This step of the tutorial ranks resources in terms of their usefulness in clinical decision making. If you are unable to find your answer in the first resource listed below, then "drill down" to the next level. Links to the resources in the Miner Digital Library are provided.
Controlled clinical trials, especially double-blind randomized controlled trials, are the basis of the evidence. But not all clinical trials are created equal. Some are of high quality and can be used to predict what will happen to particular patients or patient groups; some have design flaws. The resources listed below harvest high quality, relevant research on a particular medical topic, evaluate the validity of the research, and synthesize the findings.
1. Systematic Reviews/Meta-analyses
Strongest evidence. Researchers use rigorous methods to identify, critically appraise, and synthesize all the relevant studies from the published medical literature on a particular topic. Systematic reviews may contain meta-analyses in which the data from selected research studies are combined using statistical techniques in order to increase the power of the findings.
- Cochrane Database of Systematic Reviews - from the Cochrane Collaboration, the main producer of systematic reviews. Mainly addresses questions related to therapy or treatment. Password required.
- DARE (Database of Abstracts of Reviews of Effects) - contains detailed abstracts and reviews (or critiques) of 2500+ non-Cochrane systematic reviews mainly from the journal literature. Password required.
2. Clinical Evidence
Clinical Evidence, from the publishers of the British Medical Journal, summarizes the current state of knowledge and uncertainty about the prevention and treatment of many common clinical conditions based on thorough searches and appraisals of the literature. Covering 22 specialties and over 150 conditions, it is updated frequently. Each topic is peer-reviewed by the section editors and 3 external expert clinicians. Password required.
3. Evidence-Based Practice Guidelines
Evidence-based guidelines, not consensus-based guidelines, provide directions for handling certain clinical conditions. These are often published by specialty societies, i.e. American Gastroenterology Association, American Heart Association.
The National Guideline Clearinghouse, sponsored by the Agency for Healthcare Research and Quality, the AMA, and The American Association of Health Plans, offers free access to such guidelines.
When you can't find a systematic review or other synopses of the evidence on your topic, the next best source of evidence is a critical appraisal of a research article.
1. ACP Journal Club - From the American College of Physicians.
Contains critical appraisals of 2000+ clinically relevant research articles. The editors choose articles by screening the top clinical journals and identifying studies that are both clinically relevant and methodologically sound. There are enhanced abstracts of the chosen articles and a commentary on the value of the article to clinical practice. Password required.
2. POEMS (Patient-Oriented Evidence that Matters) - Critiques of clinically significant research articles.
The articles selected measure outcomes that matter to clinicians and patients, such as quality of life and mortality, and have the potential to change the way clinicians practice. A subset of POEMS, published by the Journal of Family Practice, is available through the Miner Digital Library. Password required.
Research studies published in the journal literature are the"raw" materials for evidence-based health care. Information has not been synthesized or validated.
1. MEDLINE
From the National Library of Medicine. Contains over 12 million citations for research articles, case reports, letters, editorials, and animal studies published in biomedical journals. All of these are not clinically relevant. However, if you haven't found your answer in the resources above - very small databases in comparison to MEDLINE - you will have to search the journal literature. The next tutorial will offer you strategies for finding the best evidence in MEDLINE .
Ovid MEDLINE is accessible through the Miner Digital Library. Password required.
- Pubmed offers free access to MEDLINE.
Health-related textbooks are well-referenced, synthesized sources of general information and are useful for answering "background" questions, rather than questions on the care of specific patients ("foreground" questions). Online textbooks are more current than print textbooks and are becoming more evidence based.
1. UpToDate
Designed for clinicians to provide comprehensive, practical answers to questions involving patient care. Topic reviews are written exclusively for UpToDate by physician experts in 15 medical specialties. Content reviewed continuously, and a new peer-reviewed version is issued every 4 months. Password required.
2. Harrison's
Contains the complete text and illustrations that can be found in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE (15th ed) in addition to links to MEDLINE. Fully searchable. Updated daily. Password required.
3. SAM-Online
Web-based full-text version of the textbook SCIENTIFIC AMERICAN MEDICINE. Features extensive graphics. Updated continually. Password required.
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