EBM Librarian - Recently Updated Pages

What's New- What's Cool

lmaggio — Thu, 12 Nov 2009 21:32:22 CST

11/12/2009

Clinical Search Tool from Lane Library at Stanford University.(Update)
Note this search tool was recently modified to allow users to: · Build searches using a PICO builder · Search a combination of journal articles, book chapters and patient handouts · Easily select preferred Medical Subject Headings (MeSH) to structure questions · Filter searches based on clinical question and publication type · View abstracts of featured citations right on the page · Know at glance if the citation is available full-text
If you have any questions or feedback, please contact Lauren Maggio at Stanford.

This is in beta test but looks very promising. Lauren A Maggio has been working at Lane Library with their programmers to create a new clinical search tool that focuses on EBM and PICO. She actually had a poster on this at MLA and now it’s finally ready for beta launch. Don’t Go It Alone: Librarians Collaborating with Health Care Practitioners to Develop a Portal Optimized for Use in Clinical Practice Lauren Maggio, AHIP, Medical Education Librarian; Ryan Max Steinberg, Knowledge Integration Programmer/Architect; Richard Zwies, Web Production Specialist; Olya Gary, Media Developer; Christopher Stave, Information Services Librarian; Marilyn L. Tinsley, Information Services Librarian; Sandra Brekke, Director, Access Services; Heidi Heilemann, AHIP, Director; Keith Posley, Chief Clinical Informationist; Lane Library, Stanford University School of Medicine, Palo Alto, CA Objective: In 2008, librarians at an academic medical center initiated the redesign of the library’s online clinical portal, which was designed to provide health care professionals quick access to clinical information. This project seeks to highlight the librarians’ efforts to collaborate with a broad range of health care practitioners to redesign this clinical portal. Methods: In 2007, the clinical portal was viewed by 28,479 users. Although heavily used, the clinical portal, which had not been significantly updated since 2006, required upgrading to better support evidence-based practice (EBP). In preparation for redesign, librarians collaborated with a group of health care professionals, including an EBP expert, to leverage clinical expertise in designing a survey to better understand portal usage and to identify key information resources, especially those supporting EBP. The jointly created survey was distributed to medical center affiliates, and with the help of the initial health care professional team, the collected data were analyzed and applied to upgrading the clinical portal. Following the introduction of the upgraded portal, librarians collected usage data over a 2-month period in 2009 for comparison with usage data collected in the same period in 2008 to determine any increased portal use.

11/3/2009
Active Learning Techniques: An Online Toolbox for Librarians

Bolt and Learn
BOLTs (Brief Online Learning Tutorials) are resources for you when you need more information or clarification and they are brief 3-5 minute animated chunks of information. Cover learning about seeking and evaluating information for evidence based nursing

8/25/2009
PubMed Search Strategies Blog
This blog has been created to share PubMed search strategies. Search strategies posted here are not perfect. They are posted in the hope that others will benefit from the work already put into their creation and/or will offer suggestions for improvements. Librarians who wish to post comments on this blog or who wish to become authors are invited to e-mail me (Cindy Schmidt, MD, MLS) . I'm not posting my unmc.edu e-mail address here, but it's easy to find on the web : - ).

8/17/2009
PRESS: Peer Review of Electronic Search Strategies
The quality of health technology assessment (HTA) reports depends on many factors. One of these factors is the evidence base from which the HTA is derived. The evidence base is created by gathering information from many sources and performing literature searches. Performing a high quality search of information resources will ensure the accuracy and completeness of the evidence base used in HTA reports. Currently, no review exists to tell us what elements of the search process have the most impact on the overall quality of the resulting evidence base....

Managing evidence-based knowledge: the need for reliable, relevant and readable resources.
Sharon Straus, MD and R. Bryan Haynes, MD. CMAJ 180(9):942-5. 28 April 2009.

Students' PEARLS: successfully incorporating evidence-based medicine in medical students' clinical attachments.
Teaching evidence-based medicine (EBM) to medical students can be tough, and even the most enthusiastic champions of EBM concede that many (most?) medical students emerge unconvinced of EBM's value. Some students “just don't get it”; others see EBM as idealistic, impractical, and unable to overcome the barriers of limited time, evidence, and generalizability. Students want quick and simple answers to myriad questions, which are often more complicated than they seem. But EBM and its teaching were initially devised for qualified doctors who were already accustomed to the subtleties and vagaries of clinical practice; answers are rarely quick or simple. ACP Journal Club. 150(4):JC4-2, 21 April 2009. More information at: http://www.medfac.usyd.edu.au/showcase/ebm/pearls/index.php

7/31/2009
Clinical Search Tool from Lane Library at Stanford University.
This is in beta test but looks very promising. Lauren A Maggio has been working at Lane Library with their programmers to create a new clinical search tool that focuses on EBM and PICO. She actually had a poster on this at MLA and now it’s finally ready for beta launch. Don’t Go It Alone: Librarians Collaborating with Health Care Practitioners to Develop a Portal Optimized for Use in Clinical Practice Lauren Maggio, AHIP, Medical Education Librarian; Ryan Max Steinberg, Knowledge Integration Programmer/Architect; Richard Zwies, Web Production Specialist; Olya Gary, Media Developer; Christopher Stave, Information Services Librarian; Marilyn L. Tinsley, Information Services Librarian; Sandra Brekke, Director, Access Services; Heidi Heilemann, AHIP, Director; Keith Posley, Chief Clinical Informationist; Lane Library, Stanford University School of Medicine, Palo Alto, CA Objective: In 2008, librarians at an academic medical center initiated the redesign of the library’s online clinical portal, which was designed to provide health care professionals quick access to clinical information. This project seeks to highlight the librarians’ efforts to collaborate with a broad range of health care practitioners to redesign this clinical portal. Methods: In 2007, the clinical portal was viewed by 28,479 users. Although heavily used, the clinical portal, which had not been significantly updated since 2006, required upgrading to better support evidence-based practice (EBP). In preparation for redesign, librarians collaborated with a group of health care professionals, including an EBP expert, to leverage clinical expertise in designing a survey to better understand portal usage and to identify key information resources, especially those supporting EBP. The jointly created survey was distributed to medical center affiliates, and with the help of the initial health care professional team, the collected data were analyzed and applied to upgrading the clinical portal. Following the introduction of the upgraded portal, librarians collected usage data over a 2-month period in 2009 for comparison with usage data collected in the same period in 2008 to determine any increased portal use.

7/16/2009
Comparative Effectiveness Research
Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. Consumers, patients, and caregivers also require this information to decide how to evaluate and treat their conditions. All too often, the information necessary to inform these medical decisions is incomplete or unavailable, resulting in more than half of the treatments delivered today lacking clear evidence of effectiveness. Comparative effectiveness research (CER) identifies what works best for which patients under what circumstances. More information from the Institutes of Medicine More information from Health and Human Services

6/09/2009
Information Mastery: A Practical Approach to Evidence-Based Medicine
Tufts Health Care Institute, in conjunction with Tufts University School
of Medicine, is hosting the 13^th annual conference, "Information
Mastery: A Practical Approach to Evidence-Based Medicine." The
conference will be held on November 12 and 13, 2009 at Tufts School of
Medicine in Boston, Mass. with an advanced course offered for faculty
and teachers on November 14.

5/08/2009
Understanding Evidence-based Healthcare: A Foundation for Action
This web course has been created by the United States Cochrane Center as part of a project undertaken by Consumers United for Evidence-based Healthcare (CUE), and is designed to help consumer advocates understand the fundamentals of evidence-based healthcare concepts and skills. Registration is open and free of charge. Participants are encouraged to finish the course in three months. We recommend that participants complete only 1-2 modules at a time. Participants must commit to filling out evaluation forms upon completion of each module.

5/06/2009
Managing evidence-based knowledge: the need for reliable, relevant and readable resources.
Straus S, Haynes RB. CMAJ. 2009 Apr 28;180(9):942-5.
PMID: 19398741

4/25/2009
Nice example of a search strategy for teaching
I am teaching an online course on health and medical libraries to Langara Library Technicians this term. I plan to post my searches given the four reference questions we examined in class. (Dean Guistini)

4/17/2009
AHRQ's WebN&M: Morbidty & Mortality Rounds on the Web
Good resource for cases and scenarios to use in teaching. They provide a scenario, commentary and a list of references.

