What is Evidence Based Medicine?

• Evidence-based medicine: a new approach to teaching the practice of medicine (also at JAMA 1992; 268: 2420-25)

• What is Evidence Based Medicine?

  • Evidence-based medicine: a new approach to teaching the practice of medicine (also at JAMA 1992; 268: 2420-25)
  • Evidence-based medicine: What it is and what it isn't, by David Sackett from the NHS (UK) Research and Development Centre for Evidence-Based Medicine
  • Evidence-based Medicine: A New Science or an Epidemiologic Fad? Bauchner H. Pediatrics 1999; 103: 1029-1031. [Full-text for AAP members/subscribers]
  • Glossary of EBM Terms also from the NHS (UK) Research and Development Centre for Evidence-Based Medicine
  • The Medical Literature as a Resource for Evidence Based Care, by McKibbon, K.A.
  • Medicine based evidence, a prerequisite for evidence based medicine. Knottnerus JA, Dinant GJ. Br Med J 1997; 315: 1109-10. (full-text editorial)
  • Clinical Epidemiology & Evidence-Based Medicine Glossary, from Washington State University College of Veterinary Medicine
  • Werk L, Bauchner H, Chessare JB. Medicine For The Millenium: Demistifying EBM. Contemporary Pediatrics December 1, 1999. [full-text with free registration]
  • Christakis DA, Davis R, Rivara FP. Pediatric evidence-based medicine: Past, present, and future. J Pediatr 2000;136:383-389. [citation] [full-text for subscribers]. Accompanied by an editorial by Moyer VA, Elliott EJ. J Pediatr 2000;136:282-4. [full-text]
  • Qualitative research and evidence based medicine. Green J, Britton N. Br Med J 1998; 316: 1230-1232.
  • Ethics and evidence based medicine. Kerridge I, Lowe M, Henry D. Br Med J 1998; 316: 1151-1153
  • Jadad AR, Haynes RB, Hunt D, Browman GP. The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management
  in health care, Can Med Assoc J 2000;162(3):362-5 [full-text]
  • Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. CMAJ 2000;163(7):837-41. [full-text]
  • Every "religion" has its critics: for EBM devotees, to be read with caution (don't say we didn't warn you!): Clinicians for the Restoration of Autonomous Practice (CRAP) Writing Group. EBM: unmasking the ugly truth. Br Med J 2002;325 1496-1498 [full-text]
  • How well is EBM doing after 10 years? The October 30, 2004 issue of the British Medical Journal is dedicated to this question.

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  How to Critically Appraise the Medical Literature User's Guide to Medical Literature; A series from the Evidence-Based Medicine Informatics Project at McMaster University, available at: The Canadian Centres for Health Evidence Now available as a reference book, CD, and handbook at: Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice How to use an article about: Prognosis Therapy or Prevention Harm Diagnosis Clinical Utilization Review or Audit Outcomes Research Health-Related Quality of Life Economic Analysis of Clinical Practice How to use a: Clinical Decision Analysis Clinical Practice Guideline Systematic Review or Overview And... How to Decide on the Applicability of Clinical Trial Results to Your Patient A Method for Grading Health Care Recommendations Also see ... Users' Guides to the Medical Literature XXII: How to Use Articles About Clinical Decision Rules. McGinn TG, Wyer PC, Naylor CD et al. JAMA. 2000;284:79-84. [full-text for subscribers only] Users' Guides to the Medical Literature XX. Integrating Research Evidence With the Care of the Individual Patient. McAlister FA, Straus SE, Guyatt GH, Haynes RB et al. JAMA. 2000;283:2829-2836. [abstract] [full-text for subscribers only] Users' guides to the medical literature, XIX: Applying clinical trial results, A: how to use an article measuring the effect of an intervention on surrogate end points. Bucher HC, Guyatt GH, Cook DJ, et al. JAMA 1999;282:771-778. [citation] [full-text for subscribers only] Users' Guides to the Medical Literature XIX. Applying Clinical Trial Results B. Guidelines for Determining Whether a Drug Is Exerting (More Than) a Class Effect. McAlister F, Laupacis A, Wells GA, et al. [citation] [full-text for subscribers only] Users' Guides to the Medical Literature XXI. Using Electronic Health Information Resources in Evidence-Based Practice. Hunt DL, Jaeschke R, McKibbon A. et al. JAMA 2000; 283:1875-1879. [full-text for subscribers only] Users' Guides to the Medical Literature XXIII. Qualitative Research in Health Care A. Are the Results of the Study Valid? Mita K. Giacomini; Deborah J. Cook; for the Evidence-Based Medicine Working Group JAMA. 2000;284:357-362. [full-text for subscribers only] Users' Guides to the Medical Literature XXIII. Qualitative