Added January 2010
JAMA has launched a new EBM online education tool, JAMAevidence: Using Evidence to Improve Care. It provides full-text access to both the second edition of the Users' Guides to the Medical Literature and The Rational Clinical Examination. Also included on the site are teaching tools, media, and interactive features to convey the best practices of evidence-based medicine. For more information. To preview the new site, go to: http://www.jamaevidence.com/ For a review of JAMAevidence, see the January 2010 issue of J Med Libr Assoc 98(10):93.
Tthe Joint Colloquium of the Cochrane Collaboration and the Campbell Collaboration will be held this year in Cctober at the Keystone Resort in Colorado, USA. The Colloquim will focus on raising evidence-based decision-making to "new heights"! See the Learning EBP section of this web site for more details.
Decision-making is also a key component of PEP, and they will be holding their 5th PEP (Putting Evidence into Practice) Workshop in February in Alberta, Canada. PEP "involves applying evidence to clinical and policy decision making. Critical appraisal provides the tools to assess the quality of evidence in the medical literature and to determine the risks and benefits of different management strategies."
For those who aren't familiar with the methods of critical appraisal, a new edition of Dan Mayer's Essential Evidence Based Medicine is now available to help you "become a more discriminating reader of the medical literature by adopting the skills of critical appraisal." It includes two new chapters on critical appraisal of uqalitative research and communicating risks and evidence to patients, and it is "geared towards the new learner, and assumes little clinical experience." For more details see the Resources section of this web site, under the heading Textbooks.
A leap of faith? An article in CMAJ (2009 Oct 13;181(8):488-93) describes what it takes to "transition from a single patient to a study of many patients" as a "leap of faith in generalizability." In his article, "Integration of evidence from multiple meta-alanyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses,"author Ioannidis notes that an even further leap is needed for the "transition from a single study to meta-analysis and from a traditional metaanalysis to a treatment network and multiple treatments metaanalysis, let alone wider domains."
Looking for a little humor to lighten your journal club assignment? Several recent articles from BMJ have been added to the Research section. demonstrating that, yes, research can be fun! For instance, read about the "Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial."
Added October 2009
Pencil it in! The annual Duke University workshop on Teaching and Leading EBM has been scheduled for March 22 -26, 2010. For more details go to the Learning Section of this website or the workshop website at http://www.mclibrary.duke.edu/training/courses/ebmworkshop/
Here are highlights from two articles just added to the Research Section of this website on the topic of systematic reviews:
While systematic reviews are generally considered good quality sources for evidence-based practice, inconsistencies in the quality of reporting the results of the reviews has led an international group PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) to develop a "27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review." A copy of the PRISMA Statement appears in the August 18, 2009 issue of Annals of Internal Medicine, which also includes an Explanation and Elaboration document that "explains the meaning and rationale for each checklist item...The PRISMA Statement, this document, and the associated PRISMA web site should be helpful resources to improve reporting of systematic reviews and meta-analyses."
In the September 2009 issue of Pharmacotherapy, Coleman, Talati and White also question the consistency used to report results in systematic reviews. In the article "A Clinician's Perspective on Rating the Strength of Evidence in a SystematicReview," they provide a better understanding of the key criteria or domains that should be considered when rating the strength of a body of evidence, why they are important, and the domains included in some of the validated and commonly used scales. This not only will enable clinicians and health care decision makers to personally grade the strength of evidence and be able to extend it to their clinical practices, but also will allow them to understand which domains are and which are not covered, and how different grading scales can provide different results and still be accurate based on the domains they include."
Several books have been added to the Resources Section of this website including the 7th Edition (2010) of the nursing research textbook, Essentials of Nursing Research: Appraising Evidence for Nursing Practice, that has been "updated with stronger coverage of evidence-based practice, including content on how to read, interpret, and critique systematic reviews."
Paul Glasziou's book, Evidence-Based Medical Monitoring: From Principles to Practice, looks at how "monitoring principles adopted in clinical pharmacology and evidence-based medicine can be applied to chronic disease in the global setting."
Also new to the Resources Section is a book from the American Society of Health-System Pharmacists titled The Pharmacists's Guide to Evidence Based Medicine for Clinical Decision Making. There is "an assumed minimal level of pharmacotherapy knowledge for the [non-pharmacist] reader... [but] reference to additional reading is made to assist those requiring a review."