3/11/2009
Find it Fast
From the Yale Medical Library. The primary goal of this series of 10 tutorials is "find it fast". This episode concludes this series and is a recap of the key messages in these tutorials.

2/25/2009
Web 2.0, Twitter and EBM
follow the Cochrane Collaboration on Twitter here: http://twitter.com/cochranecollab
@medicalstudent is designing an app to run PubMed searches through Twitter, see http://www.medicalstudentblog.co.uk/pubmed-comes-to-twitter-beta/

2/19/2009
Online course in Biomedical Statistics (free)
Series of web-based modules by Stephen Simon From Children's Mercy Hospital in Kansas City. Nice overview of relevant topics.

2/12/2009
Search Filters
Search filters are collections of search terms designed to retrieve selections of records. Search filters may be designed to retrieve records of research using a specific study design or by topic or by some other feature of the research question. Very extensive collection of filters.

1/15/2009
Top Ten Medical Stories for 2008
This year marked a number of important medical advances and intriguing health news. To help narrow the large list, ABCNews.com reached out to the top medical centers and doctors in a wide range of fields.Below is ABCNews.com's list of the Top 10 medical stories of 2008, deemed most important by doctors and found most interesting by readers. This is a good source for search examples.

12/23/2008
Study Design
Don't forget Wikipedia as a source for information. This site provides a nice explanation of study design with examples.

12/17/2008
Evidence-Based Practice in the Health Science- Tutorials. Welcome to the Evidence-Based Practice (EBP) tutorials developed by the Information Services Department of the Library of the Health Sciences-Chicago at the University of Illinois at Chicago.The tutorials are tailored to five health sciences disciplines: Applied Health, Dentistry, Medicine, Nursing, and Pharmacy. Each tutorial consists of five instructional modules:

Introduction to Evidence-Based Practice
Structure of literature
Research design
Searching the literature
Evaluating the quality of research

11/21/2008
Evidence Based Medicine
The Hayward Medical Communications group has developed this very useful set of web-based resources for medical professionals and others who might be
interested in learning about the world of evidence based medicine (EBM). First-time visitors can click on over to one of the three primary sections on the left-hand side of the homepage: "What is…?", "Gavel", and "Clinical issues in HIV/AIDS". The "What is…?" area is a good place to start, as it contains over two dozen documents that answer important questions like "What is critical appraisal?", "What is clinical audit?", and "What is quality of life?", to name only a few. All of these documents explain basic EBM-related questions in clear and accessible prose. Moving on, the "Clinical issues in HIV/AIDS" area contains links to this particular bulletin, which features
practical, up-to-date, and cogent research by key figures working in the field.

11/12/2008
The Bedford Murder: an evidence-based clinical mystery. Marshall Godwin, M.D. and Geoffrey Hodgetts, M.D. 2003.
As a family physician in the town of Bedford, you see a lot of interesting clinical cases, especially among the influential Savoy and Sampson families. When Nick Sampson disappears and a body turns up with connections to Nick, you are drawn into the case. As you are challenged to use an evidence-based approach in managing the wide variety of clinical cases you encounter in Bedford, the cases in turn provide evidence for solving the murder mystery. At once a thrilling, interactive mystery novel and a wonderful guide for incorporating evidence-based medicine into practice, The Bedford Murder is unlike any book you will ever read. A great source for good clinical questions for teaching. There are 43 clinical questions from case scenarios that follow the characters in the book. Each question is answered with a study that has it's own CAT. A great resource for EBM teachers looking for good examples.

Evidence Based Medicine in Sherlock Holmes Footsteps. Jorgen Nordenstrom. 2007
“This is the best book I’ve ever read regarding how to do EBM – it teaches you how to do powerful, effective searches for medical literature and how to review the evidence. All that you know you should be learning about EBM but previously found it difficult to start – they're spelled out clearly in this tiny beautiful book. The book’s layout was very clear, and I found myself looking forward to reading it as I practised the steps myself and found almost immediate improvement in my EBM skills.” Medical student, Edinburgh University Clear concise explanations of the principles of evidence based medicine and critical appraisal.

9/9/2008
Awakening the Searcher Within
Are you a new Medline searcher or do you feel that you've forgotten some of those tips you learned about searching Medline when you took the class years ago? Join us for this distance learning seminar. There will be a bi-weekly web session to help you get, or remember, tips and tricks for becoming, or remaining, an expert searcher.
The recorded sessions are archived on this page. From Pacific Northwest Region/NNLM.

8/26/2008
EB Nursing
Added a new page just for Nursing. Over the coming weeks we will add more resources to this page.

8/6/2008
Evaluation of a workshop on evidence-based medicine for social insurance physiciansEvidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine. Aims We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations.
Conclusions The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.

8/1/2008
Database of Uncertainties about the Effects of Treatments (DUETs): A resource to help prioritise new research
The Database of Uncertainties about the Effects of Treatments (DUETs) has been established in the UK to publish uncertainties that cannot currently be answered by referring to reliable up-to-date systematic reviews of existing research evidence. Systematic reviews are based on worldwide searches for reliable, relevant evidence, analysed using methods to reduce biases and the play of chance. More detailed information about systematic reviews and fair tests of the effects of medical treatments is available in the James Lind Library.

7-22-2008
Evidence-Paced Tutorial for Nurses
This online tutorial was created at Penn State Hershey Medical Center to promote consistent use of evidence based practices in the delivery of nursing care. The tutorial will show the steps in conducting EBP.

7-2-2008
AHRG WebM&M
AHRQ WebM&M (Morbidity and Mortality Rounds on the Web) is the online journal and forum on patient safety and health care quality. This site features expert analysis of medical errors reported anonymously by our readers, interactive learning modules on patient safety ("Spotlight Cases"), and Perspectives on Safety. Good resource for finding cases for teaching Medline, EBM, etc.

6-16-2008
Video Teaching Tips from the Journal of General Internal Medicine

Making sense of diagnostic test results using Likelihood Ratios
Adjusting for prognostic imbalances
Understanding odds ratios

5-28-2008
Teaching EBM 101
Teaching Evidence-based medicine, which will be taught at the New York Academy of Medicine August 13-15, 2008 has openings for librarian students. This is an intensive class, in which librarians will work with physicians and other librarians to perfect their ability to teach EBM. For more information on the class, please visit: http://ebem.org/brochure.html. Note: Librarian tuition is the same as Resident tuition. Questions? Contact Patricia Gallagher (pgallagher@nyam.org)

5-23-2008
The 10th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care will be July 27–31, 2008 at the Zermatt Resort & Spa, Midway, Utah (USA). The goal of this workshop is to make accessible to participants the skills and resources needed to translate research into practice. Continuing education credits and a 3:1 participant-to-tutor ratio are some of the highlights of this workshop, along with an exemplary faculty. Early registration ends May 31.
More information on the workshop and a list of faculty can be found at the web site http://ebhc.uchsc.edu, or by contacting Jen McIntyre Stachelski at jennifer.mcintyre@uchsc.edu. EBHC Workshop Coordinator Office: 303-724-7550

5-06-2008
EBCP Workshop at McMaster University
This page has been added to help support the librarians working with small groups at the McMaster EBCP Workshop. Librarians can post and share their teaching materials and experiences at the workshop.

4-09-2008
FREE online course on evidence-based health care
The US Cochrane Center is now offering an online course on evidence-based health care; the focus is on skills and knowledge for
consumer advocates, but the content is useful for anyone seeking new or re-newed competencies in evidence-based medicine.

The expectation is that the course be completed within three months of registration, and that evaluations will be completed. Course
registration is at www.cochrane.us; more complete information, including contents of each
module and course objectives, is at http://apps1.jhsph.edu/cochrane/CUEwebcourse.htm

3-17-2008
Awakening the Searcher within
Are you a new MEDLINE searcher or do you feel that you’ve forgotten some of those tips you learned about searching MEDLINE when you took the class years ago? Join us for this exciting distance learning seminar. The seven one-hour bi-weekly web sessions will help you get, or remember, tips and tricks for becoming, or remaining, an expert searcher. You will receive two questions for each session and have 2 weeks to work on the search. Then there will be a live web session where these searches will be discussed.
Andrew Hamilton and Dolores Judkins from the OHSU Library will facilitate the discussion, but remember, everyone searches differently, so you can be sure you’ll pick up some tips from everyone involved in the session.

