1. Evidence Based Resources in Miner Library Online Urology Dept. Sept. 19, 2007 marilyn_rosen@urmc.rochester.edu

2. PICO Method P = Patient or Problem I = Intervention or Exposure C = Comparative Intervention or Exposure O = Outcome

3. Clinical Question: In a patient with a distal ureteral calculus, how does treatment with an alpha blocker compare to watchful waiting with regard to stone-free rates? P: Patient with distal ureteral caluculus I: Alpha blockers C: Watchful waiting O: Stone free search concepts:distal ureteral calculi, alpha blockers, watchful waiting type of question: therapy

4. Hershey Kisses Fannie Farmer Sampler Nestle’s Quik Godiva Truffles Stever’s chocolates ( Park Ave., Rochester ) Ghirardelli Chocolate Bars D ecadence Levels of … Chocolate

5. Studies Syntheses Synopses Summaries Systems Computerized decision support EB topic reviews, Practice guidelines Appraisals of single study or systematic review Systematic reviews Original studies 5 S’s of Evidence Based Medicine (Levels of Evidence) (Haynes. ACP Journal Club. 2006:145(3), A-8-A-9) One aspect of management, or one inter- vention Full range of evidence for a given condition

6. Organizational Model for EBM Resources [Zynx Health, Clin-eguide] Clinical Evidence, UpToDate, PIER, Nat’l Guidelines,AGS Guidelines ACP Journal Club, InfoPOEMS Cochrane PubMed,Medline Studies Syntheses Synopses Summaries Systems One aspect of management, or one intervention Full range of evidence for a given condition

7. Organizational Model for EBM Resources [Zynx Health, Clin-eguide] Clinical Evidence, UpToDate, PIER, Nat’l Guidelines,AGS Guidelines ACP Journal Club, InfoPOEMS Cochrane PubMed, Medline Studies Syntheses Synopses Summaries Systems

8. Syntheses: Systematic Reviews Cochrane Database of Systematic Reviews –“Gold standard” of systematic reviews –Explicit procedures for retrieval, selection, analysis of evidence The Database of Abstracts of Reviews of Effectiveness (DARE) - Essentially, DARE contains all the systematic reviews found outside of Cochrane

9. EBM Reviews Multifile Tips Your terms are NOT mapped to Medical Subject Headings, so: Use truncation ($): cancer$ for cancer, cancers, etc. Use synonyms: tumor$ or cancer$ or neoplasm$ Limit search to SEARCH FIELDS of title, abstract Full text : Ovid PDFs for Cochrane Article review for DARE & ACP Journal Club (full text of the review, not the article) Cochrane: “Protocols” describes unfinished reviews (you can limit your search to Systematic Reviews to avoid protocols)

10. [Zynx Health, Clin-eguide] Clinical Evidence, UpToDate, PIER, Nat’l Guidelines, AGS Guidelines ACP Journal Club, InfoPOEMS Cochrane, other Systematic Reviews PubMed, Medline Studies Syntheses Synopses Summaries Systems Organizational Model for EBM Resources

11. Medline Tips Click on “more Limits”, and then use Clinical Queries to find clinically sound studies. “..pg” allows you to delete search statements “*” restrict to focus “$”- truncation or wildcard “More Limits” – publication types can limit to better evidence in Medline: clinical trials (check off all phases), practice guideline, reviews, meta- analysis, multi-center study, RCT, validation studies, evaluation studies. Search: 3050533.ui.

12. PubMed Tips Left sidebar,under Clinical Queries - search by clinical studies or for systematic reviews Limit to publication types: Clinical trials, Meta- analysis, Practice guidelines, Evaluation Studies, Review, Validation studies Left sidebar, MESH database “History” shows your search statements “Details” shows terms searched when you enter words in search box.