Research in Health Care B. What Are the Results and How Do They Help Me Care for My Patients? Mita K. Giacomini; Deborah J. Cook; for the Evidence-Based Medicine Working Group JAMA. 2000;284:478-482. [full-text for subscribers only] Users' guides to the medical literature: XXIV. How To use an article on the clinical manifestations of disease. Richardson WS, Wilson MC, Williams JW Jr, Moyer VA, Naylor CD. JAMA. 2000;284(7):869-75. [abstract] [full-text for subscribers only] Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD, Wilson MC. Users' guides to the medical literature: XXV. evidence-based medicine: principles for applying the Users' guides to patient care. JAMA. 2000;284(10):1290-6. [abstract] [full-text for subscribers only] An alternate complete Users' Guide listing is maintained at UCSF as well How to read a paper: A series in the British Medical Journal on database searching and article appraisal The Medline database Greenhalgh T. Br Med J 1997; 315: 180-4. Getting your bearings (deciding what the paper is about). Greenhalgh T. Br Med J 1997; 315: 243-6. Assessing the methodological quality of published papers. Greenhalgh T. Br Med J 1997; 315: 305-8. Papers that report diagnostic or screening tests. Greenhalgh T. Br Med J 1997; 315: 540-544. Papers that tell you what things cost (economic analyses). Greenhalgh T. Br Med J 1997; 315: 596-600. Papers that summarise other papers (systematic reviews and meta-analyses). Greenhalgh T. Br Med J 1997; 315: 672-675. Papers that go beyond numbers (qualitative research). Greenhalgh T, Taylor R. Br Med J 1997; 315: 740-743. Other resources A series on appraisal of cohort studies in the BMJ: Gurwitz JH, Sykora K, Mamdani M, et al. Reader's guide to critical appraisal of cohort studies: 1. Role and design. Br Med J 2005; 330;895-897 [full-text] Mamdani M, Sykora K, Li P, Normand SL, Streiner DL, Austin PC, Rochon PA, Anderson GM. Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. Br Med J. 2005 Apr 23;330(7497):960-2. [full-text] How to Read a Medical Journal Article, from S. Simon at Children's Mercy Hospital In Which Journals Will Pediatricians Find the Best Evidence for Clinical Practice? Birken CS, Parkin PC. Pediatrics 1999; 103: 941-947. [Abstract] [Full-text for AAP members/subscribers]. With an accompanying commentary: Evidence-based Medicine: A New Science or an Epidemiologic Fad? Bauchner H. Pediatrics 1999; 103: 1029-1031. [Full-text for AAP members/subscribers] DISCERN; a tool to evaluate clinical information publications, directed primarily to consumers of health care. Return to Top

  Statistics and Trial Design for Clinicians Fundamental Concepts Kain ZN, MacLaren J. P less than .05: what does it really mean? Pediatrics. 2007 Mar;119(3):608-10. [citation] A new series on how to learn and teach evidence-based medicine starts in the Canadian Medical Association Journal : This series is associated with a new, interactive website full of EBM tips: Evidence Based Practice Tips: Learning Tools for Evidence-based Practice Wyer PC, Keitz S, Hatala R et al. Tips for learning and teaching evidence-based medicine: introduction to the series. Can Med Assoc J 2004;171 347-348 [full-text] Barratt A, Wyer PC, Hatala R et al. Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. Can Med Assoc J 2004;171 353-358 [full-text] Montori VM, Kleinbart J, Newman TB, Keitz S, Wyer PC, Moyer V, Guyatt G, for The Evidence-Based Medicine Teaching Tips Working Group . Tips for learners of evidence-based medicine: 2. Measures of precision (confidence intervals). Can Med Assoc J 2004;171 611-615 [full-text] Canadian Medical Association Journal: Collected Series on Statistics (the previous four "basics" articles on no longer online...) Two articles published in the British Medical Journal Statistics for the non-statistician. Greenhalgh T. Br Med J 1997; 315: 364-7. Statistics for the non-statistician. II: "Significant" relations and their pitfalls. Greenhalgh T. Br Med J 1997; 315: 422-6. A series in Annals of Internal Medicine Goodman SN. Toward Evidence-Based Medical Statistics. 1: The P Value Fallacy. Annals of Internal Medicine 1999;130:995-1004. [full-text for a limited time] Goodman SN. Toward Evidence-Based Medical Statistics. 2: The Bayes Factor. Annals of Internal Medicine 1999;130:1005-1013. [full-text for a limited time] Davidoff F. Standing Statistics Right Side Up. Annals of Internal Medicine 1999; 130:1019-1021. [full-text for a limited time] Other articles discussing statistical principles and clinical epidemiology: Pewsner D, Battaglia M, Minder C, Marx A, Bucher HC, Egger M. Ruling a diagnosis in or out with "SpPIn" and "SnNOut": a note of caution. Br Med J 2004; 209-213. [full-text] Knottnerus JA, van Weel, C, Muris JW. Evidence base of clinical diagnosis: Evaluation of diagnostic procedures. Br Med J 2002;324 477-480. [full-text] Sterne JAC, Smith GD, Cox DR. Sifting the evidence: what's wrong with significance tests? Br Med J 2001; 322: 226-231. [Full-text] Sterne JAC, Egger M, Smith GD. Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. Br Med J 2001; 323: 101-105 [full-text] Frohna JG, Park SM, Gopal A. Diagnosing Bacterial Meningitis After the Haemophilus influenzae Vaccine: Still A Challenge. Arch Pediatr Adolesc Med 2001; 155:1307-1310. [full-text for subscribers] (.. excellent presentation of likelihood ratios!) Smith JE, Winkler RL, Fryback DG. The First Positive: Computing Positive Predictive Value at the Extremes. Ann Intern Med 2000; 132:804-809. [full-text for a limited time] Evidence Based Drug Therapy: What Do the Numbers Mean?, from Therapeutics Letter at Therapeutics Initiative: Evidence Based Drug Therapy, University of British Columbia When can odds ratios mislead? Davies HTO, Crombie IK, Tavakoli M. Br Med J 1998;316:989-991. Bjerre LM, LeLorier J. Expressing the magnitude of adverse effects in case-control studies: "the number of patients needed to be treated for one additional patient to be harmed." Br Med J 2000;320:503-506. [full-text] Use of confidence intervals to indicate uncertainty in research findings. Altman DG. Evidence-Based Medicine May/June 1996 (full-text editorial) Confidence intervals for the number needed to treat. Altman DG. Br Med J 1998;317:1309-1312 Calculating the number needed to treat for trials where the outcome is time to an event. Altman DG, Anderson PK. Br Med J 1999;319:1492-149. Number Needed to Treat and Likelihood Ratios from the NHS (UK) Research and Development Centre for EBM Distinguishing between "no evidence of effect" and "evidence of no effect" in randomised controlled trials and other comparisons . Tarnow-Mordi WO, Healy MJR. Arch Dis Child 1999;80:210-211. (full-text until 7/99) Statistics notes: How to randomize. Altman DG, Bland JM. Br Med J 1999; 319:703-704. Vicker AJ, Altman DG. Statistics Notes: Analysing controlled trials with baseline and follow up measurements. Br Med J 2001;323 1123-1124.[full-text] Day SJ, Altman DG. Statistics Notes: Blinding in clinical trials and other studies. Br Med J 2000; 321: 504 [full-text] Deeks JJ, Altman DG. Statistics Notes: Diagnostic tests 4: likelihood ratios. Br Med J 2004;329:168-169. [full-text] What is meant by intention to treat analysis? Survey of published randomised controlled trials . Hollis S, Campbell F. Br Med J 1999;319:670-674. Understanding controlled trials: Randomisation methods: concealment. Torgerson DJ, Roberts C. Br Med J 1999;319:375-376. (full-text) Jadad AR: Randomised Controlled Trials. London, BMJ Books, 1998. [full-text]; an excellent resource now online A series in the Canadian Medical Association Journal on RCT's Sackett DL, Hoey J. Why randomized controlled trials fail but needn't: a new series is launched. Can Med Assoc J 2000;162(9):1301-2. [full-text] Sackett DL. Why randomized controlled trials fail but needn't: 1. Failure to gain "coal-face" commitment and to use the uncertainty principle. Can Med Assoc J 2000;162(9):1311-4. [full-text] Sackett DL. Why randomized controlled trials fail but needn't: 2. Failure to employ physiological statistics, or the only formula a clinician-trialist is ever likely to need (or understand!) Can Med Assoc J 2001;165(9):1226-37. [full-text] Bias. Bandolier 80; October 12, 2000. [full-text] An excellent review! Cummings P, Rivara FP. Reporting Statistical Information in Medical Journal Articles. Arch Pediatr Adolesc Med 2003;157 321-324 [full-text for subscribers] Glasziou P, Vandenbroucke J, Chalmer I. Assessing the quality of research. Br Med J 2004;328:39-41 [full-text] Trial Design: Consistency of Reporting Moher D, Schulz KF, Altman D. The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel-Group Randomized Trials. JAMA. 2001;285:1987-1991. [abstract][full-text] Chan KBY, Man-Son-Hing M, Molnar FJ, Laupacis A. How well is the clinical importance of study results reported? An assessment of randomized controlled trials. Can Med Assoc J 2001;165(9):1197-202 [full-text] Montori VM, Guyatt GH. Intention-to-treat principle. Can Med Assoc J 2001;165(10):1339-41 [full-text] Online Statistics Texts, Calculators and General Web Resources GraphPad QuickCalcs; online calculators. GraphPad Software. Epidemiology for the Uninitiated; 4th edition. Coggon D, Rose G, Barker DJP. Br Med J 1997. UBC Clinical Significance Calculator; contingency table analysis to