New "Search Challenge" to practice and improve your searching skills from Vanderbilt University.
Interested in getting more "in-depth" into the process of designing a search strategy for patron questions - what terms are useful for a topic, what terms aren't, what databases and other resources are necessary to make sure you've identified as much as possible, etc? To this end, we're going to start posting a "search challenge" question each Monday. We encourage you to post your ideas and questions in the comments or to us by email (using our profile links above). You can also feel free to "reference interview" us by posting questions for clarification or more detail as needed. Then, each Friday we'll post a search strategy and other thoughts on that question. We hope this will add to the usefulness of the cases by giving another outlet for developing searching skills and discussing strategies with colleagues.

The week’s question is available onat http://jmlacasestudies.blogspot.com

1/30/2008
BMJ Updates
BMJ Publishing Group 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.

This service is unique: all citations (from over 110 premier clinical journals) are pre-rated for quality by research staff, then rated for clinical relevance and interest by at least 3 members of a worldwide panel of practicing physicians. Here's what we offer:

A searchable database of the best evidence from the medical literature
An email alerting system
Links to selected evidence-based resources

1/16/2008
Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical Librarians
Dartmouth College, Hanover, NH. July 28-30, 2008
This is an intensive, introductory, 2.5 day course designed for medical librarians by medical librarians. Through large group interactive lectures, small group discussion, and hands-on, case-based learning, you'll acquire skills needed to support and teach evidence-based clinical practice (EBCP). 18.25 MLA CE credits pending.

1/10/2008
EBMSearch.org/pubmed is a site in beta-test, meant for use by clinical professionals and expert searchers.EBMSearch is a specialized search engine for retrieving and managing high quality medical information from MEDLINE. For treatment, EBMSearch returns Level 1 evidence with a Grade Recommendation of A as defined by the Centre for Evidence Based Medicine. Level 1 evidence constitutes systematic reviews and individual randomized controlled trials. "A" Grade Recommendation is evidence consistent with Level 1 studies.

12/12/2007
New Australian search engine launched. A new Australian search engine, called 'Evidence Australia', has been launched. 'Evidence Australia' searches all the main Health/Medical evidence sites in Australia and includes all the national guidelines that are freely available. The search engine has been authored by Terence Harrison, Clinical Librarian, Royal Melbourne Hospital, and is an adaptation of Google technology. It is hoped that in time 'Evidence Australia' will include all hospital guidelines throughout Australia.Details are also given on how to embed the search engine on to your own website. Eventually it is hoped that 'Evidence Australia' will have its own, unique URL.

Launch of bliki.A bliki - "Exploring the evidence base: EBM & HSR resources on the Net" - was recently launched. The bliki is a combination of a blog ("Exploring the evidence base", owned by Terence Harrison, Clinical Librarian at the Royal Melbourne Hospital, and "EBM & HSR resources on the Net", a wiki owned by Catherine Voutier, an Information specialist with the Centre for Clinical Effectiveness at Monash).

2/05/2007 - can't find the right teaching material?
Try this. David Rothman has created a Google Custom Search Engine that searches across the Web pages of Medical Libraries listed at http://www.lib.uiowa.edu/hardin/hslibs.html. This is a great way to find teaching materials from other libraries.

EBM Conferences

schardt — Tue, 03 Nov 2009 13:37:09 CST

Information Mastery: A Practical Approach to Evidence-Based Medicine
Tufts Health Care Institute, in conjunction with Tufts University School
of Medicine, is hosting the 13^th annual conference, "Information
Mastery: A Practical Approach to Evidence-Based Medicine." The
conference will be held on November 12 and 13, 2009 at Tufts School of
Medicine in Boston, Mass. with an advanced course offered for faculty
and teachers on November 14.

Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical Librarians

Dartmouth College, Hanover, NH. Monday, August 3, 5 PM - Thursday, August 6, 12 noon, 2009

This is an intensive, introductory, 2.5 day course designed for medical librarians by medical librarians. Through large group interactive lectures, small group discussion, and hands-on, case-based learning, you'll acquire skills needed to support and teach evidence-based clinical practice. 20 MLA CE credits pending.
REGISTRATION OPENS MONDAY, MARCH 30, 12 NOON EDT!!!

PLEASE NOTE: THE ALL-INCLUSIVE FEE HAS BEEN REDUCED TO $700 THANKS TO A GENEROUS GRANT FROM THE NNLM-NEW ENGLAND REGION. WE ARE GRATEFUL FOR THEIR SUPPORT IN THESE TOUGH ECONOMIC TIMES.

Teaching EBM 101
Teaching Evidence-based medicine, which will be taught at the New York Academy of Medicine August 13-15, 2008 has openings for librarian students. This is an intensive class, in which librarians will work with physicians and other librarians to perfect their ability to teach EBM. For more information on the class, please visit: http://ebem.org/brochure.html. Note: Librarian tuition is the same as Resident tuition. Questions? Contact Patricia Gallagher (pgallagher@nyam.org)

Teaching and Leading EBM: A Workshop for Teachers and Champions of Evidence-Based Medicine
Duke University, Durham, North Carolina

This workshop is an innovative 4-day program designed to help clinical leaders and educators enhance their EBM skills. Sessions will feature a mix of both small and large group discussions, interactive lectures, and case-based studies. Attendees will be assigned a dedicated small-group mentor to help guide them in achieving their personal goals and objectives for the workshop.

EBCP Workshop

McMaster University, Hamilton, Ontario, Canada

Rocky Mountain Workshop on How to Practice Evidence-Based Health Care
Vail, Colorado
The Colorado Health Outcomes Program presents the Rocky Mountain Workshop on Evidence-Based Health Care. This five-day workshop will focus on teaching the basics of, and developing further insights into, the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services.

Better Evidence for Better Health

4th International EBHC Teachers & Developers Conference
Taormina (Italy), 31th October - 4th November, 2007
Meet teachers and developers from around the world in a 3-day program that will include keynote talks to highlight some of the major developments in EBHC in recent years, abstracts, posters and small group sessions to foster an exchange. You will be staying in the seaside resort of Taormina, one of most famous venues in the world, at Hotel Caparena, the place for relaxing in every season of the year in a lush scenario filled by the scent of a subtropical garden of palm and acacia trees, hibiscus, orange and red bougainville flowers.

Workshop on How to Practice Evidence-Based Health Care

These workshops are intended to serve as an introduction to evidence-based medicine.They are aimed at clinicians and other health care professionals who wish to gain knowledge of critical appraisal and experience in the practice of evidence-based health care

Putting Evidence into Practice (PEP)

Edmonton, Alberta.

This 3 day transdisciplinary workshop, taught in small groups, focuses on working through relevant examples in order to develop skills in searching for and identifying appropriate evidence, critically appraising the evidence, and applying the evidence to to an individual's area of expertise.

Summer Institute on Evidence-Based Practice

San Antonio, Texas
These 3- day national/international interdisciplinary institutes are designed to advance evidence-based quality improvement in clinicial and educational settings. Nurses, physicians, librarians, managers, scientists learn from renown EBP experts.

EBM and the Medical Librarian

Distance Education course covering the the steps in EBM - focusing questions, searching, and evaluating the validity of an article. Course is offered twice a year and runs for 8 weeks. Approved for 20 MLA CE credits.

Evidence-based Clinical Practice - A Workshop for Urologists

This workshop is an intensive 1 1/2-day meeting designed to develop the knowledge and skills required to practice and teach evidence-based medicine. Sessions will feature a mix of small and large group discussions, interactive lectures and case-based studies.

EBM Teaching Tools

schardt — Tue, 03 Nov 2009 13:28:08 CST

Class Exercises

Disciplines: Scenarios/Resources

EBM Curriculum

Course Evaluation: Knowledge Retention

Presentations

Resources:

100+ resources for teaching without textbooks

Medical Education wiki

Active Learning Techniques: An Online Toolbox for Librarians
Great resources, examples and links to help with active learning

EBM Tutorials

schardt — Tue, 03 Nov 2009 07:16:16 CST

Evidence-Based Practice Tutorial: An Interactive Case Scenario
This online tutorial introduces learners to the basic concepts of evidence-based practice (EBP). The tutorial structured around an illustrative pediatric case scenario on Otitis Media and utilizes graphics, self assessment and voice-over narration. The case actively guides learners through the step-by-step EBP process: constructing a well-built answerable clinical question in therapy, researching articles using PubMed Clinical Queries, finding the evidence from a selected Randomized Controlled Trial, and a brief appraisal of the collected evidence. Since limited classroom time is allowed for EBP instruction in the undergraduate medical education curriculum, this tutorial provides additional instruction outside the classroom. (From University of California at Irvine)
Evidence-Baced Tutorial for Nurses
This online tutorial was created at Penn State Hershey Medical Center to promote consistent use of evidence based practices in the delivery of nursing care. The tutorial will show the steps in conducting EBP.

