internet resources for evidence-based medicine

Dr. Ahmed-Refat Kashmery

Internet Resources

For Evidence Based

Medicine


Prof. Dr.

Ahmed-Refat Kashmery2007

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اقسم بالله العظيماقسم بالله العظيم,,,,,,,,,,,,,,,,,,,أن أن )))),,,,,,,,,,,,,,,,,,,))))

وأن ,,,,,,,,,,,,,,,,,,, وأن ,,,,,,,,,,,,,,,,,,,

علي طلب علي طلب أثابرأثابرو أن و أن العلمالعلم

و أسخره لنفع اإلنسان ال آلذاه و أسخره لنفع اإلنسان ال آلذاه

أوقر من علمنيأوقر من علمنيو أن و أن أعلم من يصغرنيأعلم من يصغرنيو و

من قسم األطباء:من قسم األطباء:

20032003 المادة األولى من الئحة آداب مهنة الطب - المادة األولى من الئحة آداب مهنة الطب - أ د / أحمد رفعت عبد الغفار الكشميريأ د / أحمد رفعت عبد الغفار الكشميري


Finding the Best Evidence

1. Identify PICO terms

2. Look for Secondary sources

3. Search for Primary sources

www.CEBM.NET/


Resources for Practicing EBM

What is the ideal resource?

1. Located in the clinical setting 2. Easy to use 3. Fast, reliable connection 4. Comprehensive /Full Text 5. Provides primary data

http://www.hsl.unc.edu/Services/Tutorials/EBM/Supplements/selectarSupp.htm


ACP Journal Club: started in 1991, it contains abstracts of

articles from about 100 journals of relevance to internal medicine, the articles being selected according to critical appraisal criteria. It is provided with Annals of Internal Medicine [restricted to internal medicine topics??].

2 Look for secondary sources


Summaries of the primary evidence

ACP Journal Club ACP J-C's general purpose is to select published

articles according to explicit criteria and to abstract those studies and reviews that warrant immediate attention by physicians attempting to keep pace with important advances in the treatment, prevention, diagnosis, cause, prognosis, or economics of the disorders managed by internists. These articles are summarized in "value-added" abstracts and commented on by clinical experts.



ACP Journal Club Abstracts and commentaries are

reviewed at 5 year intervals and are either archived or updated. ACP Journal Club is available in print and electronic.

: http://www.acpjc.org/



Clinical Evidence is a textbook and database of clinical questions

designed to help clinicians make evidence–based medicine part of their everyday practice. Hundreds of clinical questions, representing nearly every clinical specialty, cover the effects of treatments and interventions based on the best available research. Topics include commonly encountered or important conditions seen in primary care or ambulatory settings. http://www.clinicalevidence.com/



eMedicine is an online, peer-reviewed medical reference that

provides access to information on diseases, including background, differential diagnosis, work-up, treatment, medications, and

follow-up. Contributors include physicians and faculty from medical schools and medical societies. Additional resources include clinical calculators, images, CME, decision rules, and drug information. eMedicine is in electronic format and is available free.

http://www.emedicine.com



FPIN Clinical Inquiries Clinical Inquiries are produced by the Family

Practitioners Inquiries Network (FPIN). Clinical Inquiries are a series of answers to practicing physicians' questions that help FPIN achieve its goal to provide rapid, evidence based answers to family physicians.

http://www.fpin.org




2. Look for Secondary sources

3. Search for Primary sources

www.CEBM.NET/




Formulating a well-focused question is the first and the most important step in the EBM process.

Without a well-focused question, it can be very difficult and time consuming to identify appropriate resources and search for relevant evidence



1- Secondary Sources

Authors take data from previously published or unpublished studies, they summarize,

analyze, critically appraise and draw conclusion to it:


Ready Made Ready Made EvidenceEvidence

Search for Secondary Sources


Secondary Sources1. Guidelines:2. CATs:3. Evidence-Based Summaries: Bandolier, 4. Structured Abstracts: EBM Online, ACP

Journal Club 5. Systematic Reviews: Cochrane Library 6. To search several of the databases

simultaneously you can use: http://www.tripdatabase.com/


Secondary Sources4- Practice Guidelines:

Recommendations designed by a group of experts for the purpose of influencing medical interventions to improve quality of care. They are They are broaderbroader in scope in scope than systematic reviews, and provide than systematic reviews, and provide an an overviewoverview of the management of a condition or the use of an intervention.


Secondary Sourcesvalidity of guidelines

Did its developers carry out a comprehensive reproducible literature review within the past 12 months?

Is each of its recommendations both tagged by the level of evidence upon which it is based and linked to a specific citation?



Examples of Guidelines: National Library for Health, NICE, SIGN http://www.sign.ac.uk/



Examples of Guidelines: http://medicine.ucsf.edu/resources/guidelines

http://www.ahcpr.gov/http://www.medic8.com/ClinicalGuidelines.htm

http://www.guideline.govhttp://www.ngc.govhttp://text.nlm.nih.govhttp://www.cdc.gov



Examples of Guidelines:

Canadian Medical Association; http://mdm.ca/cpgsnew/cpgs/index.asp

New Zealand Guidelines Group.


