Advanced Legal Research

EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Churchill Livingstone, Edinburgh, 2000.)

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. Link.

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. Link.

Enter your search query. Click on the ?Additional Limits? button; select ?Systematic Reviews? under ?Subject Subsets.? Link.

Click on ?Clinical Queries? on the left side of the screen; select ?Find Systematic Reviews? and enter your search query. Link.

Authors of critically-appraised topics evaluate and synthesize multiple research studies into statements or recommendations designed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines discuss the prevention, diagnosis, treatment, and management of specific clinical presentations. They also define the most important questions related to clinical practice and identify all possible decision options and their outcomes.

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. Link.

Summarizes the current state of knowledge about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so. Its contents are driven by questions rather than by the availability of research evidence. Rather than start with the evidence and summarize what is there, we identify important clinical questions, and then search for and summarize the best available evidence to answer them. Link.

Authors of critically-appraised individual articles evaluate and summarize individual research studies.

The editors of this journal screen the top 100+ clinical journals and identify studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine. Link.

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.

A randomized controlled trial (RCT) is a research study in which participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest.

A cohort study is a research study that compares two groups (cohorts) of patients, one that received the exposure of interest and one that did not, and follows these cohorts forward for the outcome of interest.

A case-controlled study is a research study which identifies patients with the outcome of interest (cases) and patients without the same outcome (controls), and looks back to see if they had the exposure of interest.

A case series is a report on a series of patients with an outcome of interest. No control group is involved.

A case report is a report of a patient with an exposure or an outcome of interest.

To limit your PubMed search to the best evidence-producing studies: Click on “clinical queries” (on the left side of the screen). This is a specialized search with 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). Link.

To limit your Ovid MEDLINE search to the best evidence-producing studies: Clinical Queries is searchable in Ovid MEDLINE by clicking on the “Limits” icon. Link.

To limit your PsycINFO search to the best evidence-producing studies: Find the Methodology Limit close to the bottom of the page. Select the methodology (or methodologies) you want to search. Link.

Off of EBSCO?s main search page, there are a few ways to limit your search to the best evidence-producing studies: Scroll down to ?Publication Type? limit, select a publication type (i.e., practice guidelines) Scroll down to the ?Evidence-Based Practice? and check the box to retrieve evidence based care sheets. Link.

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. UpToDate started indicating the level of evidence for its Treatment Recommendations in 2006. Link.

A standard text in internal medicine. Link.

From the American College of Physicians, PIER is an EBM decision-support tool designed for rapid point-of-care delivery of evidence-based guidance for physicians. Modules focus on the diagnosis and treatment of diseases. Each module presents a series of succinct guidance statements and practice recommendations, supported by more detailed levels of pertinent rationale and rated evidence. Link.

Why was the study done (what was the research question)?

Was the study design appropriate?

Was the sample size adequate to test the study hypothesis?

Does the study PICO match your question PICO?

Were all patients who entered the trial properly accounted for and attributed at its conclusion (losses to follow-up should be less than 20%)?

Was follow-up complete?

Were the recruited patients representative of the target population?

Was the allocation (assignment) of patients to treatment randomized?

Was the allocation concealed?

Were patients analyzed in the groups to which they were randomized?

Were all randomized patient data analyzed? If not, was a sensitivity or ?worst case scenario? analysis done?

Were groups similar at the start of the trial?

Were patients, health workers, and study personnel ?blind? to treatment?

If blinding was impossible, were blinded raters and/or objective outcome measures used?

Aside from the experimental intervention, were the groups treated equally?

Notable study strengths or weaknesses or concerns?

How serious are the threats to validity and in what direction could they bias the study outcomes?

Dean Hendrix, MLIS. Health Sciences Library (716)-829-3900 x112