Introduction to EBM Tutorial

This self-paced tutorial will take you through the complete EBM process, emphasizing the elements of a well-built clinical question and the key issues that help determine the validity of evidence. This program was developed by the Medical Center Library at Duke University and the Health Sciences Library at the University of North Carolina at Chapel Hill.

Introduction to Evidence-Based Medicine Tutorial

From the Boston University Medical Center Library. A five minute interactive introduction to EBM.

Michigan Informatics

MI-INFO (Michigan Informatics) is a series of online tutorials on health information and computer skills designed to support academic public health informatics programs and public health outreach training initiatives. The nine tutorials are competency-based and feature learning objectives, key concepts, exercises, and case studies. The tutorials will enable public health audiences to better access, evaluate, manage, and apply information needed to respond to public health issues and problems. Tutorials include: Evidence Based Public Health; Finding Health Statistics Online; Searching the Internet; Searching the Public Health Literature; Staying Informed; Health Education Resources; PowerPoint Basics; Access Basics; Excel Basics

An Introduction to Information mastery

This is a Web-based course that introduces the basic concepts of Information Mastery, Evidence-Based Medicine (EBP), and critical appraisal of the medical literature. From Department of Family Practice, Michigan State University.

SUNY Downstate EBM Tutorial

Search the Literature for Evidence-Based Medicine (UCSF)

In this interactive narrated tutorial, you will learn how to effectively search for evidence-based medicine literature that will help in your clinical decision making. Turn your computer speakers on before you begin.

Learning Objectives: After completing this learning module, you should be able to:Formulate a well-built clinical question;Describe the levels of best evidence in scientific literature;Identify how PubMed defines the search terms you enter into a search;Formulate a search in the MeSH Database and run the search in PubMed;Find the highest levels of evidence using PubMed Clinical Queries;Find Randomized Controlled Trials in PubMed;Create filter tabs using PubMed's My NCBI;Find systematic reviews using the Cochrane Library database

Understanding Evidence-Based Health Care: A Foundation for Action (U.S. Cochrane Center)

Cochrane Collaboration: Open Learning

Materials to help become familiar with the rationale for systematic reviews;Understand the concept of bias; Be familiar with different types of questions that can be posed about the effects of health care interventions;Consider study designs which are most likely to give a valid answer to these questions; andBe aware of practical problems in finding, appraising and synthesising non-RCT evidence.

The EBBP Process
This interactive tutorial introduces the principles and steps of Evidence-Based Behavioral Practice (EBBP). It is designed for practitioners in a variety of health professions that target behavioral health, including psychology, social work, nursing, public health, and medicine. Learners listen to a series of testimonials that explore misconceptions of EBBP and learn about the EBBP process by applying it to a sample case scenario. Two scenarios are available, one for practitioners who work with individual clients and a second for practitioners who work with communities.
Search for Evidence
Teaches behavioral health professionals how to effectively search for evidence to support decision-making with clients and communities. Screencasts show example searches in several relevant databases. This tutorial is part of a series on topics related to evidence-based behavioral practice.

EB Nursing

lwu5 — Sun, 18 Oct 2009 15:24:38 CDT

Tutorials - How to Read Articles - Qualitative Research

Nursing and Allied Health Resource Section
This is the home page of the collaborative project by members of the Nursing and Allied Health Resource Section of the Medical Library Association. Use the left-hand navigation to browse the content. The content includes free resources for nurses including databases, electronic books, electronic journals, and Web sites related to nursing and allied health disciplines.

Tutorials:

Brief Online Learning Tutorials (BOLTs): Snippets created by LISTEN project aimed to improve nurses' information literacy and information technology for evidence-based nursing practice.

Information Literacy for Evidence-Based Nursing Practice: An Introduction WCSU Libraries (Danbury, CT)
http://library.downstate.edu/EBM2/contents.htm

E-B Public Health Nursing http://www.uic.edu/depts/lib/projects/ebphn/modulesmain.html

Evidence-based Practice Resources on the World Wide Web, Academic Center for Evidence-Based Practice (University of Texas Health Science Center at San Antonio)
(http://www.acestar.uthscsa.edu/Resources_www.htm)

Evidence Based Practice Resource Area, Oncology Nursing Society (http://onsopcontent.ons.org/toolkits/evidence/index.shtml)

“Show Me the Evidence: Finding, Understanding, and Presenting the Data” Oncology Nursing Society web cast (http://www.ons.org/ceCentral/education/speaker.shtml)

Evidence-Based Practice, University of Iowa Dept. of Nursing Services and Patient Care (http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpractice/index.html)

EBM Turorials*Free Online, St Louis Children’s Hospital Medical Library (http://beckerinfo.net/slch/2008/05/14/ebm-tutorials-free-online/)

Evidence-Based Searching tutorial (PDF) (http://beckerinfo.net/slch/tutorials/)

Evidence-Based Practice tutorial, Univ. of Minnesota Bio-medical Library (http://www.biomed.lib.umn.edu/learn/ebp/)

Evidence Based Nursing, Univ. of North Carolina Health Sciences Library (http://www.hsl.unc.edu/services/tutorials/ebn/index.htm)

“Nursing Research: Show me the evidence” Saint Joseph Hospital (Orange, CA) Nursing Research Blog (http://evidencebasednursing.blogspot.com/)

Evidence Based Practice Tutorial for Nurses, Penn State (http://www.libraries.psu.edu/instruction/ebpt-07/index.htm)

Evidence-Based Knowledge Portal, Eskind Biomedical Library, Vanderbilt Univ. (http://www.mc.vanderbilt.edu/biolib/ebmportal/login.html?refererurl=%2Fbiolib%2Febmportal%2Findex.html)

Evidence-Based Medicine, Drexel Univ. Health Sciences Libraries (http://www.library.drexel.edu/resources/guides/ebm.html)

Resources for Evidence-Based Nursing, McMaster University Health Sciences Library (http://hsl.mcmaster.ca/education/nursing/ebn/index.htm)

Searching the Literature for Evidence-Based Medicine, UCSF School of Medicine (http://missinglink.ucsf.edu/lm/EBM_litsearch/index.html)

Evidence-Based Nursing (EBN) Resources at ISU, Idaho State University (http://www.isu.edu/~franmarc/ebn.html)

How to read articles

Welk DS. Nurse Educ. How to read, interpret, and understand evidence-based literature statistics. 2007 Jan-Feb;32(1):16-20.

Qualitative Research:

Ayelet Kuper, Scott Reeves, and Wendy Levinson. An introduction to reading and appraising qualitative research. BMJ 2008;337:a288

Ayelet Kuper, Lorelei Lingard, and Wendy Levinson. Critically appraising qualitative research. BMJ 2008;337:a1035

Scott Reeves, Ayelet Kuper, and Brian David Hodges. Qualitative research methodologies: ethnography. BMJ 2008;337:a1020

Scott Reeves, Mathieu Albert, Ayelet Kuper, and Brian David Hodges. Why use theories in qualitative research? BMJ 2008;337:a949

Brian David Hodges, Ayelet Kuper, and Scott Reeves. Discourse analysis. BMJ 2008;337:a879

Lorelei Lingard, Mathieu Albert, and Wendy Levinson. Grounded theory, mixed methods, and action research. BMJ 2008;337:a567

Disciplines: Scenarios/Resources

schardt — Fri, 09 Oct 2009 09:52:46 CDT

(BOLD indicates content)

Other sources for scenarios to use as teaching examples

See Also: Class Exercises

OB/Gyn

schardt — Fri, 09 Oct 2009 09:52:26 CDT

Scenarios wanted! Please add your favorites! [Click on "Easy Edit", above]

Information about each scenario can include, but need not be limited to:

the case
the PICO'd question
type of question/preferred study design
suggested search strategies
teaching tips

_______________________________________________

Case: Based on outcome, cases averted, pregnancy loss, what is the most cost effective screening strategy for prenatal diagnosis of Down's syndrome?

