Identifying the evidence Phil Hannaford NHS Grampian Chair of Primary Care

Evidence based medicine “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 requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient’s unique values and circumstances.” Centre for EBM

Some reasons for EBM Increasing demand for high quality, effective and efficient care Continuous improvements in diagnosis, treatment and prevention of disease or unwanted health- related outcomes Recognition that clinicians rarely spend more than 30 minutes a week keeping up-to-date

Clinicians (and managers) frequently have information overload

Traditional information sources often have problems Textbooks Experts Narrative reviews Editorials Medical journals –out of date –wrong or selective –overwhelming volume / irrelevant information

We need new ways of getting and handling information

Approach depends on your information need 1.Identify and appraise original article(s) 2.Identify and appraise summary, review articles 3.Seek clinical guidance 4.Get regular relevant new information

1. Identify and appraise original article(s) Ask a friend or colleague

1. Identify and appraise original article(s) Ask a friend or colleague Ask a librarian

1. Identify and appraise original article(s) Ask a friend or colleague Ask a librarian Look up past copies of the journal

1. Identify and appraise original article(s) Ask a friend or colleague Ask a librarian Look up past copies of the journal Search a database of articles

Some databases MEDLINE EMBASE (biomedical and pharmaceutical database) CINAHL (Cumulative Index to Nursing & Allied Health) CHID (Combined Health Information Database) PsycINFO

MEDLINE Produced by the US National Library of Medicine Focus on clinical medicine and biomedical literature Includes information from Index Medicus, Index to Dental Literature, and International Nursing More than 12 million records from mid 1960s, from more than 3,900 journals, plus selected monographs of congresses and symposia ( ) Abstracts included for about 67% of the records

PubMed Free service of the National Library of Medicine Provides access to MEDLINE citations and other additional life science references Searches can be limited to particular subsets of data Includes links to many sites providing full text articles and other related resources Weekly alert service

"This is a collection of tools for identifying, assessing and applying relevant evidence for better health care decision-making. The appraisal tools are adapted from the Users' Guides series prepared by the Evidence Based Medicine Working Group and originally published in JAMA"

“The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practise and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of clinical disciplines. This site also serves as a support for the book entitled, Evidence-based Medicine: How to practice and teach EBM by David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes”. Evidence-based Medicine: How to practice and teach EBM

2. Identify and appraise summary, review articles Traditional narrative review

2. Identify and appraise summary, review articles Traditional narrative review Systematic review /meta-analysis

Systematic review A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies. If the results of the studies can be combined and summarized statistically, the systematic review is called a Meta-analysis.

Cochrane Review Groups Nearly 50 topic based groups, including: Breast cancer Consumers and communication Fertility regulation Gynecological cancer Incontinence Menstrual disorders and subfertility Sexually transmitted diseases

Cochrane library Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effectiveness Cochrane Central Register of Controlled Trials Cochrane Database of Methodology Reviews Cochrane Methodology Register Health Technology Assessment Database NHS Economic Evaluation Database

Campbell Collaboration Similar systematic approach for interventions in social, behavioural and educational fields

3. Seek clinical guidance 1.Ask a colleague

3. Seek clinical guidance 1.Ask a colleague 2.Ask an expert

3. Seek clinical guidance 1.Ask a colleague 2.Ask an expert 3.Consult a traditional (GOBSAAT) guideline

3. Seek clinical guidance 1.Ask a colleague 2.Ask an expert 3.Consult a traditional (GOBSAAT) guideline 4.Consult an evidence-based guideline

National Guideline Clearinghouse A public resource for evidence-based clinical practice guidelines An initiative of the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services Includes national and local guidelines Includes information on how guideline was developed Has links to full guideline (when available)

Medical eligibility criteria for contraceptive use Assesses who can safely use different contraceptives e-health/publications/mec/

Selected practice recommendations for contraceptive methods Provides guidance on the safe and effective use of contraceptives health/publications/spr

4. Get regular relevant new information 1.Read the journals

4. Get regular relevant new information 1.Read the journals 2.Read a journal of secondary publication (abstraction journal)

Some journals of secondary publication ACP Journal Club Evidence Based Medicine Evidence Based Mental Health Evidence Based Nursing Evidence Based Obstetrics and Gynaecology Journal of Evidence-based Health Care

4. Get regular relevant new information 1.Read the journals 2.Read a journal of secondary publication (abstraction journal) 3.Consult other evidence-based resources

Includes: Cochrane reviews from Fertility Regulation and other reproductive health related groups Commentaries and implementation aids Educational material Practical videos Available in English, Spanish, (Chinese, French,Vietnamese )

4. Get regular relevant new information 1.Read the journals 2.Read a journal of secondary publication (abstraction journal) 3.Consult other evidence-based resources 4.Organise an alert service