1. Pat Martin / Taubman Medical Library / 2006 Evidence-Based Medicine Time Saving Steps

2. Adapted from R. Brian Haynes, Of studies, synthesis, synopses and systems: the “4S’ evolution of services for finding current best evidence. ACP Journal Club, 134(2) March/April 2001, pp A-11-A-13.

3. From the top down… Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality As close as we can get… Frequently updated electronic textbooks Regularly updated clinical practice guidelines These lack the ideal functionality to filter the evidence based on patient characteristics

4. From the top down… Synopses: Synopses of individual studies and reviews ACP Journal Club It’s a matter of time…

5. From the top down… Syntheses: Summaries based on rigorous searches for evidence Cochrane Library Ovid EBMR

6. From the top down… Original Studies: Randomized control trials Clinical trials Comparative studies Multicenter studies Epidemiological studies

7. Case: 78 year old divorced African American man who presents with his third episode of major depression after a myocardial infarct. He previously responded to nortriptyline. After his last cardiac event, however, he developed conduction delay such that tricyclics are now contraindicated. You need to treat and must consider treatment options. Question 1: Is there pharmacological intervention which is safer than tricyclic antidepressants in this 78 year old man, post-MI? Question 2: In a 78 year old man, s/p MI with recurrent major depressive disorder, would psychotherapy treatment vs. a trial of antidepressant medication be effective?

8. From the top down… Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality Frequently updated electronic textbooks such as ACP Medicine ACP Medicine is a continually updated, evidence-based reference of internal medicine. Regularly updated clinical practice guidelines

9. www.lib.umich.edu/taubman

13. From the top down… Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality Frequently updated electronic textbooks such as ACP Medicine ACP Medicine is a continually updated, evidence-based reference of internal medicine. Regularly updated clinical practice guidelines UMHS guidelines National Guidelines Clearinghouse

16. www.guideline.gov

22. From the top down… Synopses: Synopses of individual studies and reviews ACP Journal Club

26. From the top down… Syntheses: Summaries based on rigorous searches for evidence Cochrane Library Ovid EBMR

33. From the top down… Original Studies: Randomized control trials Clinical trials Comparative studies Multicenter studies Epidemiological studies