SEARCH Strategy: prenatal diagnosis AND downs syndrome AND cost benefit
limit to english, and years desired

TEACHING Tips: prenatal screening doesn't map appropriately. must find correct term for cost effectiveness

_______________________________________________

I found a nice fresh PICO scenario yesterday, when an OB/GYN asked me to do this search:

“What is the optimum timing of prophylactic antibiotics for cesareans—should they be given before the incision, or after clamping the cord?”

In addition to several RCT’s, there’s a 2008 meta-analysis:
Costantine MM, et al.
Timing of perioperative antibiotics for cesarean delivery: a metaanalysis.
Am J Obstet Gynecol. 2008 Sep;199(3):301.e1-6.
PMID: 18771991.

…as well as a 2009 systematic review:
Tita AT, et al.
Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review.
Obstet Gynecol. 2009 Mar;113(3):675-82. Review. PMID: 19300334.

It’s a textbook PICO exercise. Just thought I’d pass it along. From Jeannine Gluck, Eastern Connecticut Health network

Other sources

schardt — Thu, 16 Jul 2009 13:53:39 CDT

Other sources for scenarios to use as teaching examples:

Top Priorities for Comparative Effectiveness Research

AHRQ's WebN&M: Morbidty & Mortality Rounds on the Web
Good resource for cases and scenarios to use in teaching. They provide a scenario, commentary and a list of references.

Top Ten Medical Stories for 2008
This year marked a number of important medical advances and intriguing health news. To help narrow the large list, ABCNews.com reached out to the top medical centers and doctors in a wide range of fields.Below is ABCNews.com's list of the Top 10 medical stories of 2008, deemed most important by doctors and found most interesting by readers. This is a good source for search examples.

AHRG WebM&M
AHRQ WebM&M (Morbidity and Mortality Rounds on the Web) is the online journal and forum on patient safety and health care quality. This site features expert analysis of medical errors reported anonymously by our readers, interactive learning modules on patient safety ("Spotlight Cases"), and Perspectives on Safety.Good resource for finding cases for teaching Medline, EBM, etc.

Evidence Based Case Reports from BMJ

Provides a case and then a critical appraisal of an article. This link is to the resulkts of a search in BMJ for "evidence based case report", an ongoing series in BMJ.

Specific articles that may be helpful for case studies and teaching examples:

Schaafsma F. Caution required when relying on a colleague's advice; a comparison between professional advice and evidence from the literature. BMC Health Services Research . August 31 2005. [Includes a list of 12 case vignettes with correct evidence based answer.

Agostini JV. Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients. Arch Intern Med. 2001 Sep 24;161(17):2091-7.For the case you can use with this study, see: http://www.mclibrary.duke.edu/training/ebmcourse/harm/scenario.doc

Browman GP. Essence of evidence-based medicine: a case report. Journal of Clinical Oncology 17(7):1969-73, July 1999.

De Hertog SA, Leiden Skin Cancer Study. Relation between smoking and skin cancer. J Clin Oncol. 2001 Jan 1;19(1):231-8. http://www.mclibrary.duke.edu/training/ebmclub/harm/harmcase.pdf

Maisel AS, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002 Jul 18;347(3):161-7. OR Mueller C, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004 Feb 12;350(7):647-54. Forthe case you can use with these studies, see: http://www.mclibrary.duke.edu/training/ebmclub/tbaold/heflin_case.pdf

Martin HK. Noninvasive Coronary Angiography With Multislice Computed Tomography
JAMA 2005 May 25;293:2471-

Miser WF. Critical Appraisal of the Literature at http://www.medscape.com/viewarticle/417866 (viewed 12/23/2005) or J Am Board Fam Pract. 1999 Jul-Aug;12(4):315-33.

Perrier A, et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med. 2001 Jul 17;135(2):88-97.Forthe case you can use withthis study, see: http://www.mclibrary.duke.edu/training/ebmclub/diagnosis/ebmclub/diagnosis_case.pdf

Petrella RJ. Effects of Hyaluronate Sodium on Pain and Physical Functioning in Osteoarthritis of the Knee Arch Intern Med 2002 Feb 11;162:292-8.

Ross JR. Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer.
BMJ. 2003 Aug 30;327(7413):469. [Erratum in: BMJ. 2004 Feb 14;328(7436):384.] For the case you can use withthis study, see: http://www.mclibrary.duke.edu/training/ebmcourse/systematic/review_case.pdf

Rowe BH. Nebulized ipratropium bromide in acute pediatric asthma: does it reduce hospital admissions among children presenting to the emergency department? Annals of Emergency Medicine 34(10):75-85, July 1999.

Thomas, SH. Effects of Morphine Analgesia on Diagnostic Accurracy in Emergency Department Patients with Abdominal Pain: A Propsective, Randomized Trial. J Am Coll Surg. 2003 Jan;196(1):18-31 Forthe case you can use withthis study, see: http://www.mclibrary.duke.edu/training/ebmclub/therapy/ebmclub/therapycase.pdf

Weinfeld, JM. How to answer your clinical questions more efficiently. Family Practice Management July/August 2005; 12(7):37-41.

Wiebe S. An evidence based approach to the first unprovoked seizure. Can J Neurol Sci. 2002 May;29(2):120-4.

Zakowski L. Evidence-based Medicine: answering questions of diagnosis. Clinical Medicine & Research. Dec 2003;2(1):63-69.

Journals (in alpha order)

American Heart Journal (Scenarios) àEvidence Based Consult
Bandolier
BMJ àClinical Evidence
Evidence-Based Cardiovascular Medicine (MD Consult)
Jun. 2006 when it ceased publication (use the search boxes to find specific articles)
Evidence-Based Complementary & Alternative Medicine (PubCentral)
Evidence-Based Health Policy & Management (MD Consult)
title changed to Evidence-Based Healthcare 1999
Evidence-Based Healthcare (MD Consult)
Full text 1999-2005 when it ceased publication (use the search boxes to find specific articles)
Evidence-Based Library & Information Practice (Nota)
Evidence-Based Medicine (BMJ) àEBM Notebook
Evidence-based Mental Health (BMJ)
Evidence-Based Nursing (BMJ) àEBM Notebook
Evidence-Based Obstetrics & Gynecology (MD Consult)
2006 when it ceased publication (use the search boxes to find specific articles)
Evidence-Based Oncology
JAMA Rational Clinical Exam Series (systematic reviews of physical examinations)

Journal of Family Practice à Clinical Inquiries (Example: PMID: 16882448)
JMLA has a new coloumn that uses case studies to demonstrate use of the literature (Example: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17082827)
- Please visit the accompanying blog at http://jmlacasestudies.blogspot.com/ to see a discussion and contribute yourself
Western Journal of Medicine (Best Practice section labeled "Evidence Based Case Reviews" or"Clinical Evidence." Stopped publishing in 2002. Backfiles available for free on PubMed Central. Examples: http://www.pubmedcentral.nih.gov/tocrender.fcgi?iid=116287, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1070937&blobtype=pdf, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1071389&blobtype=pdf)

Check out these sites for hot topics (what physicians and patients may be reading or listening to in news)

New York Times-Health
National Public Radio-Health
Journal Watch http://www.jwatch.org/ (This updating service (from publishers of NEJM) might be another way for us to identify topics and studies of interest to various groups when we are planning training sessions on EBM searching. Some of the summaries/critiques are free and some require subscription, but even if we can't read the whole item it gives a good idea of what's of interest to the section editors. This covers specialties other than general internal medicine and might be more useful in that respect than ACP Journal Club. If you register you can see the full text of the archives (older than 6 mos).)
Reuters

Research Activities. a digest of research findings from the Agency for Healthcare Research and Quality (AHRQ); great ideas for scenario topics;

Databases (in alpha order)

ACP Journal Club (hot topics)
Cochrane Library
TRIP
Lab Tests Onlineà "In the News" section
UpToDate, look in the "What's New" section

Clinical questions

ClinicalQuestions Collection This large collection of "real" questions posed by health providers in clinical settings is funded by NLM. Unfortunately no answers are provided, but the site offers a list of real-world clinical questions.
Eskind Library Synthesized Information - Geriatrics Digital Library A small collection of clinical questions with a literature summary and selected references.