CATs CAT Crawler



Evidence-Based Summaries:

Bandolier,

Clinical Evidence



Systematic Reviews

Cochrane Library



Evidence Based Medicine http://www.acponline.org/journals/ebm

Provides summaries to 50 journals in all subjects. Now it is merged with ACP journal club to produce best evidence



Bandolier: Evidence-Based Health Carehttp://www.jr2.ox.ac.uk/BandolierThis publication (1994-) uses EBM techniques to provide advice about diseases for health-care professionals and consumers.



InfoPOEMS: (Patient-Oriented-Evidence That Matters) prepared by editors of the Journal of Family

Practice that review over 100 journals and select those articles of high relevance to primary care physicians, then write a structured critical appraisal to these articles.



To search several of the databases simultaneously you can use: http://www.tripdatabase.com/



Do It YourselfDo It Yourself

Search for Primary Sources


3 Search for Primary Sources

PubMED – MEDLINE


PubMED - MEDLINEPubMed is a service of the U.S.

National Library of Medicine (NLM) that provides access to over 16 million citations from MEDLINE and other life science journals dating back to the 1950s


Since 1997, PubMed has been freely available to physicians, researchers, and the public. The information obtained from literature searches in PubMed can have a significant impact on patient care and clinical outcomes

PubMED - MEDLINE


Crowley et al reported on a study of 625 clinical questions asked by residents during an in-hospital general medicine rotation. Seventy-seven percent of the answers to these questions came from MEDLINE and the information from the articles changed patient management 47% of the time

PubMED - MEDLINE


Klein et al. showed that conducting a MEDLINE search early in the hospitalization of a patient could significantly lower costs, charges, and lengths of stay .

Westbrook et al reported that the use of an online information retrieval system improved the quality of clinicians' answers to clinical questions by 21%

PubMED - MEDLINE


(http://pubmed.gov)

May be searched to retrieve EBM. This is done by either of the

following two ways:~ ??? ~ Three Ways ….

PubMED - MEDLINE


- 1-Do a search on PubMed in the usual manner, < ACTION-BAR , FEATURE-BAR?>

- then apply “ Limits" and select a Publication Types category such as "Clinical Trial", "Meta-Analysis","Practice Guideline", "Randomized Controlled Trial", or "Review". >>CCZEEESTYPES????????

- These limits would filter out and retrieve hits that follow EBM principles . !!!

Skill_ONEONE Use KW ~PICO formateUse KW ~PICO formate

- Go To An illustration

PubMED - MEDLINE


2-Go directly to the "Clinical Queries". - !!! SKILL_TWOTWO ::: Just select & CHECK……. not type ::: Just select & CHECK……. not type

PICO words !!!!!!!PICO words !!!!!!! Clinical Queries have built in search filters that retrieve

EBM citations. Two options are available, first one is through searching using methodology filters for searching for a therapy, etiology, diagnosis or prognosis, with either emphasis on specificity or sensitivity options. The second option is to search for systematic reviews. !!! SKILL_THERRTHERR

Select~~~~~ not type PICO words Select~~~~~ not type PICO words

PubMED - MEDLINE


P.I.C.O + T.T


Combining the P.I.C.O with the Clinical Queries of the PubMedPICO + CQ = All You Want

!!!! ???? !!!! !!! SKILL_FOUR,5,6 & 7FOUR,5,6 & 7

خالص خلصت المعضلة

PubMED – MEDLINE

The Third Method!!!!!!! :


Combining the PICO framework with the PubMed Clinical Queries has the

potential to improve the efficiency of literature

searching.

PubMED - MEDLINE


PICO + PubMed CQquestions with at least a defined

intervention (I) and outcome

(O) were more likely to be answered than questions with

one or none of these parameters


http://pubmedhh.nlm.nih.gov/nlm/

PubMed for Handhelds

MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts

PICO search Patient, Intervention, Comparison, Outcome

askMEDLINE free-text, natural language search


Ask…..Medline

Ask Ask ??

MedlineMedlineType Your QuestionType Your Question


http://askmedline.nlm.nih.gov/ask/ask.php

.


Or Type Your PICO


http://pubmedhh.nlm.nih.gov/nlm/pico/piconew.html


askMEDLINE is intended for the clinician, researcher, or the general public who want to simply ask a question and to skip the challenge of learning how to format it in manner that will make the searching MEDLINE/PubMed efficient. It is a tool that allows the user to search MEDLINE/PubMed using free-text, natural language query, just like one would in a clinical setting, or in a conversation.