determine risks and odds ratios and their 95% confidence intervals. University of British Columbia Statistical Calculators including almost all tests you could need with Comparisons (t-test etc), Crosstabs, Regression, Power and links to all Statistics Sites on the WWW Rice Virtual Lab in Statistics; David Lane, Rice University Includes HyperStat Online, a textbook with extensive contextual links to other resources A New View of Statistics, Will Hopkins, from Sportscience.org Electronic Statistics Textbook, from StatSoft Bayesian Analysis Model Calculator, from Medical College of Wisconsin Division of General Internal Medicine An extensive online statistics textbook: SurfStat Australia, from the University of Newcastle. Introductory Guide to Statistics, from University of Queenland, Brisbane, Australia (server currently not responding) Additional statistics resources on the web listed in: Statistics and Research, J. Loadsman, ed. In The Virtual Anaesthesia Textbook. Statistics on the Web; a large and well organized list. Clay Helberg. Epidemiology and Biostatistics Resources; an excellent list from Department of Pediatrics, University of Utah School of Medicine EBM_Tools.doc - a Microsoft Word 97/98 template file that performs numerous clinical epidemiology calculations, e.g., relative risk reduction, likelihood ratios, etc., and the relevant confidence intervals. Written and submitted to PedsCCM by Arno Zaritsky, MD. Statistical calculators; spreadsheets (Excel) to calculate odds ratios, confidence intervals, sample size estimates and more. University of Utah, Pediatric Emergency Medicine. The coolest interactive demonstration of how ROC (receiver operator characteristic) curves work is here, at the Anesthestist.com Return to Top

  Understanding Systematic Reviews A full-text series in the Ann Intern Med on Systematic Reviews: Systematic Reviews: Critical Links in the Great Chain of Evidence. Mulrow CD, Cook DJ, Davidoff F. Ann Intern Med 1997; 126:389-391. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions. Cook DJ, Mulrow CD, Haynes RB. Ann Intern Med 1997; 126:364-371. Using Numerical Results from Systematic Reviews in Clinical Practice. McQuay HJ, Moore RA. Ann Intern Med 1997; 126:712-720. Locating and Appraising Systematic Reviews. Hunt DL, McKibbon KA. Ann Intern Med 1997; 126:532-538. The Relation between Systematic Reviews and Practice Guidelines. Cook DJ, Greengold NL, Ellrodt AG, Weingarten SR. Ann Intern Med 1997; 127:210-216. Quantitative Synthesis in Systematic Reviews. Lau J, Ioannidis JPA, Schmid CH. Ann Int Med 1997; 127:820-826. A full-text series on meta-analysis in the British Medical Journal: Papers that summarise other papers (systematic reviews and meta-analyses). Greenhalgh T. Br Med J 1997; 315: 672-5. In this issue also see: Meta-analysis and the meta-epidemiology of clinical research: Meta-analysis is an important contribution to research and practice but it's not a panacea. Naylor CD. Br Med J 1997; 315: 617-9. An amnesty for unpublished trials. Smith R, Roberts I. Br Med J 1997; 315: 622. Bias in meta-analysis detected by a simple, graphical test. Egger M, Smith GD, Schneider M, Minder C. Br Med J 1997; 315: 629-634. Impact of covert duplicate publication on meta-analysis: a case study. Tramer MR, Reynolds JM, Moore RA, McQuay HJ. Br Med J 1997; 315: 635-9. Publication bias: evidence of delayed publication in a cohort study of clinical research projects. Stern JM, Simes J. Br Med J 1997; 315: 640-5. Meta-analysis: Potentials and Promise. Egger M, Davey Smith G. Br Med J 1997; 315: 1371. Meta-analysis: Principles and Procedures. Egger M, Davey Smith G, Phillips AN. Br Med J 1997; 315: 1533. Meta-analysis: Beyond the grand mean. Egger M, Davey Smith G, Phillips AN. Br Med J 1997; 315: 1610. Bias in location and selection of studies. Egger M, Davey Smith G. Br Med J 1998; 316: 61. Spurious precision? Meta-analysis of observational studies. Egger M, Schneider M, Davey Smith G. Br Med J 1998; 316: 140. Meta-analysis: Unresolved issues and future developments. Davey Smith G, Egger M. Br Med J 1998; 316: 221. Hopayian K. The need for caution in interpreting high quality systematic reviews. Br Med J 2001;323 681-684. [full-text] Other relevant references van Nieuwenhoven CA, Buskens E, van Tiel FH, Bonten MJM. Relationship Between Methodological Trial Quality and the Effects of Selective Digestive Decontamination on Pneumonia and Mortality in Critically Ill Patients. JAMA. 2001;286:335-340. [abstract; full-text for subscribers] DerSimonian R, Levine RJ. Resolving Discrepancies Between a Meta-analysis and a Subsequent Large Controlled Trial. JAMA 1999;282:664-670. [abstract; full-text