Sue Shaffer Learning Commons and Library: Guides: Nursing: Evidence-Based Practice: EBM Resource Pyramid

Evidence-Based Medicine Tutorials

Evidence-Based Medicine: Literature Reviews
When talking to your patients about complementary health approaches, you want to be able to answer the question: Is there any scientific evidence that this complementary product or practice works and is safe? The resources on this page will help inform you about what the science says (limited to the past 5 years).
Evidence-Based Practice (Duke Univ.)
An extensive LibGuide from Duke University Medical Center Library & Archives.
Evidence- Based Practice Tutorial Course
From Duke University Medical Center Library and University of North Carolina at Chapel Hill Health Sciences Library.

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.)

EBM Resource Pyramid. For a text-based version, see text below image.

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. EBM Resource Pyramid.

The Evidence-Based Pyramid depicts a triangular representation of the levels of evidence with the strongest evidence at the top and progressing down through evidence with decreasing strength. At the apex of the pyramid are Systematic Reviews, which are the strongest form of evidence. Under them are lesser strength formats for filtered information including Critically-Appraised Topics (Evidence Synthesis) and Critically-Appraised Individual Articles (Article Synopses). Below that is unfiltered information, the top form being Randomized Controlled Trials. Successive lower levels include Cohort Studies, Case-Controlled Studies, Case Reports and Background Information/Expert Opinion.

TRIP (Turning Research Into Practice) Database Plus This link opens in a new window
(Free version only) 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.

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.

Clinical Study Categories and Medical Genetics topics can be specified in PubMed, and Systematic Reviews are also searchable in MEDLINE.

Tip!

Do a PubMed search and limit to the subset "Systematic Review."

MEDLINE This link opens in a new window
MEDLINE provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and much more. Created by the National Library of Medicine, MEDLINE uses MeSH (Medical Subject Headings) indexing with tree, tree hierarchy, subheadings and explosion capabilities to search citations from over 4,800 current biomedical journals.

PubMed Clinical Queries
This tool uses predefined filters to help you quickly refine PubMed searches on clinical or disease-specific topics. To use this tool, enter your search terms in the search bar and select filters before searching.

Authors of critically-appraised topics evaluate and synthesize multiple research studies, and authors of critically-appraised individual articles evaluate and synopsize individual research studies.

ACP Guidelines and Recommendations
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.
EPC Reports- Agency for Healthcare Research and Quality
"This search provides complete released evidence reports, comparative effectiveness reviews, technical briefs, Technology Assessment Program reports, and U.S. Preventive Services Task Force evidence syntheses. EPC reports and assessments may include meta-analyses and cost analyses."
Evidence Alerts
Quality articles from over 126 clinical journals are selected by research staff, and then rated for clinical relevance and interest by an international group of physicians. Includes a searchable database of the best evidence from the medical literature and an email alerting system. From BMJ Publishing Group and McMaster University's Health Information Research Unit.
JAMA Rational Clinical Exam Series
Articles examining the validity and quality of evidence of findings on physical exam.
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.

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.

CINAHL (Cumulative Index to Nursing & Allied Health Literature) This link opens in a new window
The authoritative resource for nursing and allied health professionals, students, educators and researchers. Provides indexing for journals from the fields of nursing and allied health. The database contains more than 1,000,000 records dating back to 1982. Provides full text for hundreds of journals, plus legal cases, clinical innovations, critical paths, drug records, research instruments and clinical trials.

PubMed (MEDLINE)
PubMed comprises more than 22 million citations for biomedical articles from MEDLINE and life science journals. Access to titles / abstracts is free. Citations may include links to full-text articles from PubMed Central or publisher web sites.
PubMed Health Services Research (HSR) Queries
Use research methodology filters to locate evidence based studies on appropriateness, process assessment, outcome assessment, costs and economics as well as qualitative studies related to health care services, quality and costs.

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.
Evidence-based Medicine Toolkit
Includes many resources for practicing and teaching EBM.
Medscape
Physician authors and editors contribute to Medscape's Clinical Reference Tools.. The evidence-based content covers over 30 medical specialties. It also includes a Drug Formulary by insurance plans.
What is Evidence-Based Practice? (Univ. of Utah)
EBP, or evidence-based practice, is a term we encounter frequently in today’s health care environment. But what does it really mean for the health care provider? College of Nursing interim dean Barbara Wilson and Nurse manager Gigi Austria explain how to integrate EBP into all aspects of patient care.

Evidence-Based Medicine Tutorials

Systematic Reviews / Meta-Analyses

Guide Attribution