EVIDENCE BASED MEDICINE RESOURCES ON THE INTERNET


Date: Summer 1998


Evidence-based medicine is defined in the Medical Subject Headings (MeSH) as the "process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions." According to the SUNY Health Sciences Evidence Based Medicine course, several factors are relevant to medical decision making:

  1. the patient's situation
  2. the patient's desires, values & attitudes
  3. the doctor's desires, values & attitudes
  4. the doctor's experience
  5. evidence from research
Factor #5 -- applying evidence from reported studies to treatment decisions -- bolsters other factors such as physician observation, experience, advice from other doctors and health care professionals.

USING MEDLINE TO IDENTIFY RELEVANT JOURNAL LITERATURE

Finding, evaluating and extracting useful data from the research -- using the MEDLINE database -- is the first step in applying the evidence-based model to clinical practice. MEDLINE is the international database of biomedical journal literature. It dates from 1966 to the present, and includes journal article citations from nearly 4000 health care journals published worldwide. The MEDLINE database is available from a number of commercial vendors (OVID, PaperChase, SilverPlatter) on a variety of platforms (Windows, Web, Telnet, CD-ROM).

The Alumni Medical Library subscribes to the OVID MEDLINE software, which has been mounted on our BUMC MEDLINE Plus system. BUMC MEDLINE Plus can be searched from computers in the library or via remote access to registered users. BUMC MEDLINE Plus is available from the Windows and WWW versions of BUMC MEDLINE Plus.

MEDLINE training workshops are offered each month for beginners or more experienced searchers. These workshops focus on a variety of skills including creating effective search strategies and posing "searchable" questions; quickly locating clinical trials, meta analyses and EBM-related materials; and taking advantage of MEDLINE's controlled vocabulary (MeSH).


BUMC MEDLINE PLUS SYSTEM INCLUDES "EVIDENCE-BASED MEDICINE REVIEWS" DATABASE

"Evidence Based Medicine Reviews" is now available on BUMC MEDLINE Plus. The database includes the complete Cochrane Database of Systemic Reviews and Best Evidence (both described below), which are enhanced by OVID's graphical user interface and sophisticated search software. Features include an evidence-based option in MEDLINE, which allows BUMC MEDLINE Plus users to restrict their search results to articles which meet evidence-based criteria. Links between existing databases and "Evidence Based Medicine Reviews" also allow users to follow a complete train of thought: moving from a MEDLINE citation, to a particular review, to the full text of that reviewed article, to articles referenced therein. Finally, expert topic searches allow users to recreate the searches designed by members of the Cochrane Collaboration to get the latest information on that topic.

The Cochrane Database of Systemic Reviews contains reviews of current medical research. It is published by the Cochrane Collaboration, an international organization whose mission is to apply evidence-based medicine principles to the review of clinical topics. The Cochrane Collaboration surveys the medical literature for clinically relevant and methodologically sound research, then synthesizes and reports on these studies in the Cochrane Database.

Best Evidence is designed to alert clinicians to important advances in medicine by summarizing and providing commentary on evidence-based articles from the biomedical literature. Included in the database are summaries of current studies of diagnosis, cause, course, and management of a number of clinical disorders. The Best Evidence database contains two EBM publications: the ACP Journal Club and Evidence-Based Medicine.


EVIDENCE BASED MEDICINE ON THE INTERNET

In an effort to develop tools and strategies for improving the quality of health care services worldwide, a growing number of organizations, collaboratives and government agencies share evidence-based practice information on the Internet. EBM Web sites include information on current research, publications, databases, CE opportunities, funding, practice guidelines, consensus development programs, clinical trials and more. Several of these EBM Web sites are listed here for your convenience.

