Evidence-based Health Care: A Guide to the Resources

The purpose of this guide is to assist library users in locating materials about Evidence-based Health Care. It includes materials published since 1996 that are part of the collection in the Health Sciences Library of the University at Buffalo. The guide comprises books that broadly cover the topic of evidence-based health care, as well as books that address the application of evidence-based principles to specific disciplines. Search the UB Libraries’ catalog for additional information.

The most common definition of Evidence-based Medicine comes from Sackett and his colleagues: “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
Sackett, DL, et al. Evidence-Based Medicine: What it is and what it isn't.

The term “Evidence-based Health Care” indicates that these principles can be applied to many health care disciplines.

Randomized Controlled Clinical Trial/Controlled Clinical Trial
Carefully planned projects undertaken to evaluate the clinical effects of an intervention on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control groups. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control groups, the trial is characterized as a randomized controlled trial. Trials using non-validated allocation methods are designated as controlled clinical trials. (Note: used for studies related to therapy or diagnosis.)

Case Control Studies
Case control studies are studies in which patients who already have a specific condition are compared with people who do not have that condition. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other.

Case control studies include retrospective studies, used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.

Case Series and Case Reports
Case series and case reports consist of collections of reports on the treatment of individual patients or a report on a single patient. Because they are reports of cases and use no control groups with which to compare outcomes, they have no statistical validity.

Cohort Study
Studies that follow patients with a specific condition or receiving a particular treatment over time and compare them with another group that has not been affected by the condition/treatment. Cohort studies are not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study. By comparing the incidence of disease in different groups, researchers can make quantitative statements about the strength of association between the risk factor and the disease. (Note: used for studies related to prognosis, harm/etiology or prevention)

Cohort studies include longitudinal studies, in which variables relating to an individual or group of individuals are assessed over a period of time. � Follow-up studies. individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. � Prospective studies.Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.

Crossover Design
The administration of two or more experimental therapies one after the other in a specified or random order to the same group of patients. Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. (This contrasts with longitudinal studies in which patients are followed over a period of time.) The defined population is observed at a single point in time or time interval and exposure and outcome are determined simultaneously.

Double-Blind Method
A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.

Match-pair analysis A type of analysis in which subjects in a study group and a comparison group are made comparable with respect to extraneous factors by individually pairing study subjects with the comparison group subjects (e.g., age-matched controls).

Meta-Analysis
A quantitative method of combining the results of independent studies (usually drawn for the published literature) and synthesizing summaries and conclusions for the purpose of evaluating therapeutic effectiveness, planning new studies, etc. It is often an overview of clinical trials. A meta-analysis looks for consensus within the data.

Multicenter studies
Controlled studies which are planned and carried out by several cooperating institutions to assess certain variables and outcomes in specific patient populations.

Predictive Value of Tests
Related to the sensitivity and specificity of screening and diagnostic tests. The probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test. The probability that the person with a negative test does not have the disease is referred to as the predictive value of a negative test.

Random Allocation
A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups.

Reproducibility of Results
The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.

Review/ Systematic Review
An article published after examination of published material on a subject, such as reviews of the current literature. The material examined can encompass clinical material as well as experimental research or case reports. State-of-the-art reviews tend to address more current matters. A systematic review usually focuses on a clinical topic and answers a specific question. An extensive review of the evidence is presented after the methodology for identifying the studies in the literature is presented.

Sample size
The number of units (persons, animals, patients, specified circumstances, etc.) in a population to be studied. The sample size should be big enough to have a high likelihood of detecting a true difference between two groups.

Sensitivity and Specificity
Measures for assessing the results of diagnostic and screening tests. Sensitivity represents the true positive ratio, that is, the proportion of patients with the disease that are identified by the test. It is a measure of the probability of correctly diagnosing a condition. Specificity is the proportion of subjects without the disease that are so identified by the screening test, that is, test negative. It is a measure of the probability of correctly identifying a nondiseased person.

Single-Blind Method
A method in which either the observer(s) or the subject(s) is kept ignorant of the group to which the subjects are assigned.

Originally adapted from: Course Document: Evidence-Based Medicine and the Medical Librarian, July-August 2000; Medical Subject Headings: Study Types. Duke University Medical Center Library; Li, Alain Wan Po. Dictionary of evidence-based medicine. Abingdon: Radcliffe Medical Press, 1998.

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The Medical Subject Headings (MeSH) is a controlled vocabulary developed by the National Library of Medicine. MeSH terms can be used for searching both the UB Libraries Catalog and online databases produced by the National Library of Medicine, such as MEDLINE. To search for information about evidence-based health care, use the MeSH term Evidence-based Medicine or search phrases such as Evidence-based Medicine or Evidence-based Health Care as keywords.

