1. S ELECTED F REE E VIDENCE B ASED R ESOURCES Carolyn Klatt, MLIS Health Sciences Library Mercer University School of Medicine -- Savannah Memorial University Medical Center 4700 Waters Avenue P.O. Box 23089 Savannah, GA 31404 Phone: 912-350-3546 FAX: 912-350-8685 Email: klatt_ca@mercer.edu klattca1@memorialhealth.com

2. W HAT IS “E VIDENCE B ASED ”? Definition from: (Straus, Sharon E., Richardson, W.S., Glasziou, P., and Haynes, R.B. Evidence-based medicine: how to practice and teach EBM. London: Churchill-Livingstone, 2005) “Evidence based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.”

3. W HAT IS “E VIDENCE B ASED ? Best Research Evidence Clinical Expertise Patient Values EBM

4. H OW E VIDENCE IS A PPLIED Prevention Diagnosis Therapy and Treatment Prognosis Etiology Harm

5. P YRAMID OF E VIDENCE Medical literature is immense. Only a small portion is immediately useful in answering clinical questions. Literature reports the whole spectrum of the scientific research process. Journey from in-vitro studies to double-blind randomized control trials is called the “wedge of evidence” or the “pyramid of evidence.”

6. P YRAMID OF E VIDENCE

7. T YPES OF S TUDIES Meta-analysis Systematic Reviews Evidence Guidelines Evidence Summaries Randomized Controlled Trials (RCT) Cohort Studies Case Control Studies Clinical Research Critiques Case series and Case reports

8. L EVELS OF E VIDENCE (LOE) “Evidence-based” involves tracking down the available evidence, assessing its validity and then using the “best” evidence to inform decisions regarding care. Rules of evidence have been established to grade evidence according to its strength. The terms "levels of evidence" or "strength of evidence" refer to systems for classifying the evidence in a body of literature through a hierarchy of scientific rigor and quality. Several dozen of these hierarchies exist. Some systems comprise three levels and others eight or more.

9. E XAMPLE L EVELS OF E VIDENCE 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 Centre for Evidence-Based Medicine, Oxford

10. E XAMPLE L EVELS OF E VIDENCE A : There is good research-based evidence to support the recommendation. B: There is fair research-based evidence to support the recommendation. C: The recommendation is based on expert opinion and panel consensus. X: There is evidence of harm from this intervention. Agency for Healthcare Research and Quality (AHRQ)

11. E XAMPLE L EVELS OF E VIDENCE Beneficial Likely to be beneficial Trade off between benefits and harms Unknown effectiveness Unlikely to be beneficial Likely to be ineffective or harmful British Medical Journal’s Clinical Evidence

12. E VIDENCE BASED TUTORIALS Evidence Based Practice http://www.biomed.lib.umn.edu/learn/ebp/ From the University of Minnesota Bio-Medical Library. Introduction to EBM http://ktclearinghouse.ca/cebm/intro From the Centre for Evidence Based Medicine Toronto.

13. F REE R ESOURCES Cochrane Collaboration http://www.cochrane.org/index.htm Contains high-quality, independent evidence to inform healthcare decision-making. Cochrane systematic reviews represent the highest level of evidence on which to base clinical treatment decisions. In addition to Cochrane reviews, the Cochrane Library provides other sources of reliable information: from other systematic review abstracts technology assessments economic evaluations individual clinical trials Abstracts are free

14. F REE R ESOURCES PubMed (Medline) Clinical Queries http://www.ncbi.nlm.nih.gov/pubmed/clinical Search by a clinical study category such as etiology, diagnosis, therapy, prognosis Find systematic reviews, meta-analysis, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines.

15. F REE R ESOURCES TRIP (Turning Research Into Practice) http:// www.tripdatabase.com/ A meta-search engine of many Evidence Based resources, including the Cochrane Library, e- journals, practice guidelines, e-textbooks, and PubMed.

16. F REE R ESOURCES SumSearch http://sumsearch.org/ From the University of Texas Health Sciences Center at San Antonio - Simultaneously searches MEDLINE, DARE, the National Guideline Clearinghouse, the Merck Manual, and other resources.

17. F REE R ESOURCES Bandolier http://www.medicine.ox.ac.uk/bandolier/ Bandolier http://www.medicine.ox.ac.uk/bandolier/ Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes “information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.”.

18. F REE R ESOURCES AHRQ (Agency for Healthcare Research and Quality) http:// www.ahrq.gov The lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. The AHRQ website includes access to research findings, fact sheets, data and surveys on various health topics as well as reports on specific populations, quality and patient safety, Health IT, and clinical information. ePSS (elctronic Preventative Services Selector) tool on web and PDA

19. F REE R ESOURCES National Guidelines Clearinghouse http:// www.guideline.gov A comprehensive database of evidence-based clinical practice guidelines and related documents. An initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.

20. F REE R ESOURCES ClinicalTrials.gov http://clinicaltrials.gov Provides regularly updated information about federally and privately supported clinical research in human volunteers. Gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details.

21. F REE R ESOURCES eMedicine http:// www.emedicine.com Has over 7,000 physician authors and editors who create thousands of peer-reviewed, disease specific articles. Publishes over 400 new review articles monthly. Each article incorporates 4 levels of physician peer-review. Includes over 100 useful medical tools and calculators, as well as a clinical image case, radiograph and ECG of the week, and over 30,000 images.

22. F REE R ESOURCES Evidence Updates http://plus.mcmaster.ca/EvidenceUpdates A collaboration between BMJ Group and McMasterUniversity's Health Information Research Unit Email alerting service Searchable database of articles that are pre-screened for quality and given a clinical relevancy rating Links to selected evidence-based resources

23. K NOWLEDGE IS : K NOWING W HERE TO F IND I T