for subscribers only] The Hazards of Scoring the Quality of Clinical Trials for Meta-analysis. Jni P, Witschi A, Bloch R, Egger M. JAMA. 1999;282:1054-1060. [full-text or pdf for limited time] [abstract] With an accompanying editorial: Measuring the Quality of Trials: The Quality of Quality Scales. Berlin JA, Rennie D. JAMA 1999; 282:1083-1085. [full-text or pdf for limited time] Numbers needed to treat derived from meta-analyses, sometimes informative, usually misleading. Smeeth L, Haines A, Ebrahim S. Br Med J 1999;318:1548-155. (full-text) Anderson P, Roberts I. Should journals publish systematic reviews that find no evidence to guide practice? Examples from injury research. Br Med J 2000;320:376-377. [full-text] Jadad AR, Moher M, Browman GP, et al. Systematic reviews and meta-analyses on treatment of asthma: critical evaluation. Br Med J 2000;320:537-540. [full-text] Gotzsche PC. Why we need a broad perspective on meta-analysis. Br Med J 2000; 321: 585-586. [full-text] Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. Br Med J 2001;323:157-162. [full-text] Altman DG. Systematic reviews in health care: Systematic reviews of evaluations of prognostic variables. Br Med J 2001;323 224-228. [full-text] Return to Top

  Evidence-Based Medicine in Critical Care IntensiveCare.com: tutorials, evidence alerts, research networks, information systems, and more. The PedsCCM Evidence-Based Journal Club: Peer-reviewed critical analyses of clinical trials pertinent to pediatric critical care medicine Examples include: Schindler MB, Bohn D, Cox PN, McCrindle BW, Jarvis A, Edmonds J, Barker, G. Outcome of out-of-hospital cardiac or respiratory arrest in children. N Engl J Med 1996; 333:1473-9. [abstract] Critical Appraisal by A. Randolph (Posted 3/17/97) Raad D, Darouiche ER, Dupuis J. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. Ann Intern Med 1997;127:267-274. [abstract] Critical Appraisal by S. Schexnayder (Posted 1/29/98) From the Evidence Based Critical Care Medicine series in Critical Care Medicine: Evidence based critical care medicine; what is it and what can it do for us? Evidence Based Medicine in Critical Care Group. Cook DJ, Sibbald WJ, Vincent JL, Cerra FB. Crit Care Med 1996; 24:334-337. [abstract] How to keep up with the critical care literature and avoid being buried alive. Cook DJ, Meade MO, Fink MP. Crit Care Med 1996; 24:1757-1768. [abstract] Evidence based medicine in critical care: will it take us over the cutting edge? Niederman MS. Crit Care Med 1997;25:1448-1449. (editorial; no abstract available) How to use diagnostic test articles in the intensive care unit: diagnosing weanability using f/Vt. Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. Crit Care Med 1997; 25:1514-1521. [abstract] How to use an article on therapy or prevention: pneumonia prevention using subglottic secretion drainage. Cook DJ, Hebert PC, Heyland DK, Guyatt GH, Brun-Buisson C, Marshall JC, Russell J, Vincent JL, Sprung CL, Rutledge F. Crit Care Med 1997; 25:1502-1513. [abstract] How to use articles about harm: the relationship between high tidal volumes, ventilating pressures, and ventilator-induced lung injury. Meade MO, Cook DJ, Kernerman P, Bernard G. Crit Care Med 1997; 25:1915-1922. [abstract] How to use practice guidelines in the intensive care unit: Diagnosis and management of unstable angina. Cook DJ, Ellrodt AG, Calvin J, Levy MM. Crit Care Med 1998 Mar;26(3):599-606. [abstract] How to use a review article: prophylactic endoscopic sclerotherapy for esophageal varices. Cook DJ, Levy MM, Heyland DK. Crit Care Med 1998; 26: 692-700. [abstract] Prognosis in the intensive care unit: finding accurate and useful estimates for counseling patients. Randolph AG, Guyatt GH, Richardson WS. Crit Care Med 1998; 26: 767-772. [abstract] Understanding articles comparing outcomes among intensive care units to rate quality of care. Randolph AG, Guyatt GH, Carlet J. Crit Care Med 1998; 26: 773-781. [abstract] Understanding articles describing clinical prediction tools. Randolph AG, Guyatt GH, Calvin J, Doig G, Richardson WS. Crit Care Med 1998; 26: 1603-1612. [abstract] How to use the results of an economic evaluation. Heyland DK, Gafni A, Kernerman P, et al. Crit Care Med 1999; 27: 1195-1202. [abstract] How to use articles about diagnostic technology: Gastric tonometry. Keenan SP, Guyatt GH, Sibbald WJ, et al. Crit Care Med 1999;27:1726-1731. [abstract] Critical Care Clinics, July 1998 issue, is dedicated to evidence based critical care. Articles include: Evidence-based medicine. A tool for enhancing critical care practice. Cook DJ, Levy MM. Crit Care Clin 1998; 14:353-8. [abstract] Interpreting