To search for information about Evidence-based Health Care in CINAHL, use the CINAHL subject headings Nursing Practice, Evidence Based or Professional Practice, Evidence Based or, search using phrases such as Evidence Based Health Care as keywords.

Databases such as MEDLINE, CINAHL, or PubMed can be used to search for clinical information that is evidence-based and has been published in the journal literature. Locating evidence-based studies is facilitated by the use of filters (or hedges) that limit the search to those articles reporting research conducted using specific methodologies, such as a randomized controlled trial or a cohort study. For further information about the use of filters, refer to the resources in the above list. (Note: PubMed has built in filters in the Clinical Query section.)

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Online databases provide citations to journal articles and other literature. Databases such as MEDLINE and CINAHL can be used for searching for information about evidence-based health care. The specialty databases (Best Evidence, Cochrane and DARE) are used for searching for clinical information that meets criteria for evidence-based practice. The full text of some materials may also be available online. MeSH topics or keywords may be used for searching.

The "5S" Pyramid of Evidence Resources might be useful to put it all in context. It has recently evolved to a "6S" pyramid!

Internet access to some online databases is restricted to current faculty, staff and students of the University at Buffalo. Individuals not affiliated with the University at Buffalo may visit the Health Sciences Library to search the databases. Databases that are free and open to the public are indicated with an asterisk (*).

MEDLINE
The premier source for biomedical literature. Indexes journals and selected monographs from medicine, dentistry, nursing and other areas of allied health, biological and physical sciences, humanities and information science as they relate to medicine and health care. The Ovid version of MEDLINE provides links to some full-text articles and allows limiting of the search to those articles that are also indexed in one of the EBM specialty databases. The PubMed version of MEDLINE allows preselected EBM filtering through Clinical Queries. Search MEDLINE through UB Online Resources (Ovid), HUBNET (Ovid), or PubMed.(*)

CINAHL (Cumulative Index to Nursing & Allied Health Literature)
Provides coverage of the journal literature related to nursing and allied health. Selected journals are also indexed in the areas of consumer health, biomedicine and health sciences librarianship. Also includes limited coverage of monographs (e.g., NLN publications) and some full-text resources. Search CINAHL through UB Online Resources or HUBNET

ACP Journal Club (ACP)
This database provides access to the contents of ACP Journal Club’s bimonthly print journal dating back to 1991. The editors select articles from more than 100 biomedical journals reporting original studies and systematic reviews important to the practice of internal medicine. The database includes “structured abstracts” outlining the research methods and evidence-based conclusions, as well as provides brief, highly expert commentary on the topics discussed as well as links to the original articles. Search ACP Journal Club through UB Online Resources or HUBNET

Evidence Based Medicine Reviews: Cochrane Database of Systematic Reviews
This database includes the full text of the regularly updated systematic reviews of the effects of health care prepared by the Cochrane Collaboration. Links to the original articles are also provided. Search Cochrane through UB Online Resources or HUBNET

Evidence Based Medicine Reviews: Database of Abstracts of Reviews of Effects (DARE)
DARE is a full text database containing critical assessments of systematic reviews from a variety of medical journals. The database includes both the structured abstracts and links to the original articles. Search DARE through UB Online Resources or HUBNET

Evidence Based Review: Cochrane Central Register of Controlled Trials (CCTR)
This database is a culmination of an international effort to search the world’s medical journals to locate unbiased data for systematic review. An excellent source for reports of randomized controlled or controlled clinical trials. Search CCTR through UB Online Resources or HUBNET

UpToDate and PIER
Searchable through HUBNET.

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You may be interested in visiting the Evidence Informed Nursing Practice blog maintained by Sharon Murphy of the Health Sciences Library.

National Guideline Clearinghouse A public warehouse of evidence-based clinical practice guidelines, courtesy of the Agency for Healthcare Research and Quality.

American Academy of Pediatrics
American Association of Clinical Endocrinologists
American College of Cardiology
American College of Physicians and American Society of Internal Medicine
American College of Radiology
American College of Radiology - Appropriateness Standard
American Diabetes Association
Cancer Care Ontario Practice Guidelines Initiative
Guide to Clinical Preventive Services, Third Edition (2003)
Guideline Advisory Committee Recommended Clinical Practice Guidelines
Institute for Clinical Systems Improvement
National Comprehensive Cancer Network

The following Internet sites provide information about the practice of Evidence-based Health Care, or resources for finding evidence-based clinical guidelines and practices.

Agency for Healthcare Research and Quality - Dept. of Health and Human Services
AHRQ is the lead agency charged with supporting research designed to improve the quality of healthcare. The agency sponsors and conducts research that provides evidence-based information on healthcare outcomes; quality; and cost, use, and access.

Centres for Health Evidence
This Canadian site links to the “Users’ Guides to Evidence-Based Practice.”

