Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.)
EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang. EBM Resource Pyramid.
The Evidence-Based Pyramid depicts a triangular representation of the levels of evidence with the strongest evidence at the top and progressing down through evidence with decreasing strength. At the apex of the pyramid are Systematic Reviews, which are the strongest form of evidence. Under them are lesser strength formats for filtered information including Critically-Appraised Topics (Evidence Synthesis) and Critically-Appraised Individual Articles (Article Synopses). Below that is unfiltered information, the top form being Randomized Controlled Trials. Successive lower levels include Cohort Studies, Case-Controlled Studies, Case Reports and Background Information/Expert Opinion.
TRIP (Turning Research Into Practice) Database Plus (free version)
Simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.
Filtered resources appraise the quality of studies and often make recommendations for practice.
Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. A meta-analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results.
Consists of detailed, structured topic reviews of hundreds of articles. Teams of experts complete comprehensive literature reviews, evaluate the literature, and present summaries of the findings of the best studies. Published by the International Cochrane Collaboration.
Full-text database containing structured abstracts of systematic reviews from a variety of medical journals. DARE is produced by the National Health Services' Centre for Reviews and Dissemination (NHS CRD) at the University of York. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.
Clinical Study Categories and Medical Genetics topics can be specified.
Systematic Reviews are also searchable in MEDLINE:
Authors of critically-appraised topics evaluate and synthesize multiple research studies.
"This search provides complete released evidence reports, comparative effectiveness reviews, technical briefs, Technology Assessment Program reports, and U.S. Preventive Services Task Force evidence syntheses. EPC reports and assessments may include meta-analyses and cost analyses."
A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Updated weekly.
Note: Guideline evidence varies from expert opinion to high levels of evidence.
Articles examining the validity and quality of evidence of findings on physical exam.
Experts in primary care and prevention systematically review the evidence of effectiveness and develops recommendations for clinical preventive services.
Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
Clinically focused, research-based responses to a specific clinical question. The audience is practicing healthcare professionals..
Quality articles from over 126 clinical journals are selected by research staff, and then rated for clinical relevance and interest by an international group of physicians. Includes a searchable database of the best evidence from the medical literature and an email alerting system. From BMJ Publishing Group and McMaster University's Health Information Research Unit.
Editors scan over 50 journals, select and identify articles that warrant immediate attention by nurses. These articles are summarized in "value added " abstracts and commented on by clinical experts.
Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use specific search strategies in MEDLINE and other databases to achieve the highest possible level of evidence.
To limit your PubMed search to the locate evidence-producing studies: Click on "Clinical Queries" (under PubMed Tools). This specialized search is intended for clinicians and has built-in search "filters." Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you may indicate whether you wish your search to be more sensitive (i.e., include most relevant articles but probably including some less relevant ones) or more specific (i.e., including mostly relevant articles but probably omit a few).
To limit your Ovid MEDLINE search to the best evidence-producing studies: Clinical Queries (See PubMed) is searchable in Ovid; click on the "Limits" icon.
Major biomedical and pharmaceutical database covering drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation. Produced by Excerpta Medica and updated weekly.
To limit your EMBASE search to the best evidence-producing studies: Click on the ‘Advanced Search’ then click on 'More Limits' then select any of the 'Evidence Based Medicine' limits.
International coverage of the professional and academic literature in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas.
To limit your PsycINFO search to the best evidence-producing studies: Click on the ‘Limits’ icon to use ‘Clinical Queries’ or limit to ‘methodology’ types.
Cumulative Index to Nursing and Allied Health Literature
To limit your CINAHL search to the best evidence-producing studies: Use ‘Clinical Queries’ or use "Publication Types" to limit to ‘Research’ or 'Systematic review", etc.).
CENTRAL contains randomized controlled trial and controlled clinical trial from all Cochrane Review Groups' Specialised Registers. These registries include records from MEDLINE and EMBASE, as well as records from their handsearch results registries. Note: To use CENTRAL, select Trials from "Search Limits" feature on the Cochrane search screen.
Use research methodology filters to locate evidence based studies on appropriateness, process assessment, outcome assessment, costs and economics as well as qualitative studies related to health care services, quality and costs.
Note: Evidence in these resources may vary from expert opinion to high levels of evidence.
Physician authors and editors contribute to Medscape's Clinical Reference Tools.. The evidence-based content covers over 30 medical specialties. It also includes a Drug Formulary by insurance plans.
Search from one convenient location and use document clustering to locate full text book content from HSLS’s electronic clinical books of STAT!Ref, MD Consult, AccessMedicine, AccessSurgery, Books@Ovid, and Wiley.
Searchable and continually updated version of Harrison's Principles of Internal Medicine. Linked via AccessPharmacy
Electronic textbook of surgery continuously updated by the American College of Surgeons.
A clinical information resource, which offers up-to-date, fully referenced expert answers to patient-care, diagnosis, and treatment questions. Topic reviews are written by recognized authorities who review the topic, synthesize the evidence, summarize key findings, and provide specific recommendations.
The Centre promotes evidence-based health care and provide support and resources to anyone who wants to make use of them. Includes the EBM Toolbox, an assortment of materials which are very useful for practitioners of EBM, and EBM Teaching Materials, including PowerPoint presentations.
Includes many resources for practicing and teaching EBM.
An extensive LibGuide from Duke University Medical Center Library & Archives.
This JAMA series from the Evidence-Based Medicine Working Group provides detailed guidance on how to critically appraise studies and other types of research articles and how to apply their clinical findings to specific patients.
From Duke University Medical Center Library and University of North Carolina at Chapel Hill Health Sciences Library.
National Center for Complementary and Integrative Health reviews the past 5 years of evidence on CAM topics.