INFORM Workshop Training Materials
Evidence Based Medicine Resources
Evidence Based Medicine Resources (EBM)
EBM is a hot topic, and a huge amount of material about it is available on-line. Two years ago, if you did a search on Yahoo for evidence based medicine, you got about 140,000 ‘hits’. Today you get about 310,000! The following pages will help you get an overview of the resources and introduce you to some of the major ones.
Learning on your own
You can learn about EBM in several different ways. Alternative resources for learning on your own include on-line bibliographies, article series, tutorials, syllabi, and books.
Bibliographies—lists of publications on a topic—are useful for getting a ‘feel’ for the literature. You will find bibliographies about EBM at many of the EBM sites listed below. The best on-line bibliography is perhaps the one at the Evidence-based Medicine Resource Center at www.ebmny.org/ebmbib.html. Most of the publications are from the 1990s, which was when the classic papers in EBM were published. Other examples of on-line bibliographies include one at BESTT at www.allconet.org/ahec/bestt/ebmbib.htm and the ‘EBM Librarian: Bibliographies of Possible Readings for an EBM Syllabus’ at www.geocities.com/nqiya/EBMbib.html.
The most famous set of articles on EBM is the series by Trisha Greenhalgh, first published in the British Medical Journal, on ‘How to Read a Paper’. The whole set is available on-line at bmj.com/collections/read.htm.
Also noteworthy is the Users’ Guides to Evidence-Based Practice, which were originally published as a series of articles in the Journal of the American Medical Association (JAMA). The Centre for Health Evidence provides the basic text of the guides as a tutorial on EBM (www.cche.net/usersguides/main.asp). The full guides, including worksheets, calculators, and other teaching/learning materials, are now available on-line from JAMA by subscription at www.usersguides.org/.
Both of the BMJ and JAMA series—plus others about, for example, systematic and getting research findings into practice—can also be accessed on-line through the EBM bibliography at the Evidence-based Medicine Resource Center mentioned above.
Medical libraries play a major role in producing EBM tutorials. Three sites to check out are www.hsl.unc.edu/services/tutorials/ebm/welcome.htm (University of North Carolina’s health science library, www.uic.edu/depts/lib/lhsp/resources/ebm.shtml (University of Illinois at Chicago’s health science library at Peoria) and, from Australia, www.library.usyd.edu.au/subjects/medicine/tutorials/ebmtut/index.html.
The Centre for Evidence-Based Medicine in Toronto, Canada, which originally produced the book Evidence Based medicine: How to practice and teach EBM, provides on-line syllabi for EBM teaching units, based on materials from the book. Their site also provides teaching materials such as critical appraisal worksheets, teaching tips, and a powerpoint presentation on teaching EBM in developing countries. The address is www.cebm.utoronto.ca.
At the moment there are no free full-text on-line books on EBM. Possibly the best choice if you are going to buy a text is the one mentioned above, which is available now in 3rd edition from Elsevier.
Finding EBM information for your work
There are many place you can turn to find EBM based reviews and guidelines. These are expert evaluation of the evidence for a particular preventive measure, diagnostic test, treatment, or rehabilitation method.
The Cochrane Collaboration www.cochrane.org, which arranges systematic reviews of health care interventions and publishes the results as protocols and reviews, is perhaps the most famous. Tanzanian users have full access through INASP/PERI. The review abstracts are at www.cochrane.org/cochrane/revabstr/crgindex.htm and are available free to everyone.
Another large resource for guidelines and evaluations of impact is the Agency for Healthcare Research and Quality (www.ahrq.gov/), including the National Guideline Clearinghouse www.guideline.gov. The Clearinghouse provides links to guidelines from around the world in all areas of medicine. AHRQ itself carries out its own evaluations of interventions and technologies, in part in collaboration with medical universities and other research institutes.
Another large guideline collection is available at www.gfmer.ch. The most detailed list is available on obstetrics, gynaecology, and reproductive health. The WHO Reproductive Health Library, available now on-line at www.who.int , includes a fair number of full-text Cochrane reviews within the area of reproductive health and perinatology, as well as other useful materials.
The eMedicine site at www.emedicine.com provides peer-reviewed articles summarizing the state-of-the-art for specific medical conditions.
BMJ has gathered and evaluated information about clinical interventions and made it available at a site called ‘Cinical evidence’ at www.clinicalevidence.com/. Access requires a subscription but is free of cost for developing countries.
Journals specializing in EBM and related topics continue to grow in number and popularity. You should check your local library first to see if it provides on-line full-text access for all articles in these journals. If not, you still may be able to get abstracts and perhaps full text for older articles by going directly to the journal’s website. A list of EBM journals, together with direct links, is provided by the EBM Resource Center at www.ebmny.org/journal.html.
