Evidence-Based Guidelines

Lynn Kysh, MLISkysh@usc.edu

Information Services LibrarianNorris Medical Library

Evidence Pyramid – Publication Types

Evidence-Based Guidelines

Systematic Review & Meta-

analysis

Randomized Controlled Trials

Cohort Studies

Case Control Studies

Case Series, Case Reports

S y n t he s e s

St

ud

ie

sHigher Quality of Information

Lower Quality of Information

Fewer Articles

More Articles

Agenda•A note about guidelines•Clinical Scenario: Prostate Cancer Screening•Ask• PICO

• Acquire• PubMed• National Guidelines Clearinghouse

•What about clinical information tools?

Evidence (research)

Patient values

Clinical expertise

Guide to formulate a question

•Problem/Patient• Intervention•Comparison (if any)•Outcome

Clinical Scenario

Your patient is a 50 year old African-American Chief Executive Officer for a Los Angeles company presents for his executive physical. His friend was recently diagnosed with prostate cancer and he wants to know if he should have a digital rectal examination and/or PSA. How would you respond?

Using PICO

•P 50 y/o African American man•I Digital rectal exam or PSA•C No screening•O Decrease morbidity and mortality related to prostate cancer

Finding guidelines:Use “Article Type” filter

National Guidelines Clearinghouse

• Guidelines Information• Organization• Process• Evidence used• Disclosures

• Comparison feature

But what about clinical information tools?

Are these EBM Resources?

•Opinions vary (and that’s okay!)

•Appraise the information• Check evidence ratings• Follow links to evidence• Check author information

Examined from UpToDate & Dynamed articles on:• erectile dysfunction• fibromyalgia• hypogonadism • Psoriasis• rheumatoid arthritis • Crohn's disease

All articles from the UpToDate articles demonstrated a conflict of interest. At times, the editor and author would have a financial relationship with a company whose drug was mentioned within the article.

Agenda•A note about guidelines•Clinical Scenario: Prostate Cancer Screening•Ask• PICO

• Acquire• PubMed• National Guidelines Clearinghouse

•What about clinical information tools?

Lynn Kysh, MLISInformation Services Librarian

kysh@usc.edu(323) 442-1124

Questions?

Lynn Kysh, MLISInformation Services Librarian

kysh@usc.edu(323) 442-1124

Thanks!