

  22. ACP journal club • The editors of ACP Journal Club screen the top clinical journals on a regular basis and identify studies that are both methodologically sound and clinically relevant. • They write an enhanced abstract of the chosen articles and provide a commentary on the value of the article for clinical practice.

  23. ACP journal club

  24. ACP journal club

  25. ACP journal club

  26. ACP journal club

  27. ACP journal club

  28. ACP journal club

  29. Info-POEMs • Similar to ACP Journal Club in that it provides alerting to well-done and important clinical advances and a searching service of its collected articles. • Its main focus is family medicine • Clinical staff read more than 100 journals for articles of direct application to common and uncommon diseases and conditions seen by family physicians • (http://www.infopoems.com)

  30. Synthesis

  31. Syntheses • "If more detail is needed or no synopsis is at hand, then databases of systematic reviews (syntheses) are available..." (Haynes, 2001)

  32. Systematic Reviews • Clear statement of purpose and scope • Comprehensive search and retrieval of the relevant research • Explicit selection criteria • Critical appraisal of the primary studies • Reproducible decisions regarding relevance, selection, and methodologic rigor of the primary research • When quantitative methodology applied meta-analysis

  33. CochraneLibrary • Cochrane Database of Systematic Reviews (CDSR) • Database of Abstracts of Reviews of Effectiveness (DARE) • Cochrane Controlled Trials Registry (CCTR)

  34. CochraneLibrary

  35. DARE • DARE is a Full Text database containing critical assessments of systematic reviews from a variety of medical journals. • DARE is produced by the expert reviewers and information staff of the National Health Services' Centre for Reviews and Dissemination (NHS CRD) at the University of York, England • consists of structured abstracts of systematic reviews from all over the world. • DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.

  36. Studies

  37. Studies • "If every other S fails (i.e., no system, synopses, or syntheses), then it's time to look for original studies” (Haynes, 2001) • Medline, Cochrane Controlled Trials Register • Bibliographic Databases (Medline,Embase)

  38. MEDLINE (www.pubmed.com) • National Library of Medicine USA • Numbers of Journals: 3600 (>4000) • Bias: English Language, Strong American Bias • Thesaurus: Uses Medical Subject Headings (MeSH) • Subject Coverage: All Specialties of Medicine • Materials Indexed: Letters, Editorials, Research Articles from 1966 onwards • 60% of References contain Abstracts • Update: Updated Monthly but can be 3 or more months behind • Type of Database: Bibliographic

  39. Medline (clinical query)

  40. Medline(clinical query)

  41. Turning Research Into Practice • www.tripdatabase.com

  42. TRIP Database • The TRIP Database is produced by TRIP Database Ltd. • The aims of the TRIP Database :allowing health professionals to easily find the highest-quality material available on the web. • It is not a true database but looks like a mainstream search engine (such as Google or Yahoo) • The content of the site is reviewed monthly and new material from the publications covered is added to the site. • Typically 300-400 new articles are added monthly.

  43. TRIP database

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