Centerwatch Clinical Trial Listing Service
Information related to clinical trials, sponsored by both industry and government.

Centre for Evidence-Based Medicine
Information and clinical tools related to EBM, from the National Health Service (UK).

Clinical Epidemiology & Evidence-based Medicine Glossary
From Washington State University, College of Veterinary Medicine.

Clinical Trials/Evidence Based Medicine
An annotated list of EBM links from the Texas Medical Association Internet Gateway.

Evidence Based Medicine: Finding the Best Clinical Literature
A list of resources, search filters and other EBM information from the Library of the Health Sciences at the University of Illinios at Chicago.

Evidence-based Medicine Resource Center
References, bibliographies, tutorials, glossaries and on-line databases. From the New York Academy of Medicine and Evidence-based Medicine Committee of the American College of Physicians.

Evidence Based Medicine Tool Kit
“Collection of tools for identifying, assessing and applying relevant evidence for better health care decision- making.based on the work of the Evidence Based Medicine Working Group.”

Evidence-based Practice Centers
Institutions in the United States and Canada that have been awarded contracts from the AHRQ to review and report on scientific literature on assigned clinical care topics and conduct research on methodologies and the effectiveness of their implementation.

Evidence-based Practice Resources on the World Wide Web
Compiled by the Academic Center for Evidence-based Practice from the University of Texas Health Science Center at San Antonio

Evidence Based Resources
A list of EBM resources, including clinical trials, research tools, tutorials, discussion lists and more, from the William H. Welch Medical Library at Johns Hopkins University.

health-evidence.ca
Free, searchable online registry of published research evidence that evaluates public health interventions. Although the creators’ ultimate goal is to facilitate the adoption and implementation of effective policies/programs/interventions at the local and regional public health decision making levels across Canada, the site has useful information for all.

Introduction to Evidence-Based Medicine
A tutorial from the Duke University Medical Library and the Health Sciences Library of University of North Carolina, Chapel Hill.

Knowledgeshare
Knowledgeshare is a knowledge management project designed to support the information needs of health care professionals in evidence based practice. The project is attached to the Library, Sussex Postgraduate Medical Centre, Brighton, UK.

National Electronic Library for Health
UK version of NLM website, focusing on electronic resources.

Nesbit Guide to Evidence-Based Resources
A list of resources, tutorials, search filters and more from the Edward G. Miner Library at the University of Rochester.

Netting the Evidence - Introduction to Evidence Based Practice on the Internet
An extensive and varied list of Internet resources and tools related to EBM from the University of Sheffield School of Health and Related Research.

OTSeeker: Occupational Therapy: Systematic Evaluation of Evidence
Contains abstracts of systematic reviews and randomised controlled trials relevant to occupational therapy. Trials have been critically appraised and rated to assist you to evaluate their validity and interpretability. These ratings will help you to judge the quality and usefulness of trials for informed clinical interventions.

PEDro: Physiotherapy Evidence Database
Developed to give rapid access to bibliographic details and abstracts of randomised controlled trials, systematic reviews and clinical practice guidelines in physiotherapy.

Student's Guide to the Medical Literature
Designed by a 4th year medical student specifically for medical students, but helpful for everyone. Features a 4-step approach, search strategies, and critical appraisal guides.

U.S. Preventive Services Task Force
Sponsored by the US Department of Health and Human Services, Agency for Healthcare Research and Quality, providing links on several health related issues and additional websites.

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Li, Alain Wan Po. Dictionary of evidence-based medicine. Abingdon: Radcliffe Medical Press, 1998. Ref W 13 L693d 1998 (HSL Reference - Dictionary Section)

This is a small selection of EBHC monographs from our collection. Click here to run a full search of the catalog.

American Academy of Pediatrics. Pediatric clinical practice guidelines & policies: a compendium of evidence-based research for pediatric medicine. Elk Grove Village, IL: American Academy of Pediatrics, 2004. HSL Ref WS 100 AM354p 2004.

American Psychiatric Association practice guidelines for the treatment of psychiatric disorders: compendium 2002. Washington, DC: American Psychiatric Association, 2002. HSL Ref WM400 A5131a 2002

Bartholomew, L. Kay. Intervention mapping: designing theory– and evidence-based health promotion programs. Mountain View, CA: Mayfield Pub. Co., 2001.