Examples of EBM focused journals include Bandolier, ACP Journal Club: Evidence Based Medicine for Better Patient Care, Clinical Evidence plus a host of other EBM journals on various specialities, including Evidence-Based Nursing, Evidence-Based Mental Health, Evidence-Based Cardiovascular Medicine, Evidence-Based Healthcare and Public Health,, Evidence-Based Obstetrics and Gynecology, and Evidence-Based Practice. These journals review articles in selected journals and report findings that are considered by the reviewers to be scientifically sound and of significant clinical interest. The BMJ Publishing Group and Elsevier Scientific are among the major publishers for this type of journal. Check to see if your library has paid or subsidized subscriptions to any of these journals.
For further exploration
You can save a great deal of time looking for WWW sites about EBM if you begin at a gateway, that is, a site where someone has kindly collected together a large number of relevant addresses. All you need to do is scroll through the list, find something interesting, click on the text, and you’re immediately connected.
EBM gateways often include connections to many kinds of resources, including the following: WWW sites for EBM centres and organizations; on-line EBM articles and other publications; EBM conference and course information; guidelines, protocols and other reviews; journals with focus on EBM; information about methodological filters for finding EBM research papers; tools for evaluating research; glossaries of terminology used in EBM; databases such as Best Evidence, the Clinical Trials Databases at NIH, and the Cochrane Library; and on-line EBM tutorials and other general introductions to EBM.
Here are some sites to try:
In the United Kingdom, the Centre for Evidence Based Medicine in Oxford is a major promoter of EBM and specializes in training courses, teaching materials, and analytical tools. The address is www.cebm.net.
The Learning and Information Services of the University of Hertfordshire has an EBM gateway at www.herts.ac.uk/lis/subjects/health/ebm.htm.
The University of Sheffield’s School of Health and Related Research (SchARR) has an EBM gateway called ‘Netting the Evidence’, available at www.shef.ac.uk/~scharr/ir/netting/. .
Another UK site you may want to visit is the NHS Centre for Reviews and Dissemination (CRD) at the University of York at www.york.ac.uk/inst/crd/. CRD was established to provide the National Health Service with information on the effectiveness of various aspects of health care. It does this by carrying out research reviews, which are provided in three on-line databases—DARE (abstracts of quality assessed systematic reviews), NHSEED (economic evaluations of health care interventions), and HTA (health technology assessment). Professionals with questions about systematic reviews and economic evaluations can even contact CRD for free assistance. Click on ‘Enquiry Service’ for details.
Canada is also a leading country in the EBM field. One centre for EBM activity is McMaster University’s Health Information Research Unit (hiru.mcmaster.ca). Two major EBM journals, Evidence Based Medicine and The ACP Journal Club, are edited by the head of the unit, Brian Haynes.
Another Canadian focal point is the Centre for Evidence Based Medicine, University of Toronto at www.cebm.utoronto.ca/. CEBM gives guidance on how to practice EBM and supplies syllabi (reading lists) together with practice exercises. The site also incorporates a gateway (click on evidence resources in left panel), including links to EBM journals, to publishers of textbooks (e.g., Elsevier for Evidence-Based Medicine: How to Practice and Teach EBM), and to 30 Web sites.
A third major Canadian site is the Centre for Health Evidence at the University of Alberta (www.cche.net), which is engaged in numerous EBM projects.
In the US, the major gateway to EBM resources includes the one provided by the and by the New York Academy of Medicine Library and the New York Chapter of the American College of Physicians at their Evidence-based Medicine Resource Center at www.ebmny.org/.
However, there are also numerous excellent gateways run by librarians in collaboration with EBM specialists. An excellent example is the EBM gateway at the Miner Library, University of Rochester Medical Center at www.urmc.rochester.edu/Miner/Links/ebmlinks.html. The gateway at the Welch Library, Johns Hopkins University, is more limited but the listed items have been evaluated and ranked (www.welch.jhu.edu/internet/ebr.html). Finally, INASP has included a set of EBM sites in its health links set, which can be reached at www.inasp.info/health/links/contents.html.
Finally, something funny about EBM
Among the many thousands of articles about EBM, ones deserve special mention just because it is very, very funny!
This classic piece is entitled ‘Seven Alternatives to Evidence Based Medicine’. It was written by David Isaacs and Dominic Fitzgerald published in the British Medical Journal (volume 319, 18-25 December 1999).
Among the alternatives to evidence based medicine that are ‘proposed’ by the authors as possible ways to judge validity in medicine are eminence based medicine, vehemence based medicine, eloquence based medicine, providence based medicine, diffidence based medicine, nervousness based medicine, and confidence based medicine. You can access the full text by going to www.bmj.com and searching in the archives.
Martha J Garrett
INFORM
Faculty of Medicine, Uppsala University
Uppsala University, Sweden
June 2005
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