Escolar Documentos
Profissional Documentos
Cultura Documentos
Dr Nadira A Albaghlie
Source of evidence
Primary literature
EBM Secondary resource
Sources of primary literature
Medline
Medline: produced by the national Library of Medicine
in Bethesda, Marylan
the best-known bibliographic database of biomedical
journal literature which it index from 1966 on.
Many ways exist to access to MEDLINE, and one of
the popular ones is Pub Med (http://
www.ncbi.nlm.nih.gov/entrez/query.fcgi//)
not consider as the definitive source of medical
evidence
33% to 49% of all clinical trials were not included in
MEDLINE
pubMed
pubMed is produced by national library of medicine in the USA
The advantage:
Up-todate: pre-Medline records are added to the database daily
before they are available on other commercially produced Medline
system
Free
Include additional features: access to full-text of freely available
journals
Citation matchers: enable you to find references to articles when
you have incomplete details
Clinical queries screen: provides short cut to searching for
evidence-based materials
Tips for search
Boolean operator
AND, OR, NOT
Truncation with asterisk (*)
“”
EMBASE: EMBASE is the Excerpta Medical
database for biomedical and pharmaceutical
journal articles. This database indexes 3,500
journals. It is available since 1988, and is
searchable by a controlled vocabulary, it is
especially usefully useful for searching for
evidence regarding drugs and pharmaceuticals.
More information is available at
http://www.elsevier.com/inca/publications/store/5
/2/3/3/2/8/index.htt.
CINAHL:
Database of material related to nursing and the
other allied health disciplines. It is smaller than
Medline, with over 300,000 records from 600
journals, books, but it is much richer, including
the full text of articles and other materials such
as clinical practice guidelines. More information
including access can be found at
www.cinahl.com/.
Full-text Online Journals:
Access occasionally is free, but most often full
text requires subscription. A web site that
explains electronic journals and the issue
surrounding them, and that also provides a rich
source of the issues surrounding them, is:
http://library.kumc.edu/journals/onlinejnls.asp.
Journals:
A hand search of current journals in the field is
still one of the best ways to find newly published
information. But it is inefficient however, in that
articles on the topics of interest may be
published in medical journals other than these in
that discipline.
EBM secondary
resources
Evidence based abstraction
services
Best evidence
www.acponline.org/catalog/electronic/best_e
Annual cost: $ 85
ACP journal club and evidence based
medicine
Search 170 medical journals regularly to
identify original studies & systematic
review that are methodologically sound
&clinically relevant
Structured Reviews
Cochrane library
www.update-software.com/cochrane
Annual cost :$225
Focus primarily on systematic reviews of controlled trials of
therapeutic interventions
Updated quarterly
Contains 3 main sections:
Cochrane database of systematic review (CDSR) include
complete reports for all the systematic review prepared by
members of the Cochrane collaboration
The database of review of effectiveness (DARE) include
systematic review published outside collaboration
The Cochrane controlled trials registry (CCTR)list of reference
of clinical trials that Cochrane investigators found by searching
Text book
uptodate
www.uptodate.com
Annual cost: $495
Well referenced online textbook updated
every 4 mos
it is too large to print
No explicit methodological quality criteria
High quality studies chosen by authors
Clinical evidence
www.evidence.org
Annual cost:$ 115
Six monthly
Published by BMJ publishing group &
American college of physicians/
American society of internal medicine
Harrison’s online
www.harrisonsonline.com
Annual cost :$ 89
e-medicine
www.emedicine.com
free
medscape
www.medscape.com/home/topics/homepage
free
ScHARR netting the evidence
www.shef.ac.uk/~scharr/ir/netting/
free
bandolier
http://www.jr2.ox.ac.uk/bandolier/
free
Clinical practice guidelines
www.guidelines.gov
www.cma.ca/cpgs
free
National electronic library for
health (NHS)
http://rms.nelh.nhs.uk/guidelinesfinder/
Scottish intercollegieat network guidelines
SIGN
http://www.sign.ac.uk/guidelines/
National health & medical
research council (NHMRC)
Australia
http://www.health.gov.au/cgi-
bin/htsearch
MD consult
www.mdconsult.com
Annual cost :$ 200
Turning research into practice
TRIP
Evidence based medicine reviews
OVID
www.ovid.com/products/clinical/ebmr.cfm
Annual cost $ 1995
Combine several electronic databases
Cochrane database of systematic reviews,
best evidence, evidence based mental
health, cancerlit, evidence-based
nursing, healthstar, Medline, in addition
to link to over 200 full text journals
drsdesk
http://drsdesk.sghms.ac.uk/
make a links to full text evidence-based
medicine sources such as Bandolier,
Effective Matters and ACPOnline
Limitation of EBM
Limitation unique to practice of
EBM
the need to develop skills in searching
and critical appraisal
busy clinicians have limited times to
apply these skills
the resources required for access to
evidence are usually inadequate in
clinical sitting.
Limitation universal to any practice
of science and medicine
shortage of coherent consistent scientific
evidence;
difficulties in applying any evidence to
the care of individual patients
barriers to any practice of high quality
medicine.
pseudo limitations which arise from
misunderstanding of what EBM really
means
it ignores clinical expertise
ignores patients’ values
promotes a cookbook approach to
medicine
it is a cost-cutting tool