Brownson, Ross C. et al. Evidence-based public health. Oxford ; New York : Oxford University Press, 2003. HSL WA 100 E93 2003

Cassel, Christine K. Geriatric medicine : an evidence-based approach. 4th ed. New York : Springer, c2003. HSL WT 100 G36635 2003

Clarkson, Jan. Evidence based dentistry for effective practice. London ; New York : Martin Dunitz 2003. HSL WU 100 E93 2003

Clinical evidence. London: BMJ Pub. Group, 2002. HSL Ref WB 39 C6415 General Section

Clinical practice guidelines directory. Chicago, IL: American Medical Association, 2000. HSL Ref ZW 84.AA1 D5

Donaldson, Cam, Mugford, Miranda, and Vale, Luke. Evidence based health economics: from effectiveness to efficiency. London : BMJ, 2002. HSL W 74 E93 2002

Egger, Matthias et al. Systematic reviews in health care: meta-analysis in context. London: BMJ Books, 2001. HSL 20.5 S995 2001

FitzGerald, J. Mark. Evidence-based asthma management. Hamilton, ON: B.C. Decker, 2001. HSL WF 553 E92 2001

Gerstein, Hertzel C. et al. Evidence-based diabetes care. London, BC Decker, 2001. HSL WK 815 E93 2001

Glasziou, Paul et al. Systematic reviews in health care: a practical guide. New York: Cambridge University Press, 2001. HSL W 20.5 S995 2001

Goodman, Kenneth W. Ethics and evidence-based medicine : fallibility and responsibility in clinical science. New York : Cambridge University Press, c2003. HSL WB 60 G653e 2003

Gross, Richard. Decisions and evidence in medical practice. St. Louis: Mosby, 2001. HSL WB 102 G878d 2001

Guyatt, Gordon et al. Users’ guides to the medical literature: essentials of evidence-based clinical practice. Chicago: AMA Press, 2002. HSL WB 102 U841 2002

Haines, Andrew and Anna Donald, ed. Getting research findings into practice. London: BMJ Books, 2002. HSL WB 102 G394 2002

Helewa, Antoine and Joan M. Walker. Critical evaluation of research in physical rehabilitation: towards evidence-based practice. Philadelphia: Saunders, 2000. HSL WB 460 H474c 2000

Kitchen, Sheila et al. Electrotherapy: evidence-based practice.11th ed. New York: Churchill Livingstone, 2002. HSL WB 495 E384 2002

Law, Mary, Bosch, Jackie, et al. Evidence based rehabilitation: a guide to practice. Thorofare, NJ : Slack, 2002. HSL WB 320 E93 2002

Marik, Paul Ellis. Handbook of evidence-based critical care. New York: Springer, 2001. HSL WX 218 M335h 2001

McLean, Peter D. Anxiety disorders in adults: an evidence-based approach to psychological treatment. New York: Oxford University Press, 2001. LML RC531 .M365 2001

Price, Christopher P. and Christenson, Robert H. Evidence-based laboratory medicine : from principles to outcomes. Washington, DC : AACC Press, c2003. HSL WB 102 E9328 2003

Sackett, David L., et al. Evidence-based medicine: how to practice and teach EBM. 3rd ed. Edinburgh; New York: Churchill Livingstone, 2005. HSL WB 102 E933 2005

Spencer, John W. and Jacobs, Joseph J. Complementary and alternative medicine : an evidence-based approach. 2nd ed. St. Louis, Mo. : Mosby, c2003. HSL WB 890 C7365 2003

Stevens, Andrew, ed. The advanced handbook of methods in evidence based healthcare. London: Sage, 2000. HSL WB 102 A244 2001

Stevens, Kathleen R. Essential competencies for evidence-based practice in nursing. San Antonio: Academic Center for Evidence-Based Practice, 2005. HSL WY 100 S844e 2005.

Wan, Thomas T.H. Evidence based health care management: multivariate modeling approaches. Boston : Kluwer Academic Publishers, 2002. HSL W 84.3 W244e 2002

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Audio-Visual materials are located in the Media Resources Center (MRC) in the basement of the Health Sciences Library. In addition to the CD’s that accompany some of the above books, the following video is available:

Medical Library Association. Evidence-based health care in action. Chicago: Medical Library Association, 1998. HSL Media Resources Center VHS Z675.M4 E93 1998

The following is a selected list of periodicals owned by HSL that address topics in Evidence-based Health Care. For a full listing, click here to search our E-Journals page:

ACP Journal Club

Bandolier: Evidence-based healthcare online

Evidence-based Complementary & Alternative Medicine

Evidence-based Dentistry. London: British Dental Journal, 1998- .

Evidence-based Healthcare. Edinburgh: Churchill Livingstone, 1999- (Available through ScienceDirect)

Evidence-based Nursing. Harrow, Middlesex: RCN Pub. Co.; London: BMJ Pub. Group, 1998- .
Get a sense of what features the journal has to offer.

JAMA has published the User's Guides to the Medical Literature, a series of articles since 1993 that relate to evidence-based practice. HSL WB102.U84 2002

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Edited by HSL Reference Staff
Assistant editor Deborah Chiarella, MLS