and using clinical trials. Doig GS. Crit Care Clin 1998; 14:513-525. [abstract] Evidence-based medicine and cost-effectiveness analysis. Chalfin DB. Crit Care Clin 1998; 14:525-37. [abstract] with other management-specific articles cited throughout the PedsCCM File Cabinet The status of EBM in Critical Care Medicine Villar J, Perez-Mendez L, Aguirre-Jaime A, Kacmarek RM. Why are physicians so skeptical about positive randomized controlled clinical trials in critical care medicine? Intensive Care Med. 2005 Feb;31(2):196-204 [citation] Vincent JL. Evidence-Based Medicine in the ICU: Important Advances and Limitations. Chest 2004;126 592-600 [abstract] How well do we understand our interventions? Ferreira F, Vincent JL, Brun-Buisson C et al. Doctors' perceptions of the effects of interventions tested in prospective, randomised, controlled, clinical trials: results of a survey of ICU physicians. Intensive Care Med, 2001; DOI 10.1007/s001340000749 [abstract, full-text for subscribers] Generalizability of clinical trials Padkin A, Rowan K, Black N. Using high quality clinical databases to complement the results of randomised controlled trials: the case of recombinant human activated protein C. Br Med J 2001;323:923-926. [full-text] Return to Top

  EBM Groups on the WWW The Centre for Evidence-Based Medicine, Mount Sinai Hospital, University Health Network, Toronto, Canada. This site now has many new resources. Website of the book, Evidence-Based Medicine: How to Practice and Teach EBM, Sackett et al., editors, An excellent EBM STATs calculator online, for your Palm or Pocket PC PDAs. Teaching resources for EBM in Critical Care and Child Health Other Evidence resources A glossary of EBM terms The Evidence-Based Medicine Informatics Project from the Health Informatics Research Unit (HIRU) at McMaster University The Canadian Centres for Health Evidence "The principal task of Centres of Health Evidence (CHE) is to package, disseminate, and present health knowledge in ways that facilitate its optimum use." Also includes the full-text of the User's Guide to the Medical Literature Series The Cochrane Collaboration an international organization with the goal of critically appraising and systematically reviewing the evidence underlying our clinical management across all areas of medicine Also see The Australasian and Canadian Cochrane Centers Update Software to subscribe to the CD-ROM version of the Cochrane Library at the UK Cochrane Center Web Site Search the abstracts of the latest Cochrane Database of Systematic Reviews, from Update Software The Cochrane Database of Systematic Reviews on the WWW; a fee-based online subscription from Synapse Publishing or Health Communication Network. Cochrane Collaboration Child Health Field. Neonatal Collaborative Review Group Olsen O, Middleton P, Ezzo J. et al. Quality of Cochrane reviews: assessment of sample from 1998. Br Med J 2001;323 829-832. [abstract/full-text] The Sheffield Centre for Health and Related Research Netting the Evidence: A ScHARR Introduction to Evidence Based Practice on the Internet Now with a Core Library for Evidence Based Practice Evidence Based Medicine Resource Center, from New York Academy of Medicine NHS Centre for Reviews and Dissemination. Database of Abstracts of Reviews of Effectiveness (DARE) Structured reviews and critiques of systematic reviews and meta-analyses. Examples include: Theophylline in acute childhood asthma: a meta-analysis of its efficacy reviews: Goodman D C, Littenberg B, O'Connor G T, Brooks J G. Theophylline in acute childhood asthma: a meta-analysis of its efficacy. Pediatric Pulmonology, 1996; 21: 211-218 [Medline abstract] Efficacy of bronchodilator therapy in bronchiolitis: a meta-analysis reviews: Kellner J D, Ohlsson A, Gadomski A M, Wang E E.. Efficacy of bronchodilator therapy in bronchiolitis: a meta-analysis. Arch Pediatr Adolesc Med 1996; 150: 1166-1172. [Medline abstract] The NHS (UK) Research and Development Centre for Evidence-Based Medicine Tools and Terminology Evidence-Based On-Call; a remarkably easy to use resource providing comprehensive evidence in the diagnosis and management of numerous (mostly adult) conditions. Also supported by the National Electronic Library for Health Glossary of Terms What's a CAT? (Critically-appraised topic) Specific tools, such as Number Needed to Treat and Likelihood Ratios Faculty of Medicine and Oral Sciences, University of Alberta The EBM Toolkit clinical epidemiology definitions Medline definitions list Zynx Health A subsidiary of Cedars Sinai Health System in Los Angeles, California, offers a commercial set of web based evidence based medicine tools for disease management, clinical guidelines, patient safety, health caremanagement, and tools to reduce medication errors for health care organizations, hospitals, and medical practitioners. I-Medicine.info A unique site linking resources for evidence-based medicine, clinical guidelines, health care databases, and medical informatics. Return to Top

