LibGuides: Evidence-Based Practice in Health & Medicine: EBP Resources

EBP Pyramid & Definition

EBM Definition & EBM Resources Pyramid

Evidence-Based Medicine (EBM) 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.).

The terms evidence-based medicine (EBM) and evidence-based practice (EBP) are often used interchangeably.

The EBM Resources Pyramid, below, is just one pyramid used for EBP, and demonstrates different levels of evidence. As you move up the pyramid, the level of evidence gets higher. The width of each level provides context for the amount of information at each level.

EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved.
Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

Sources Related to Levels of EBP Resource Pyramid

Filtered Resources

Filtered resources appraise the quality of studies and often make recommendations for practice. Filtered resources include the top levels of the pyramid: Critically-appraised individual articles (article synopses), critically-appraised topics (evidence-syntheses), and systematic reviews that includes the systematic review type of meta-analyses.

Systematic Reviews / Meta-Analyses (highest pyramid level)

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.

Cochrane Library This link opens in a new window
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.

Trip Database
Simultaneously searches evidence-based sources 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.

PubMed This link opens in a new window
Run a search and then use the left-hand filters and select the Article Type of Systematic Review or Meta-Analysis, or from PubMed's homepage, scroll down the screen and under Find select Clinical Queries to run your search and find systematic reviews.

Critically-Appraised Topics / Evidence Syntheses

Authors of critically-appraised topics evaluate and synthesize multiple research studies.

EPC Reports- Agency for Healthcare Research and Quality
"AHCQ evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues. EPC reports and assessments may include meta-analyses and cost analyses."
Essential Evidence Plus & AHFS DI Essentials
"Provide best-evidence answers to the most important clinical questions concerning symptoms, diseases, drugs, and other treatment regimens. Its concise, highly structured content is tightly integrated and hyperlinked to thousands of calculators, articles, Cochrane Systematic Reviews, and evidence summaries within EE+ to make searching for answers quick and seamless. Each topic has a "strength-of-evidence" rating for every recommendation, a "Bottom Line" summary that introduces each section, and a broad array of algorithms to aid in the decision-making process." - From publisher site.
The 5-Minute Clinical Consult
"5MinuteConsult is a fully integrated digital resource to help guide primary care professionals and clinical students in daily decision support, based on the best-selling clinical content in the family medicine market for over 20 years, giving access to the information needed at the point-of-care. It is the fastest resource to obtain the most likely diagnosis, treatment, and management for thousands of diseases." -From the publisher
JAMA Rational Clinical Exam Series
"Explore JAMA's groundbreaking series on evidence-based use of the medical history, physical examination, and testing to diagnosis disease." -From JAMA
U.S. Preventive Services Task Force (USPSTF)
Experts in primary care and prevention systematically review the evidence of effectiveness and develops recommendations for clinical preventive services.

Critically-Appraised Individual Articles

Authors of critically-appraised individual articles evaluate and synopsize individual research studies.

ACP Journal Club
ACP Journal Club summarizes the best new evidence for internal medicine from over 120 clinical journals. Once a bimonthly stand-alone journal, ACP Journal Club is now a monthly feature of Annals of Internal Medicine.
Evidence Alerts
*Requires free registration. "DynaMed Plus and McMaster University's Health Information Research Unit are collaborating to provide you with access to current best evidence from research, tailored to your own health care interests, to support evidence-based clinical decisions.
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This service is unique: all articles (from over 120 premier clinical journals) are pre-rated for quality by highly trained research staff, then rated for clinical relevance and interest by at least 3 members of a worldwide panel of practicing physicians."
Worldviews on Evidence-Based Nursing
Along with other article types, this journal offers "Knowledge synthesis articles with best practice applications and recommendations for linking evidence to action in real world practice, administrative, education and policy settings."

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 (contained in PubMed) and other databases to achieve the highest possible level of evidence.

PubMed This link opens in a new window
To limit your PubMed search to the best evidence-producing studies: Click on "Clinical Queries" (under PubMed Tools). 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).
CINAHL: Cumulative Index to Nursing and Allied Health Literature (EBSCO) This link opens in a new window
Note: To limit your CINAHL search to the best evidence-producing studies: From the Advanced Search there are multiple options, including Clinical Queries, Special Interest > Evidence-Based Practice, and Publication Type > (select Meta Analysis, Meta Synthesis, Systematic Review, etc.)
PsycINFO and PsycArticles (APA via ProQuest) This link opens in a new window
International coverage of the professional and academic literature in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas.

Note: To limit your PsycINFO search to the best evidence-producing studies: Scroll down the default search screen (Advanced Search), and under "Document Type" select "Evidence Based Healthcare".
Cochrane Library This link opens in a new window
Cochrane CENTRAL is a part of the Cochrane Library and contains randomized controlled trials and controlled clinical trials from all Cochrane Review Groups' Specialised Registers. These registries include records from MEDLINE and EMBASE, as well as records from their handsearch results registries. Note: To use CENTRAL, run your search, and then use the left-hand limits and select the button next to Trials.

Background Information / Expert Opinion (lowest pyramid level)

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

STAT!Ref (Teton Data Systems) This link opens in a new window
STAT!Ref cross-searches numerous medical reference books at the same time. Reference books are a great source for background information.
Ebook Central (ProQuest) This link opens in a new window
ProQuest Ebook Central is an online digital library that provides numerous ebooks that include easy-to-use tools for taking notes and creating citations.

Harrison's Principles of Internal Medicine by Dennis L. Kasper
ISBN: 0071802134
Searchable and continually updated version of Harrison's Principles of Internal Medicine.