Added April 2008
Articles related to EBM were recently published in the Journal of the Medical Library Association:
Kathleen Burr Oliver, et al, developed an academic, graduate-level course for acquiring the skills needed to be an informationist in clinical medicine and public health, as reported in their ariticle, Bringing evidence to practice: a team approach to teaching skills required for an informationist role in evidence-based clinical and public health practice. See J Med Libr Assoc. 2008 Jan;96(1):50-7.
Paul Bracke, David Howse and Samual Keim described the development of a tool at the Arizona Health Sciences Library for "searching clinical evidence that can be customized for different user groups" in their article, Evidence-based medicine search: a customizable federated search engine. See J Med Libr Assoc. 2008 Apr;96(2):108-13.
Lauren Maggio and Keven Jeffery demonstrated how "just as librarians play essential roles in helping medical schools meet medical accreditation requirements, they can also help dental schools integrate the EBD process defined by the ADA" in their article, Helping a dental school put the "e" in evidence-based dentistry. See J Med Libr Assoc. 2008 Apr;96(2):152-5.
The Natural Standard database is now listed in our Resources section, providing "evidence-based, consensus-based, and peer-reviewed" information on complementary and alternative medicine. Read more about it in reviews from JMLA and MRSQ which are cited in the Natural Standard entry under databases, or register for a free webinar, "Herbs & Supplements: an Evidence-Based Approach" by Catherine Ulbricht on May 20th.
To see what sources of evidence based medical information searchers are using, Paul Galsziou asked subscribers to the Evidence-Based-Health listserv to send him the names of the secondary sources they use every week. Included in his summary (posted March 27, 2008) are: Archimedes, ATTRACT, Best Bets, BMJ Clinical Medicine, BMJ Updates, Dyna-Med, Evidence based medicine journal, Essential Evidence Plus (formerly InfoRetriever), Johanna Briggs, OT Seeker, PEDro, UpToDate, and the WHO Reproductive Health Library.
Evidence-based medical information isn't just for students and health care and professionals! Clinical librarian Terence Harrison from Royal Melbourne Hospital in Australia is working with the Cochrane Consumer Network to offer a series of workshops for patients and outpatients on (1)accessing and evaluating evidence-based, quality websites, and (2) how to use the information to stay informed about a particular long-term health condition.
The Food and Drug Administration has received a lot of criticism recently about its lack of adequate oversight of the pharmaceutical industry. A new proposal for Good Reprint Practices indicates that it considers evidence important, even in advertising. According to the FDA news release, they will allow pharmaceutical manufacturers to distribute reprints of journal articles that support a particular use of a drug or device that does not appear on its label, but it recommends [does not require, unfortunately] against the distribution of articles that "are not supported by credible medical evidence" and are therefore considered "false and misleading."
Added January 2008
A New Year Brings Change!
Following the March/April issue, ACP Journal Club will become a regular feature in Annals of Internal Medicine and no longer be an independent publication. It wil appear once each month in Annals starting with the May 20, 2008 issue, offering "busy practicing physicians the evidence based clinical information necessary to practice good medicine."
InfoRetriever with InfoPOEMS has changed to Essential Evidence Plus. The new web address is http://www.essentialevidenceplus.com however, the old web address will redirect you to this one. New sections include EBM Guidelines and e-Essential Evidence, a "truly evidence-based reference that will be tightly integrated and hyperlinked to all of the other resources in Essential Evidence Plus, including the Daily POEMS summaries and The Cochrane Database of Systematic Reviews Abstracts."
Finding it difficult to meet the increasing challenge to keep up to date with resources, the editors of Netting the Evidence Resource List have replaced it with Google! This famous search engine is being put to use to search "over one hundred web sites (107) associated with the METHODOLOGY of evidence-based practice." Note that "all links will be periodically refreshed but you only retrieve material on assessed EBP sites."
Using Evidence to Drive Improvements
The Institute of Medicine of the National Academy Roundtable on Evidence Based Medicine met in Washington, D.C. in December, 2007, as part of a series of discussions with key stakeholders from multiple sectors...to explore "ways that evidence can be better developed and applied to drive improvements in the effectiveness and efficiency of medical care in the United States." Members of the roundtable have been focusing on " 1) accelerating progress toward the long-term vision of a learning healthcare system, in which evidence is applied and developed as a natural product of patient care; 2) advancing the near-term capacity to generate the evidence for the medical care that is most effective and produces the greatest value; and 3) improving public understanding about the nature of evidence, its dynamic character and its importance."
Look for upcoming sessions of the Roundtable on Evidence Based Medicine in our Learning EBM section where we post information about workshops, conferences and tutorials being held locally, nationally and internationally.
Knowing is Not Enough
An article in BioMed Central's Medical Education published in January 2005, echoes these imperatives. The Sicily Statement on evidence-based practice, crafted by delegates from an EBHC conference in Sicily in 2003, quotes Geothe as saying: "Knowing is not enough; we must apply. Willing is not enough, we must do." They conclude by advocating that "all health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice.'"
Taking Critical Appraisal One Step Further
Another serendipitous find from the literature is an article by Victor Montori, Gordon Guyatt (of the famed Users' Guides series published in JAMA) and others. This article, published in BMJ in November, 2004, is a Users' guide to detecting misleading claims in clinical research reports that alerts readers to six methods that researchers sometimes use to make their studies sound more convincing.