  Evidence-Based Medicine Databases and Directories Databases National Institute of Child Health and Human Development Cochrane Neonatal Collaborative Review Group; complete listing of systematic reviews (full-text) Database of Abstracts of Reviews of Effectiveness (DARE) from the NHS Centre for Reviews and Dissemination. Abstracts of Cochrane Reviews, sorted by Review Groups TRIP Database: a searchable database of evidence-based medicine sources on the net Now TRIP has a special search page for critical care. National Guideline Clearinghouse; evidence-based guideline collection - a joint effort of the Agency for Health Care Policy and Research (AHCPR), American Medical Association (AMA), and American Association of Health Plans (AAHP). Primary Care Clinical Practice Guidelines on the web. Compiled by Peter Sam. UCSF Directories WWWeb Epidemiology & Evidence-based Medicine Sources for Veterinarians; an incredibly comprehensive list of clinical epidemiology and EBM links for health care practitioners treating all species! SUMSearch is a "meta-search" engine for evidence-based medicine resources. It searches multiple online databases and returns a customized list - that can be further refined - of retrievable documents. From the University of Texas Health Science Center at San Antonio Evidence-Based Health Care Resources on the Internet, from University of Rochester Medical Center Edward G. Miner Library Evidence-based medicine and the Internet. Hersh W. ACP Journal Club 1996 July/Aug; 125: A14-16. (full-text editorial) Evidence Based Health Care; a succinct compilation of resources, including EB Health Care Databases on the web and Finding the Best Clinical Literature, a guide to MEDLINE search strategies. From HealthWeb A bibliography of references on evidence-based medicine Evidence Based Medicine Italian Group, with an excellent bibliography listing Return to Top

  Medline Search Strategies SUMSearch is a "meta-search" engine for evidence-based medicine resources. It searches multiple online databases and returns a customized list - that can be further refined - of retrievable documents. From the University of Texas Health Science Center at San Antonio Beyond ACP Journal Club - How to harness MEDLINE for review articles. McKibbon, K.A. et al. ACP J Club 1996 May/June; 124: A12-13.(full-text editorial) Medline definitions list from the Faculty of Medicine and Oral Sciences, University of Alberta Making your database search easier from Andre Tomlin at Oxford Applying Clinical Search Features, a guide to MEDLINE search strategies. From Evidence Based Health Care of the Library of the Health Sciences-Peoria, University of Illinois at Chicago, and HealthWeb. Return to Top

  Pediatric and General Online Journal Clubs, Teaching Resources & Tutorials Online Journal Clubs and Critically Appraised Topic "Banks" Pediatric-specific Resources Phillips RS. Accessing electronic information for clinical decisions Arch Dis Child 2000; 83: 373-374. [full-text for subscribers] Pediatra Basada en la Evidencia; Pediatric Evidence Based Medicine; an excellent and comprehensive Spanish language resource. The PedsCCM Evidence-Based Journal Club: Peer-reviewed critical analyses of clinical trials pertinent to pediatric critical care medicine Evidence Based Pediatrics Critically Appraised Topics, from the University of Michigan Health System's Department of Pediatrics and Communicable Diseases Cochrane Neonatal Review Group The Archives of Pediatric and Adolescent Medicine adopts the Evidence-based Journal Club appraisal method: King TM, Alperovitz-Bichell, Rowe PC, Lehmann HP. Is Epinephrine Efficacious in the Treatment of Bronchiolitis? Arch Pediatr Adolesc Med 2003;157 965-968 [full-text] is a critical appraisal of: Hartling L, Wiebe N, Russell K, Patel H, Klassen TP. A Meta-analysis of Randomized Controlled Trials Evaluating the Efficacy of Epinephrine for the Treatment of Acute Viral Bronchiolitis. Arch Pediatr Adolesc Med 2003;157 957-964 [abstract] General journal clubs Critically Appraised Topics: examples of evidence-based medicine analyses, from the Southwestern Ontario Regional Health Science Network Evidence-Based Clinical Practice Guidelines, by K. Moores, from MedScape Journal Club on the Web POEM's: Patient Oriented Evidence that Matters, from the Journal of Family