2. Acquiring the evidence

schardt — Wed, 27 May 2009 12:43:06 CDT

Resources:

EBM Page Generator from Dartmouth & Yale

Using the EBM Page Generator, you can select the resources that you want on your page from our Resource Database (complete with descriptions and definitions). You can also add your own resources - or edit ours. After you've completed your selections, you can preview the page that you've created, edit it if necessary, and finally copy the code to your own page that you will then post to your web site.

EBM Resources Dartmouth College

Includes a resource pyramid and hierarchical listings of select resources.

Finding Evidence-Based Answers to Clinical Questions - Quickly and Effectively From the Dartmouth Biomedical Libraries

Search the Literature for Evidence-Based Medicine (UCSF)

In this interactive narrated tutorial, you will learn how to effectively search for evidence-based medicine literature that will help in your clinical decision making. Turn your computer speakers on before you begin.Learning Objectives: After completing this learning module, you should be able to:Formulate a well-built clinical question; Describe the levels of best evidence in scientific literature;Identify how PubMed defines the search terms you enter into a search; Formulate a search in the MeSH Database and run the search in PubMed;Find the highest levels of evidence using PubMed Clinical Queries; Find Randomized Controlled Trials in PubMed; Create filter tabs using PubMed's My NCBI;Find systematic reviews using the Cochrane Library database

EBM Search Process - From the Boston University Medical Center Library

EBM Resources - comparison chart

provides information about EBM resources. from Duke EBM Workshop

EBM resources from the 5S pyramid

EBM resources arranged by 5s (systems, summaries, synopses, syntheses, and studies)

Searching Tips:

Find it Fast
From the Yale Medical Library. The primary goal of this series of 10 tutorials is "find it fast". This episode concludes this series and is a recap of the key messages in these tutorials.

Tutorials for searching Cochrane Library.

Self-paced tutorials on using and searching The Cochrane Library exist in several languages: these can be found at http://www3.interscience.wiley.com/aboutus/demo/ or by typing interscience.wiley.com/tutorials

Useful MeSH for EBM

Medical Subject Headings (MeSH) recommended for evidence-based medicine research. Tufts University

Awakening the Searcher Within

Are you a new Medline searcher or do you feel that you've forgotten some of those tips you learned about searching Medline when you took the class years ago? Join us for this distance learning seminar. There will be a bi-weekly web session to help you get, or remember, tips and tricks for becoming, or remaining, an expert searcher.
The recorded sessions are archived on this page. From Pacific Northwest Region/NNLM.

Search Filters

Search filters are collections of search terms designed to retrieve selections of records. Search filters may be designed to retrieve records of research using a specific study design or by topic or by some other feature of the research question. Very extensive collection of filters.

Articles:

Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information services for evidence-based health care decisions. ACP Journal Club. 2006 Nov-Dec;145:A8.
Dr. Haynes has revised his levels of evidence to include summaries. In his editorial, he provides advise on where to look for current best evidence: "How can this model guide decision makers to find the evidence they need, with speed and confidence? Begin the search for evidence to guide clinical decisions at the highest possible level in the 5S pyramid of evidence. If you have a computerized decision support system integrated into your electronic medical record system that reliably links your patient's characteristics with current evidence-based guidelines for care, you don't need to look any further. If you do not work in such an environment (or if you do but the system does not provide support for your patient's problems), then the next place to look is for integrated evidence in a summary service, such as Clinical Evidence or PIER. If the topic isn't covered there, look for a synopsis in one of the evidence-based journals suited to your practice, such as ACP Journal Club , Evidence-Based Medicine , and Evidence-Based Nursing . If you have no success there, look for a systematic review in BMJUpdates+ , the Cochrane Library , or PubMed Clinical Queries . Failing that, you could look up original studies via BMJUpdates+ first, then Clinical Queries if needed. If you are not familiar with which evidence-based resource is best for a particular clinical problem—or you know that the resources you usually use don't cover the problem at hand—then “federated search engines,” such as TRIP and SUMsearch , provide means to search many resources, with the retrieval being organized according to the source of evidence. But if you use such services, you will need to keep your critical appraisal filters on alert: The quality of the retrieval depends on the source, and many sources do not provide critical appraisal of evidence."

Efficient literature searching: a core skill for the practice of evidence-based medicine. Doig GS. Intensive Care Med. 2003 Dec;29(12):2119-27. This review presents a simple, easy-to-follow, three-step searching strategy that emphasises the use of powerful new PubMed features that allow clinicians to retrieve high-quality systematic reviews, clinical practice guidelines and primary studies with a single mouse click. The overall effectiveness of the process is further improved by highlighting the major features of successful and unsuccessful literature searches. At the end of this tutorial the reader should be able to conduct efficient and effective literature searches that support clinical decision making in under 10 minutes.

How to answer your clinical questions more efficiently. Weinfeld JM et al. Fam Pract Manag. 2005 Jul-Aug;12(7):37-41.

Evidence-based Practice. Ann McKibbon. Bull Med Libr Assoc. 1998 July; 86(3): 396–401
This article gives an overview of how to search for therapy, diagnosis, etiology, and prognosis both for original studies and secondary publications such as systematic reviews, meta-analyses, and clinical practice guidelines. Understanding how this research is done, how it is indexed, and how to retrieve the clinical evidence are an important set of skills that librarians can provide for clinicians interested in EBP.

What are the results? (statistics)

schardt — Fri, 17 Apr 2009 11:49:18 CDT

General overview of statistical concepts:

2845 ways to spin risk - From the Understanding Uncertainty Blog

Video Teaching Tips from the Journal of General Internal Medicine

BMJ series on statistical concepts

Perhaps the finest series of short articles on the use of statistics is the occasional series of Statistics Notes started in 1994 by the British Medical Journal.

Grimes and Schulz series in Lancet

Many clinicians report that they cannot read the medical literature critically. To address this difficulty, Grimes and Schulz provide a primer of clinical research for clinicians and researchers alike.

Tips for learning and teaching

From the Evidence-Based Medicine Teaching Tips Working Group. What distinguishes this series is that it targets not only clinician learners but also the teachers of EBM principles. These teachers regularly communicate the principles of critical appraisal to clinician learners in a variety of settings, including ward rounds, at the bedside, during journal club exercises and in formal lectures and seminars. There are 2 versions of the articles: one for learners and one for teachers, which includes supplemental materials.

Effective Clinical Practice From ACP; Easy to understand , short explanations of statistical concepts.

What are confidence intervals? (Bandolier)

A difficult challenge in teaching EBM to clinical students is teaching the methodological and statistical concepts needed to be able to read and understand research studies. This is especially true in clinical programs where the students are training to be clinicians, not researchers. Here is the link to the PowerPoint presentation developed by the biostatician who co-teaches EBM with me for our physician assistant students. (Submitted by Mike Kronenfeld)

Statistical Concepts - http://www.atsu.edu/ebm/step3/stats_basic.htm

This presentation was developed by Dr. Curtis Bay for the Fall, 2006 EBM class for the Physician Assistant Program at the A.T. Still Univ. of the Health Sciences – Mesa Campus.

Dr. Chris Cates' EBM Web Site

Good site for clearly explanation of EBM concepts

Stats - Steve's Attempt to Teach Statistics

Stephen Simon is a Research Biostatistician at Children's Mercy Hospital in Kansas City. His website has lots of information about EBM and statistics and he's easy to understand. Scroll down a bit and check out the pdf of "An introduction to diagnostic testing". Further down, under "All Topics", check out diagnostic testing. We really liked his explanation of number needed to treat, in the "Ask Professor Mean" section...

Online course in Biomedical Statistics (free)
Series of web-based modules by Stephen Simon From Children's Mercy Hospital in Kansas City. Nice overview of relevant topics.

Therapy/Harm:

Relative risks and odds ratios; Whats the difference? Journal of Family Practice. Feb 2004; 53(2):108.

What is an NNT? (Bandolier)

Willy Sutton and the Number Needed to Treat Am J Med. 2004 Apr 15;116(8):564-5

Evidence-Based Practice Teaching Tips - from the Centre for Health Evidence, University of Alberta [Click on “Balancing Benefits and Risk”, “Number Needed to Treat”, and/or “Risk and Risk Reduction” on the left side of the screen under “Therapy --“Risk”]

Visual Rx - Numbers Need to Treat (click on links under "Visual Rx" on left side of screen) - from Dr. Chris Cates' EBM Website

Stating the Meaning of Effect Size Measures in Plain English - from the Duke Program on Teaching Evidence-Based Practice

Show me the evidence: Using Number Needed to treat. Southern Medical Journal. 100(9):881-4, September 2007.

