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EBM: Acquiring Best Evidence

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ASK

ASK:

Background Questions
Ask for general knowledge about conditions, illnesses, patterns of disease, and pathophysiology.

Best bet information sources:

E-book aggregator sites which allow you to search 100+ textbooks covering dozens of specialties, such as:

Clinical evidence summary tools such as:

Be sure to check for qualified authors and references to recent primary literature

Foreground Questions
Ask for specific knowledge to inform clinical decisions or action.

Use PICOTT format to help clarify question.

P: Patient/population
I: Intervention/exposure
C: Comparison/control
O: Outcome(s)
T: Type of question (Therapy/Diagnosis/Prognosis/Harm)
T: Type of study

Best bet information sources:
* Pre-appraised information resources such as those listed on the InFocus 6 Resource List. – These resources provide critical appraisals of individual studies with potential practice-changing implications, as well as context for where the study fits into the larger context of literature on the topic.
* UpToDate – Use UpToDate references to help relevant identify primary literature. Remember UpToDate is a good clinical information summary tool but in and of itself is not evidence. (It's expert opinion.)
* PubMed – Remember to use search options such as sorting and filtering to minimize number of results to review and maximize relevance.

ACQUIRE

ACQUIRE

PubMed Tips

  • Filters:

    • Article types: Help identify “best evidence”
    • Sex, Ages: Help narrow search results to relevant population
    • Core Clinical Journals (under Journal Categories):Filters results to high impact journals

  • Sorting: Sort by Relevance to view most relevant instead of most recent

  • MeSH terms/major topics and subheadings: Can greatly increase relevance of search results, very useful except when searching for very recent publications

Recommended Apps

  • UpToDate
  • AccessMedicine – Features Quick Medical Diagnosis & Treatment (QMDT) and Diagnosaurus

Browse all mobile resources available from Levy Library at Levy Library Medical Apps and Mobile Resources

App access instructions are the same for most resources. 1. Browse or search for the site whose app you would like to access on the Levy Library Databases. 2. Register for a user account on the site. Note that you do not need to use your network ID/password, you can choose your username/password. 3. Download the app from the app store for your device. 4. Open the app on your device and login with your chosen username/password.

On UpToDate use the Log In/Register prompt in the upper right corner
On AccessMedicine, click on the Mt. Sinai and NYU Schools of Medicine, then select Login or Create a Free Personal Account

Any questions? Contact Levy Library

APPRAISE

APPRAISE

Critical appraisal is the process of evaluating the evidence for its validity, impact, and applicability. Each type of evidence calls for its own set of questions during the critical appraisal process.

Pre-appraised information resources such as ACP Journal Club, AAP Grand Rounds, and BMJ Evidence Based Medicine provide critical appraisals of individual studies with potential practice-changing implications, as well as context for where the study fits into the larger context of literature on the topic. Full list and links available at InFocus 6 Resource List.

If you need to appraise an individual study, click the links below to access free, brief critical appraisal checklists for each type of EBM question.

APPLY

APPLY

Per the Users’ Guides to the Medical Literature, “Evidence-based medicine requires that clinical decisions be consistent with the informed values and preferences of the patient. We use values and preferences as an overarching term that includes patients' perspectives, priorities, beliefs, expectations, values, and goals for health and life… [m]ore precisely, to mean the processes that individuals use in considering the potential benefits, harms, costs, and inconveniences of the management options in relation to one another.”

Decision aids are tools which are designed to help patients better understand the potential benefits and harms of the available care options.

Two websites offering excellent decision aids include:

EBM Cycle

EBM