Practice Critique et Pratique, critical appraisals. From Laval University Family Medicine Department, in French. Critical Care Journal Club, from The American Thoracic Society Other Resources for Teaching EBM Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. Br Med J. 2004 Oct 30;329(7473):1017. [abstract; full-text] Frohna JG, Park SM. Promoting the use of evidence-based medicine in pediatrics. J Pediatr 2002; 141:599-600. [full-text] CAT-Maker Software developed at the Centre for Evidence Based Medicine in Oxford to produce critically appraised topics (CATs) by Douglas Badenoch. Centre for Evidence Based Medicine A range of teaching materials including scenarios and checklists. Centre for Evidence Based Mental Health This site has examples of mental health scenarios to be used in critical appraisal workshops. EBM Toolbox from the University of Alberta. Not to be confused with the Centre for Evidence Based Medicine's resource of the same name, this is a Canadian based collection of resources to support EBM. Evidence Calculator for Therapeutic Decisions; from B Djulbegovic, University of South Florida. Online Tutorials Emergency Medicine-Ambulatory Care (EMAC) at Emory University: Evidence Based Medicine Clinical Epidemiology for Effective Clinical Practice, from IntensiveCare.com An Introduction to Information Mastery, from Michigan State University Introduction to Evidence-based Medicine, from Duke University and the University of North Carolina. Courses for Learning EBM & How to Teach EBM Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer H-H, Kunz R. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. Br Med J 2002;325: 1338-1341. [full-text] Workshop on How to Teach Evidence Based Medicine at McMaster University Department of Clinical Epidemiology and Biostatistics have assembled sets of readings dealing with evidence-based medicine and critical appraisal issues in therapy, diagnosis, prognosis, harm, overviews and economic analysis. A similar workshop is held at Oxford University and they post a Calendar of Events on the WWW. CAMS - Critical Appraisal for Medical Students CAMS is a student-led group dedicatedto provide exciting opportunities to develop the skills of applying papers to patients. North Thames Research Appraisal Group. This regional initiative runs a series of training courses designed to equip clinical staff with the skills required to find and to appraise the evidence. How to find the evidence; a self-directed web course on locating research evidence for translation into practice. Return to Top

  .uk/ebmisisnt.html">Evidence-based medicine: What it is and what it isn't, by David Sackett from the NHS (UK) Research and Development Centre for Evidence-Based Medicine
• Evidence-based Medicine: A New Science or an Epidemiologic Fad? Bauchner H. Pediatrics 1999; 103: 1029-1031. [Full-text for AAP members/subscribers]
• Glossary of EBM Terms also from the NHS (UK) Research and Development Centre for Evidence-Based Medicine
• The Medical Literature as a Resource for Evidence Based Care, by McKibbon, K.A.
• Medicine based evidence, a prerequisite for evidence based medicine. Knottnerus JA, Dinant GJ. Br Med J 1997; 315: 1109-10. (full-text editorial)
• Clinical Epidemiology & Evidence-Based Medicine Glossary, from Washington State University College of Veterinary Medicine
• Werk L, Bauchner H, Chessare JB. Medicine For The Millenium: Demistifying EBM. Contemporary Pediatrics December 1, 1999. [full-text with free registration]
• Christakis DA, Davis R, Rivara FP. Pediatric evidence-based medicine: Past, present, and future. J Pediatr 2000;136:383-389. [citation] [full-text for subscribers]. Accompanied by an editorial by Moyer VA, Elliott EJ. J Pediatr 2000;136:282-4. [full-text]
• Qualitative research and evidence based medicine. Green J, Britton N. Br Med J 1998; 316: 1230-1232.
• Ethics and evidence based medicine. Kerridge I, Lowe M, Henry D. Br Med J 1998; 316: 1151-1153
• Jadad AR, Haynes RB, Hunt D, Browman GP. The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management
in health care, Can Med Assoc J 2000;162(3):362-5 [full-text]
• Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. CMAJ 2000;163(7):837-41. [full-text]
• Every "religion" has its critics: for EBM devotees, to be read with caution (don't say we didn't warn you!): Clinicians for the Restoration of Autonomous Practice (CRAP) Writing Group. EBM: unmasking the ugly truth. Br Med J 2002;325 1496-1498 [full-text]
• How well is EBM doing after 10 years? The October 30, 2004 issue of the British Medical Journal is dedicated to this question.

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