Twenty Statistical Errors Even YOU Can Find
In an article in the Croatian Medical Journal in 2004 (45):361-370, Tom Lang describes "20 common statistical reporting guidelines that can be followed by [those] who know little about statistical analysis." He cautions us, however, that "these guidelines are but the tip of the iceberg" and refers us to his book How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors and Reviewers (American College of Physicians,2006) and other texts for a more in-depth understanding.
Cochrane on YouTube?
A recent edition of the online Wiley-Blackwell Library Newsletter points out a few YouTube videos that might be of interest to librarians. Included is one that might also be of interest to EBM learners, "What is the Cochrane Collaboration?"
Added October 2007
Librarians at the Tufts University Hirsh Health Sciences Library have created a web site for MEDLINE searchers, Useful MeSH for Evidence-Based Medicine. They provide lists of MeSH and subheadings to use in your search strategies for evidence-based Diagnostic Testing/Screening, Differential & Physical Diagnosis, Drug Therapy, Other Therapies, Treatment Outcomes, Prognosis, Etiology/Harm or Economic Analysis.
The September issue of MLA News features a table of online resources helpful in Reducing Clinical Uncertainty and Answering Clinical Questions. "Clinical-question-answering services (i.e. responsive clinical information services) are a potentially important means for improving the availability and accessibility of high-quality knowledge in clinical decision making."
Familiar resources, such as TRIP and PubMed Clinical Queries, show up on the list, but several less-familiar ones are also listed, such as the Database of Uncertainties about the Effects of Treatments (DUETs) from the UK.
An Expert Searching column in an earlier edition of MLA News (February 2007) features an article by Vanderbilt University librarian Rebecca Jerome," When is the Case Report Useful in Answering Clinical Questions?" Case reports are usually "found at the bottom of most evidence-grading or ranking scales, [so] this raises the question, when is a case report a'useful' piece of data?"
Librarians Janis Glover from Yale and Karen Odato from Dartmouth have developed a free form-based tool, EBM Page Generator, that can be used to create an annotated Web page of locally available evidence-based (EMB) resources. Go to http://www.ebmpyramid.org for more information on how to customize a page for your own institution's web site.
In the July 2007 issue of the Journal of the Medical Library Association there is an article by librarians Andrea Rice and Sherry Dodson, A Partnersip in Teaching Evidence-based Medicine to Interns at the University of Washington Medical Center. "This model...provides one example of how librarians can be integral to meeting the EBM requirements for ACGMB's residency training programs."
A comprehensive Review for Librarians of Evidence-based Practice in Nursing and the Allied Health Professions in the United States was published in the October 2007 issue of the Journal of the Medical Library Association. Included is an extensive list (122 entries) of references to articles in the literature. JMLA 2007 Oct;95(4)394-407.
Added July 2007
The 5th International Conference of Evidence-Based Health Care Teachers & Developers will be held in Taormina, Italy this fall from October 31 - November 4. The theme of the conference is Better Evidence for Better Health Care.
Is Italy a little more than your travel budget will allow? Then head for the mountains in Asheville, North Carolina where Mountain AHEC is holding a workshop on September 20 on Finding Evidence-based Medicine: From Cochrane to TRIP.
For details on each of these upcoming sessions, as well as other educational opportunities, see the Learning EBM section of this web site.
An article by William Miser in Primary Care: Clinics in Office Practice (2006;33: 811-29) titled "An Introduction to Evidence-Based Medicine" includes our tutorials in its list of recommended courses for primary care physician[s] to develop the essential skills that are required in today's practice in medicine."
Also in the same issue (831-37) is an article by John McConaghy titled "Evolving Medical Knowledge: Moving Toward Efficiently Answering Questions and Keeping Current." He addresses the need for high-quality information that has been "evaluated for validity and scientific rigor as well as relevance to clinical practice" in order to "facilitate the incorporation of evidence into patient and medical practices." See our Resources section for more details on the resources referred to by McConaghy.
TRIP, Turning Research Into Practice, was re-released last fall as a free online resource. The new version also includes some new features which Tina Fyfe evaluates for us in her review of the database published in the April 2007 issue of the Journal of the Medical Libarary Association.
Also reviewed in an earlier (January 2007) issue of the JMLA, is the latest (5th) edition of the book by Stephen Gehlbach, Interpreting the Medical Literature. In comparing this book to two other classic books on EBM, Users' Guides to the Medical Literature and How to Read a Paper, reviewer Kathel Dunn finds that "of the three books, Gehlbach's offers a more accessible read, stepping the reader through study types and providing clearer definitions of terminology that aid in understanding how a statistic would be applied and interpreted in the literature."
According to its own guidelines approved in 2003, recommendations made by the World Health Organization should be evidence-based, but authors Oxman, Lavis, and Fretheim, in an article in The Lancet in June 2007, find that this is not necessarily the case. "Systematic reviews and concise summaries of findings are rarely used for developing recommendations. Instead processes usually rely heavily on experts in a particular specialty, rather than representative of those who will have to live with the recommendations." Lancet 2007;369:1883-89.
This section compiled by:
Karen Crowell, UNC Chapel Hill
Last modified on
April 30, 2008