Evidence Based Medicine Definition Evidence based medicine is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” [Sackett DL, et.al. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72] Five steps in the EBM Process 1. Create focused questions 2. Find evidence that answers the question 3. Critically appraise the evidence for validity and usefulness 4. Apply the results in clinical practice 5. Evaluate the clinical application of the evidence Sources to be used in identifying EBM Literature Primary literature, Randomized Controlled Clinical Trials (RCCT), can be found in Medline (Ovid Medline or PubMed) Secondary literature (filtered & synthesized) can be found in: Cochrane Database of Systematic Reviews ACP Journal Club Database of Abstracts of Reviews of Effectiveness (DARE) Ovid Medline (using EBM Limits) Clinical Evidence UpToDate Loyola Health Sciences Library’s EBM resources: http://library.luhs.org OVID EBM Reviews: Ovid provides links in MEDLINE to all the Cochrane databases and the ACP Journal Club as well as full text links in the references which allow you to read the evidence in the primary source The Cochrane Collaboration - Developed at the Research & Development Programme, United Kingdom National Health Service, maintains systematic reviews of randomized controlled trials across all areas of health care focusing on the effectiveness of treatments and the delivery and organization of health care. Cochrane Databases include Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness (DARE), and Cochrane Controlled Trials Register. ACP Journal Club - Comprised of two journals ACP Journal Club, a publication of the American College of Physicians, and Evidence-Based Medicine, a joint publication with the British Medical Journal Group. 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. An enhanced abstract and commentary on the value of the article for clinical practice are included. Clinical Evidence - Continuously updated international source of evidence on the effects of clinical interventions. It describes the best available evidence and if there is no good evidence, it says so. Clinical Evidence has an international advisory board and is published by BMJ Publishing Group Ltd. UpToDate - Offers original, peer-reviewed topic reviews making available detailed, authoritative clinical answers to more then 6000 topics. Also offers patient information handouts and a “What’s New” summary.   FINDING THE BEST CLINICAL LITERATURE Quality filters for finding evidence-based medicine literature: The best strategy when searching for EBM articles is to break your question into parts, search the disease or topic in question in MEDLINE, and then apply one or more of the following search criteria. Limit to EBM Reviews Applying this limit in MEDLINE will retrieve results found in the Cochrane databases or the ACP Journal Club. Limit to one or more publication types; publication type is found on the limit screen. Examples of publication types used in EBM searches: randomized controlled trial controlled clinical trial meta-analysis practice guidelines Use MeSH subject headings exp cohort studies double blind method comparative study outcome assessment risk factors Use textword searching Search word or phrase in titles and abstracts by adding .tw. to end of entry; (Use .ti. to limit the word or phrase to occurrences in title only). (systematic review).tw. random:.ti. (Use of colon : allows for various endings to the root word; random: retrieves random, randomize or randomized) (double blind).tw. Example: Should you prescribe antibiotics to treat otitis media in young children? 1. exp otitis media 2. exp antibiotics 3. 1 and 2 4. limit 3 to (human and english language) 5. limit 4 to preschool child <2 to 5 years> 6. limit 5 to randomized controlled trial 7. --OR-- 7. double blind method 8. 5 and 7 -- OR-- 9. (systematic review).tw. 10. 5 and 9