Diagnosis:

Diagnostic Test Calculator Developed by Dr. Alan Schwartz Assistant Professor of Clinical Decision Making in the Department of Medical Education at the University of Illinois at Chicago.

Understanding sensitivity and specificity with the right side of the brain. BMJ. 2003 Sep 27;327(7417):716-9.

Systematic Reviews;

Interpreting and understanding meta-analysis graphs. (forest plots). A practical guide. Australian Family Physician 36(8):635-8, August 2006.

Welcome

nsdettmar — Sun, 05 Apr 2009 00:12:54 CDT

The purpose of this wiki is to develop a community of librarians who are involved in teaching and supporting the practice of Evidence-Based Medicine (EBM). This site offers a place to:

share teaching materials and class handouts
discuss issues and ask advice from colleagues
share useful information about teaching ebm

Please feel free to use these materials. However if you use them,
please give credit to the original authors. And then sign up as a
writer so you can add your materials to the site.

See What's New - What's Cool

Connie Schardt
Duke University

Karen Odato
Dartmouth College

Within these sections you will find handouts, examples, teaching tips, scenarios, references, etc. to help support the teaching of EBM

What's New - What's Cool
EBCP Workshop 2008
EBM overview
1. Asking clinical questions
- Study design
2. Acquiring the evidence
3. Appraising the evidence
- Is this study valid?
- What are the results? (statistics)
4. Applying the evidence
CATS: Putting it all Together
EBM Teaching Tools
- Class Exercises
- Disciplines: Scenarios/Resources
- EBM Curriculum
- Course Evaluation
EBM Tutorials
EBM Conferences
Related blogs, wikis, etc
References

EBM overview

nsdettmar — Sun, 05 Apr 2009 00:09:53 CDT

Evidence-Based Practice in the Health Science- Tutorials.

Welcome to the Evidence-Based Practice (EBP) tutorials developed by the Information Services Department of the Library of the Health Sciences-Chicago at the University of Illinois at Chicago.The tutorials are tailored to five health sciences disciplines: Applied Health, Dentistry, Medicine, Nursing, and Pharmacy. Each tutorial consists of five instructional modules:

Introduction to Evidence-Based Practice
Structure of literature
Research design
Searching the literature
Evaluating the quality of research

From "Netting the Evidence" a Google Search Engine that searches over one hundred web sites (107) associated with the methodology of evidence based practice (as of 4/09, last updated Oct 20, 2007). You can add the search engine to your own website or create your own customized EBM Search engine. http://tinyurl.com/2poh3a. [Please note: the TRIP database is the best source of actual evidence). Here's an example of how it can be added to your own webpage: http://www.mclibrary.duke.edu/subject/ebm?tab=overview&extra=teaching

Introduction to EBM Tutorial

This self-paced tutorial will take you through the complete EBM process, emphasizing the elements of a well-built clinical question and the key issues that help determine the validity of evidence. This program was developed by the Medical Center Library at Duke University and the Health Sciences Library at the University of North Carolina at Chapel Hill.

Users' Guides to Evidence-Based Practice - From the Centre for Health Evidence, University of Alberta

EBM Subject Guide Duke University

Evidence-based Answers to Clinical Questions for Busy Clinicians From the Centre for Clinical Effectiveness (CCE), Monash Medical Centre, Australia (28 page workbook)

Evidence-based Practice Tutorial for Nurses from Penn State University Libraries. Includes basic PICO concepts, audio clips, and links to library and free-web sources for evidence.

Evidence Based Medicine Tutorials

From Lamar Soutter Library, UMass Medical School.

Evidence Based Medicine Web Tutorial

From Norris Library, USC

The Evidence Cycle - from the Duke Program on Teaching Evidence-Based Practice

Education Prescription - from the Duke Program on Teaching Evidence-Based Practice

Introduction to Evidence-Based Medicine Tutorial

From the Boston University Medical Center Library. A five minute interactive introduction to EBM.

Evidence Based Medicine Information

From Thomas Jefferson University. This tutorial will acquaint you with the concept of Evidence Based Medicine and help you to develop MEDLINE search strategies to locate reports of research in the medical literature which use evidence-based principles.

Evidence based Medicine and the Hospital Librarian. Journal of Hospital Librarianship. 1(2):1-14. 2001.

request a copy from Connie Schardt

American International Health Alliance

Includes a resource Center and Toolkit with lots of vakluabkle links to useful EBM resources. There is a mirror site in Russian.

Cardiology

schardt — Tue, 24 Feb 2009 07:21:15 CST

Scenarios wanted! Please add your favorites! [Click on "Easy Edit", above]

Information about each scenario can include, but need not be limited to:

the case
the PICO'd question
type of question/preferred study design
suggested search strategies
teaching tips

_______________________________________________

While competing in a league soccer game, Chris died when he was hit directly in the chest with a soccer ball. Chris was an active, healthy 18 year old student working toward a degree in Kinesiology. You have heard about sudden death as a result of a blow to the chest but can't recall the name of the condition. Before meeting with Chris' parents you would like to search the literature to find out more about it.

_______________________________________________
Case: In patients undergoing cardiac surgery, is amiodarone more effective than beta blockers in preventing arrhythmias such as atrial fibrillations?

P heart surgery
I amiodarone
C beta blockers
O prevent arrhythmias (atrial fibrillation)
T Therapy
T RCT

TEACHING Tips:cardiac surgery, as well as heart surgery, maps to both thoracic surgery and cardiac surgical procedures--which is too broad. Go to the MeSH Database or check details and pick out cardiac surgical procedures to search on

1. Asking clinical questions

kodato — Wed, 11 Feb 2009 09:15:32 CST

The Clinical Question Worksheet - (PDF or word) and example From the Dartmouth Biomedical Libraries

Focusing Clinical Questions - from the Oxford Centre for Evidence-Based Medicine

Template for forming clinical questions online from Duke University

EBM: Asking Focused Questions Duke University example of class case study (see attached file - below comments)

Forming A Clinical Question Tutorial

From the Boston University Medical Center Library. A five minute interactive tutorial on formulating clinical questions.

See also -- Study Design

Study design

schardt — Tue, 23 Dec 2008 09:15:07 CST

Study Design
Don't forget Wikipedia as a source for information. This site provides a nice explanation of study design with examples.

Study Design - from the Oxford Centre for Evidence-Based Medicine

Types of Studies - from the SUNY Downstate EBM Tutorial

Type of Studies from NICHSR

Evidence Pyramid and Study Design Duke University

Handout explaining the evidence pyramid and study design

Brief introduction to study design

Camtasia video - PowerPoint slides with audio

Cohort studies: marching towards outcomes. Grimes DA and Schultz KF. Lancet 359:341-345

Pediatrics

schardt — Fri, 24 Oct 2008 09:55:51 CDT

Scenarios wanted! Please add your favorites! [Click on "Easy Edit", above]

Information about each scenario can include, but need not be limited to:

the case
the PICO'd question
type of question/preferred study design
suggested search strategies
teaching tips

_______________________________________________

Scenario #1:
Ms. Crosbie has been asked to schedule an appointment for her baby's 18 month needle (MMR). She is very concerned about this as she has heard reports that the MMR needle causes autism. She asks you whether or not there is a link between the MMR vaccine and an increased risk of autism in children?
P: 18 month old child
I: MMR vaccine
C: no MMR vaccine
O: autism / autistic spectrum disorder

Answerable question: In 18 month old children, does receiving the MMR vaccine increase the risk of developing autism?
MeSH: autistic disorder/etiology; Measles-Mumps-Rubella Vaccine/*adverse effects
PubMed keyword: (mmr OR measles mumps rubella) AND autis*
Teaching tips:

this is a good one for thinking about reasonable limits to set. For example, there is little need to limit this search to children because most articles on MMR and autism are about the 18-month age group.

_____________________________________________
Scenario #2:

Role of leukotriene receptor antagonists such as montelukast or zafirlukast in the management of asthma in children.
These are drugs you see advertised on TV sometimes – Singulair (montelukast). There’s interest in them because they have anti-inflammatory effects without being steroids. There have been a number of systematic reviews that mention children, including Cochrane. Good for showing “details,” limiting, therapy and systematic review Clinical Query filter. In this example I limited to child 6-12 only to eliminate the adult studies you’d get with “all child.” Also the limit to Core Clinical Journals. This example was used for a Pediatric Journal Club.