Added July 2009
Recognizing that there is a broader concept to describe evidence based medicine, one that reflects its ever-widening adoption in all fields of study, we have changed the name of our Center of Excellence to Evidence Based Practice (EBP).
Models of evidence based practice include two very important steps that complete the cycle, moving the evidence that research generates into the hands of those who practice medicine:(1) interdisciplinary implementation of the practice change, and (2) data analysis to evaluate the effects of the practice change. As Sue Sendelbach notes in Evidence Based Practice: Then and Now
(AJN 108(10):75-76)," this last step is essential - and often skipped."!
As for the future, read what Kevin Chung, plastic surgeon, has to say in his article Evidence-Based Medicine:The Fourth Revolution in American Medicine? (Plastic and Reconstructive Surgery 2009 Jan;123 (1) 389-97). Invoking Arnold Relman's proclamation that the outcomes movement was the third revolution, Chung takes a close look at both sides of the debate on the movement that he calls the "national tidal wave to revamp the health care system by embracing evidence-based medicine in our practices."
Another article reinforces the importance of evidence in the practice of medicine. In their article Breaking the Mould in Patient Safety ( BMJ 2009 June 29;338:b2585), the authors note that "safety may be defined as increasing the patient's chance of receiving appropriate care that is in line with evidence based medicine. Any obstacle to such access is considered as a loss of chance and a potential failure of the health care system."
Podcasts from the recent US Cochrane Center Stakeholder Summit on Using Quality Systematic Reviews to Inform Evidence-based Guidelines(June 4-5, 2009) are now available online at: http://apps1.jhsph.edu/cochrane/NSvideopodcastola.htm
UK InterTASC Information Specialists' Sub-Group has developed a Search Filter Appraisal Checklist that captures relevance criteria and methods used to develop and test search filters. The checklist includes categorical and descriptive responses and is accompanied by a structured abstract that provides a summary of key quality features of a filter. Details of their process and how the checklist can be used are described in their article So Many Filters, So Little Time published in JMLA 2008 Oct;96(4):356-61
Added April 2009
A second edition of Ann McKibbon's book PDQ: Evidence-Based Principles and Practice is now available. "Readers found the first edition useful in understanding health research and seeking this information. The second edition strengthened both purposes. It also adds 4 new chapters to the existing 9 that cover new areas of understanding and producing health research. All chapters from the previous edition have been revised. Several new chapters (hot topics) have been added: Clinical Prediction Guides, Decision Analyses, Differential Diagnosis and Disease Manifestation, and Health Technology Assessment.."[ Amazon.com editorial review]
Looking for an interactive tutorial on EBM? Try the Searching the Literature for Evidence-Based Medicine tutorial developed by librarians at the University of California at San Francisco. A link to the tutorial can be found in our Learning EBM section. Scroll down to find this and many other helpful tutorials under Learning EBM Online.
How systematic are search strategies for systematic reviews? An article in the Journal of Clinical Epidemiology provides a detailed evidence-based guideline [that] facilitates the improvement of search quality through peer review, and thus the improvement in quality of systematic reviews. It is relevant for librarians/information specialists, journal editors, developers of knowledge translation tools, research organizations, and funding bodies."
Another analysis of systematic reviews appears in an article in the January issue of the Journal of Medlical Librarians Association. University of Florida librarians took a close look at the reporting of search strategies in the Cochrane Database of Systematic Reviews. Results showed that "of the 65 reviews analyzed, none included all 7 recommended elements. Four reviews (6%) included 6 elements. Thirty-two percent (21/65) included 5 or more elements, with 68% (44/65) including 4 or fewer. Three included only 2 elements."
To see how "evidence-based rigor can breathe new life into story-telling", read EBP [Evidence-Based Practice] editor Jon Neher's version of the story of the three little pigs "among the 0.0001% of pigs that build houses (extrapolated from pig house prevalence studies)" and their encounter with the BBW (big bad wolf) who "gave himself an asthma attack (defined as a 20% reduction in FEV1) trying to blow down their houses."
This section compiled by:
Karen Crowell, UNC Chapel Hill
Last modified on
January 29, 2010