Duke University Medical Center Library Online

Hierarchy of Evidence-Based Medicine (EBM) Resources/

Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.)

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TRIP (Turning Research Into Practice) Database Plus

Simultaneously searches evidence-based websites of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE's Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.

Filtered Resources

Filtered resources appraise the quality of studies and often make recommendations for practice.

Systematic Reviews / Meta-Analyses
Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. A meta-analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results.
The Cochrane Database of Systematic Reviews
Consists of detailed, structured topic reviews of hundreds of articles. Teams of experts complete comprehensive literature reviews, evaluate the literature, and present summaries of the findings of the best studies. Published by the International Cochrane Collaboration.
The Database of Abstracts of Reviews of Effect (DARE)
Database containing structured abstracts of systematic reviews from a variety of medical journals. DARE is produced by the National Health Services' Centre for Reviews and Dissemination (NHS CRD) at the University of York. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.
Systematic Reviews are also searchable in MEDLINE:

Ovid MEDLINE: Enter your search query. Click on the "Limits" icon; select "Systematic Reviews" under "Subject Subsets."

PubMed: Click on "Clinical Queries" on the left side of the screen; select "Find Systematic Reviews" and enter your search query.
Critically-Appraised Topics
Authors of critically-appraised topics evaluate and synthesize multiple research studies.
National Guideline Clearinghouse
A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Updated weekly.
Note: Guideline evidence varies from expert opinion to high levels of evidence.
Critically-Appraised Individual Articles
Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
The ACP Journal Club
The editors of this journal screen the top 100+ clinical journals and identify studies that are clinically relevant and methodologically sound. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine.
Bandolier
Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes "information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies."
"Evidence-Based�" Journal series
(e.g., Evidence-Based Medicine, Evidence-Based Mental Health, Evidence-Based Nursing) Primary research articles within the discipline are selected for quality and clinical relevance. A structured abstract and expert commentary are provided for each study.
Check ejournals for a complete list of titles in Evidence-Based Medicine.

Unfiltered Resources

Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use specific search strategies in MEDLINE and other databases to achieve the highest possible level of evidence.

PubMed
PubMed is a service of the U.S. National Library of Medicine that includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.
To limit your PubMed search to the best evidence-producing studies: Click on "clinical queries" (on the left side of the screen). This specialized search is intended for clinicians and has built-in search "filters." Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you may indicate whether you wish your search to be more sensitive (i.e., include most relevant articles but probably including some less relevant ones) or more specific (i.e., including mostly relevant articles but probably omit a few).
Ovid Medline
To limit your Ovid MEDLINE search to the best evidence-producing studies: Clinical Queries (See PubMed) is searchable in Ovid; click on the "Limits" icon.
PsycINFO
International coverage of the professional and academic literature in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas.
To limit your PsycINFO search to the best evidence-producing studies: Click on the 'Limits' icon to use 'Clinical Queries' or limit to 'methodology' types.
CINAHL
Cumulative Index to Nursing and Allied Health Literature

Background Information/Expert Opinion

Note: Evidence in these resources may vary from expert opinion to high levels of evidence.

UpToDate
A clinical information resource, which offers up-to-date, fully referenced expert answers to patient-care, diagnosis, and treatment questions. Topic reviews are written by recognized authorities who review the topic, synthesize the evidence, summarize key findings, and provide specific recommendations.
(Access restrictions: UpToDate is licensed for on-site use only at Dartmouth College, Dartmouth Medical School, and the Dartmouth-Hitchcock Medical Center. Remote access is not permitted.)
eMedicine
Physician authors and editors contribute to the eMedicine Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content provides the latest practice guidelines in 62 medical specialties. eMedicine's professional content undergoes multiple levels of physician peer review.
Some content available with registration. Full database requires a subscription.
eBooks
Full-text electronic books.

Evidence-Based Medicine Information Sites

Centre for Evidence-Based Medicine (Oxford University)
The Centre promotes evidence-based health care and provide support and resources to anyone who wants to make use of them. Includes the EBM Toolbox, an assortment of materials which are very useful for practitioners of EBM, and EBM Teaching Materials, including PowerPoint presentations.
Centre for Evidence-Based Medicine (Toronto)
Includes many resources for practicing and teaching EBM.
Evidence-Based Medicine at Duke
This site is designed to assist faculty, house staff, and students in understanding and teaching the principles involved in practicing EBM. The site includes 6 units: General Information, Building Questions, Searching Literature, Appraising Evidence, EBM at Duke, and Internet Resources. It includes teaching tools, tips and critical appraisal forms.
Netting the Evidence
From the School of Health and Related Research (ScHARR) at the University of Sheffield, UK. Includes a comprehensive list of EBM databases, journals, articles, and other information sources.
Users' Guides to Evidence-Based Practice
From the University of Alberta's Centre for Health Evidence. Includes the complete set of EBM Users' Guides originally published as a series in the Journal of the American Medical Association (JAMA).

Evidence-Based Medicine Tutorials

Introduction to Evidence-Based Medicine
From Duke University Medical Center Library and University of North Carolina at Chapel Hill Health Sciences Library.
SUNY Health Sciences Evidence-Based Medicine Course
Users Guide Interactive Web site
The Users' Guide Interactive Web site contains the entire contents of Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, and makes this content interactive with dynamic tips, worksheets, calculators, and illustrative clinical cases. New interactive features are added continually.

Evidence-Based Medicine Resources for PDA

Evidence-Based Medicine Resources for the PDA
A list of resources from the Dartmouth Biomedical Libraries.

Local Resources (e.g., Class Handouts, Tip Sheets)

Evidence Pyramid
Handout showing hierarchy of evidence and search strategies. Includes definitions of study designs.
EBM Resources Comparison Chart
Chart comparing the various EBM Resources