American College of Physicians
U.S. Department of Health & Human Services Agency for Health Care Policy & Research (AHCPR)
Centre for Evidence-Based Mental Health (U.K.)
Evidence-based Medicine and Evidence-based Practice Resources
Patient Oriented Evidence That Matters (POEMS)
The Prise Project (Primary Care Sharing the Evidence)

MEDLINE SEARCHING TUTORIALS & EVIDENCE-BASED "FILTERS"

Many EBM Web sites include MEDLINE tutorials and information on creating effective search strategies, or using existing MEDLINE search "filters" for retrieving clinical studies:

SUNY Health Sciences Evidence Based Medicine Course
Evidence-based Medicine Toolkit
Searching for the Best Evidence in Clinical Journals
Table for Clinical Queries using Research Methodology Filters
Search Strategy to Identify Reviews and Meta-analyses in Medline and CINAHL

Evidence-based journals are also growing in popularity. Several of these journals now have Web sites where tables-of-contents, abstracts and some full text are made available:

Technological progress has improved the Internet's ability to function as a forum for the dissemination of evidence-based practice information, but its role can grow even further. Experts predict that the Internet will emerge as one of the most popular mechanisms for delivering EBM-related studies which were formerly available only in print or on CD-ROM. For example, the Cochrane Database and Best Evidence are available to most people only as a subscription-based CD-ROM. BUMC MEDLINE Plus users, however, have access to both collections as part of OVID's "Evidence Based Medicine Reviews" database. Users can do a BUMC MEDLINE Plus search, limit to "evidence based medicine reviews" and have immediate access to the latest information.

Another scenario for making evidence-based data easier to locate and use involves the integration of medical records systems on the Internet. Words on the medical record could be hyperlinked to appropriate EBM resources on the Web, which would allow physicians to view a patient record and link directly to a related Web site. The physician could also paste information from a Web site directly into the patient record. Other improvements include wireless Internet connections or voice controlled systems. As one can imagine, however, issues such as of privacy & confidentiality, service fees, registration, and licensing will need to be resolved before such technologies can be fully implemented.

In the meantime, those who are interested in furthering their knowledge about EBM can use the plethora of existing resources on the Internet. For more links to EBM sites, use the Library's Evidence Based Medicine site.



References, Web Links & Additional Readings:

Atkins D, Kamerow D, Eisenberg JM. Evidence-based medicine at the Agency for Health Care Policy and Research. ACP Journal Club. 1998 Mar-Apr ;128(2):A12-4.

Dans AL, Dans LF, Guyatt GH, Richardson S. Users' guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. Evidence-Based Medicine Working Group. JAMA. 1998 Feb 18;279(7):545-9.

Davidoff F, Haynes B, Sackett D, Smith R. Evidence based medicine. BMJ. 1995 Apr 29;310(6987):1085-6.

Domenighetti G, Grilli R, Liberati A. Promoting consumers' demand for evidence-based medicine. International Journal of Technology Assessment in Health Care. 1998 Winter ;14(1):97-105.

Geyman JP. Evidence-based medicine in primary care: an overview. Journal of the American Board of Family Practice. 1998 Jan-Feb ;11(1):46-56.

Green J, Britten N. Qualitative research and evidence based medicine. BMJ. 1998 Apr 18;316(7139):1230-2.

Greenhalgh T. Is my practice evidence-based? BMJ. 1996 Oct 19;313(7063):957-8.

Haynes, RB et al Developing optimal search strategies for detecting clinically sound studies in MEDLINE. Journal of the American Medical Informatics Association. 1994 Nov;1(6):447-458.

Heffner JE. Does evidence-based medicine help the development of clinical practice guidelines? Chest. 1998 Mar; 113(3 Suppl):172S-178S.

Hunt, DL et al Locating and appraising systematic reviews. Annals of Internal Medicine. 1997April 1;126:532-538. Knottnerus JA. Dinant GJ. Medicine based evidence, a prerequisite for evidence based medicine. BMJ. 1997 Nov 1;315(7116):1109-10.

Patil JJ. Clinical experience and evidence-based medicine. Annals of Internal Medicine. 1998 Feb 1;128(3):245.

Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. Edinburgh: Churchill Livingstone, 1996.

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

Stevens L. Evidence-based medicine: applying new rules to medical problem solving. Medicine on the Net 1998 May;4(5):6-11.