A simple, handheld-friendly search interface was created where users can enter free-text, natural language searches (Figure 1.) The results are also provided in text-only mode, optimised for use by the mobile health care personnel using handheld devices. Links to abstracts, related citations in MEDLINE and full-text articles are provided. Full-text links to journal publishers are not text-based, and may require journal subscription or fees for viewing.



Overall, askMEDLINE retrieved 72/95 exact matches of cited references (gold standard) in POEMs, an accuracy of 75.8%, while Entrez' accuracy was 22% (21/95.) If citations that are not the same as those cited in POEMs, but are relevant and considered satisfactory for answering the clinical question are included, askMEDLINE's total efficiency is 96.8%. Entrez' total efficiency for finding specific and relevant citations for BMJ POEMs is 38.9% (21 specific and 16 relevant citations found.)





MEDLINE/PubMed Search MEDLINE/PubMed Read Journal Abstracts

PICO search Patient, Intervention, Comparison, Outcome

askMEDLINE free-text, natural language search




MEDLINE/PubMed Search MEDLINE/PubMed

http://pubmedhh.nlm.nih.gov/nlm/pubmed/index.html


http://askmedline.nlm.nih.gov/ask/da.php


Searches performed on a PICO-formatted screen retrieved a higher percentage of relevant citations than searches performed on the standard PubMed search interface.


http://pubmedhh.nlm.nih.gov/nlm/pubmed/jbrowse.html


Cochrane CollaborationCochrane Collaboration


Cochrane CollaborationCochrane CollaborationIt is an international organization that started in 1993. It was developed after Archie Cochrane,

an epidemiologist in UK noticed that health-care is not always based on good evidence.


Cochrane CollaborationCochrane Collaboration It prepares, maintains and promotes the

accessibility of systematic reviews of the effects of health care intervention.

It has 15 centers worldwide, with 7000 members.

Each subject area in health care is covered by a specialized Cochrane review group.


Cochrane collaboration aims for information to be:

Evidence -based, Easily accessible, Internationally developed, Quality controlled, Clinically useful and Periodically updated



Use the Cochrane Library to answer questions such as: -Is treatment effective?-Is accepted practice "best" practice?-What is the best treatment?



Do not use Cochrane Library :-To obtain general health care information -To answer queries on causation, prognosis & epidemiology. -To search for clinical practice guidelines.



Cochrane contains Cochrane contains !!! SKILL_88 1. Cochrane Database of Systematic Reviews

(CDSR):2. Database of Abstracts of Reviews of

Effectiveness (DARE):.3. Cochrane Central Register of Controlled Trials

(CENTRAL) 4. Cochrane Database of Methodology Reviews

contains articles on research synthesis and systematic reviews.



- Cochrane Database of Systematic Reviews (CDSR): are full text documents reviewing effects of health care. These reviews are highly structured and systematic. These are the main output of Cochrane Library.



- Database of Abstracts of Reviews of Effectiveness (DARE): provides structured abstracts of Systematic reviews that have been initially appraised by reviewers giving comment on the quality of methodology of reviews.

It actually complements the CDSR by offering a selection of high-quality assessed reviews in those subjects where there is currently no Cochrane review.

-



-- Cochrane Central Register of Controlled Trials (CENTRAL) is a bibliography of controlled trials, it also includes reports published in conference proceedings and other sources not indexed in Medline or other bibliographic databases.

- Cochrane Database of Methodology Reviews contains articles on research synthesis and systematic reviews.



Cochrane Logo: -Illustrates a systematic review of data

from 7 randomized controlled trials (RCT) comparing one health care treatment with a placebo. Each horizontal line represents results of one trial. The shorter the line means the more certain the result. The diamond is the combined result, if it is to the left then treatment is beneficial.



Cochrane Collaboration Logo: If a horizontal line touches the

vertical one then the trial found no clear difference between the treatments. If the horizontal line is to the right or the diamond is to the right of the vertical line then the treatment in not good, and may do harm more than good.



!!!!!! TripDatabase SKILL_99 http://www.tripdatabase.com/index.html


!!! SKILL_SKILL_TENTEN

http://sumsearch.uthscsa.edu/


Other sites include:Canadian Centers for Health

Evidence http://www.cche.net Medic8 http://www.medic8.com/EvidenceBasedMedicine.htm Center for EBM http://cebm.jr2.ox.ac.uk

Netting the Evidence http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/netting.html

Trawling the Nethttp://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/trawling.html


Health Evidence Bulletin Wales http://hebw.uwcm.ac.uk

NHS Center for Reviews & Dissemination http://www.york.ac.uk/inst/crd/

Tufts University http://www.library.tufts.edu/hsl/ebm.html

Glossary of EBM terms:http://www.cebm.utoronto.ca/glossary/

Other sites include:


http://www.hsl.unc.edu/Services/Tutorials/EBM/practice.htm

Other sites include:


Thankاشكر لكمYou~~

الصبر و المتابعة و المشاركة

و الدعم و المحبة

internet resources for evidence-based medicine

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