#21Search (#11 AND #17) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) Limits: Core clinical journals, Child: 6-12 years 23
#20Search (#11 AND #17) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) Limits: Child: 6-12 years 175
#19Search #11 AND #17 Limits: Child: 6-12 years 318
#18Search #11 AND #17 1595
#17Search leukotriene receptor antagonist 3337
#12Search singulair 833
#11Search asthma 98312

_________________________________________________________________________

Case: You are seeing a beautiful 1 month old girl for a WCC. Her exam is notable for thrush. You are about to prescribe nystatin orally, your standard practice, when the mom comments that she could never do anything four times a day, and wonders whether she could use a once-daily medicine like fluconazole, which she had taken once for a yeast infection.

Answerable questions: In healthy infants with thrush, is fluconazole one daily as effective as nystatin four times daily?
In healthy infants with thrush, does fluconazole once daily lead to better compliance than nystatin QID, or early resolution?

SEARCH Strategy: thrush AND fluconazole AND nystatin limit: All infant

TEACHING Tips: straightforward question, use limits, show other features of PubMed with this easy question
_____________________________________________

Case: You are in Same Day clinic, and have a 7 month old patient with a fever to 103, but no other localizing signs. You want to follow the protocol and get blood (CBCD and blood culture) and urine, but your attending comments that this kid has gotten all of his immunization, including Prevnar.

Answerable questions:
In infants who have received the Prevnar vaccine, and present with fever without signs (fever wtihout source, fever with no localizing signs), what is the prevalence of occult bactermia? UTI?

In infants with fever without signs, what are the sensitivity/specificity and likelihood ratios of a CBC with diff?

SEARCH Strategy:prevnar AND fever AND (bacteremia OR urinary tract infection)--doesn't give you too much to work with, no limits needed
2nd search: (complete blood count AND fever) AND (sensitivity OR specificity) limits: All infants

TEACHING Tips: go to MeSH Database to see that fever explodes to include "fever of unknown origin". NOTE: typing in blood occult will lead you down a strange path, check details to show this
_____________________________________________

Case: You are in Same Day Clinic, seeing a 5 yo boy with an asthma exacerbation. He has some impressive increased work of breathing, enough so that you think he may eventually need to be admitted. You order oral prednisolone and albuterol, and are wondering whether you should give ipratroprium (Atrovent) as well.

P asthma
I albuterol
C atrovent
O reduce hospitalization rate
T therapy
T RCT

Answerable question: In children with moderate to severe asthma exacerbation, does Atrovent added to albertol decrease rate of hospital admission?

SEARCH Strategy:(asthma AND atrovent AND albuterol) AND (length of stay OR patient admissions OR hospitalization)
can do therapy narrow clinical query, though not really necessary with the small number of citations retreived

_____________________________________________

Case: You are on the floors admitting a 5 year old boy with an asthma exacerbation as he has some impressive increased work of breathing. He is in q2 albuterol and q4 atrovent. Your attending wants to continue the atrovent and wean it with the albuterol (e.g. q3 albuterol/q6 atrovent, then q4 albuterol/q8 atrovent). You wonder whether this really makes a difference in getting this kid home any faster.

Answerable question: In hospitalized children with asthma, does atrovent added to albertol decrease length of stay?

SEARCH Strategy:(asthma AND atrovent AND albuterol) AND (length of stay OR patient admissions OR hospitalization)
can do therapy narrow clinical query, though not really necessary with the small number of citations retreived

_____________________________________________
Case: You are seeing a two-month-old baby boy who has been growing well for a well-child exam. No specific concerns per mom. No sweating or problems with feeding. Prenatal course unremarkable and (-) PMH. On exam, P 110, RR 30, BP 80/50 with normal 4 limb BPs, no distress. Lungs clear. Heart RRR with 2-3/6 ejection murmur without radiation. No S3 or S4. No hepatosplenomegaly. No edema. Good femoral pulses. You had not heard the murmur at his other visits and begin to wonder how to evaluate this. You’re thinking about getting a chest x-ray and an EKG.
Question: The question should be something along the lines of: “In children with a heart murmur, what is the usefulness (sensitivity/specificity) of obtaining a chest x-ray in making a diagnosis?”
_______________________________________________________________________

Case: You are seeing a 2 month old baby girl for a well-baby exam. In your discussion about feedings, the parents report that their daughter “spits up” after every feeding. It is non-projectile, nonbilious, and non-bloody. They are breast-feeding, but this occurs after bottles also. The baby has otherwise been well and was born full-term. On exam, the baby’s weight is just below the 10th percentile, height at 50th and head circumference at the 50th. The baby generally looks nourished, but smallish. Well-hydrated. Lungs are clear. Abdominal exam is normal. You believe this infant's GE reflux may be interfering with her growth. You recall that many kids are being sent home from the NICU on cisapride and ranitidine and wonder how effective those measures are.
Question: “In infants with gastroesophageal reflux, is there a non-surgical therapy that improves outcome (pick an outcome, like growth)?”

Is this study valid?

schardt — Fri, 12 Sep 2008 11:14:04 CDT

Therapy:

The intention-to-treat principle: a primer for the orthopaedic surgeon. Bubbar VK. Journal of Bone and Joint Surgery. Sept 2006 88A(9):2097-99. Very clear explanation of this concept.

Intention-to-treat. Montori VM, Guyatt GH. CMAJ. 2001 Nov 13;165(10):1339-41.

Double blind, you are the weakest link - good-bye! ACP Journal Club Jan/Feb 2002:A-11-12.

Bandolier Bias Guide

Assessing allocation concealment and blinding in randomised controlled trials: why bother? Shultz KF. Evidence Based Medicine 2000 5:36-38.

Risk Reduction Calculator

Diagnosis:

Evidence and Diagnostics from Bandolier

Diagnostic Test CalculatorCopyright (c) 2002-2006 by Alan Schwartz

Systematic Reviews:

Appraising Systematic Reviews - From the Joanna Briggs Institute

Table for Comparing Several Types of Summary (Review) Articles - From the Duke Program on Teaching Evidence-Based Practice

Practice Guidelines:

The AGREE Instrument for Appraising Practice Guidelines – From the AGREE Collaboration

Qualitative Research:

Ayelet Kuper, Scott Reeves, and Wendy Levinson. An introduction to reading and appraising qualitative research. BMJ 2008;337:a288

Ayelet Kuper, Lorelei Lingard, and Wendy Levinson. Critically appraising qualitative research. BMJ 2008;337:a1035

Scott Reeves, Ayelet Kuper, and Brian David Hodges. Qualitative research methodologies: ethnography. BMJ 2008;337:a1020

Scott Reeves, Mathieu Albert, Ayelet Kuper, and Brian David Hodges. Why use theories in qualitative research? BMJ 2008;337:a949

Brian David Hodges, Ayelet Kuper, and Scott Reeves. Discourse analysis. BMJ 2008;337:a879

Lorelei Lingard, Mathieu Albert, and Wendy Levinson. Grounded theory, mixed methods, and action research. BMJ 2008;337:a567

Related blogs, wikis, etc

schardt — Tue, 09 Sep 2008 19:18:56 CDT

DavidRothman
David Rothman now works as the Information Services Specialist at the Community General Hospital Medical Library, managing the day-to-day operation of the CGH Medical Library

The Krafty Librarian
Michelle Kraft has been a medical librarian since 1998 and is currently the medical librarian for a hospital system in Ohio. She enjoys looking at technology and its effect on everything in libraries. "I seem to be a reference librarian with a flare of techie in me."

Journal Watch
Journal Watch is written by Dr Richard Lehman and is a lighthearted review of the leading medical journals from a GP perspective. It is updated weekly. Excellent overview of the weekly literature.

JMLA Case Studies in Health Sciences Librarianship

The October 2006 issue of the Journal of the Medical Library Association (JMLA) will contain the first installment in a new series of case studies. These cases will provide narrative and insight from expert commentators drawn from librarianship, informatics, medicine, research, and other areas that inform the development of a given case situation. This feature will share commentary and practices for a variety of scenarios with the intent of prompting discussion of issues facing health sciences librarianship as a developing profession and the development of potential solutions.

This blog will serve as an online forum for further discussion of the scenarios and facets of the strategies for addressing these information-related challenges. The curator of the column, JMLA co-editor Rebecca Jerome, will collate prominent issues from comments/questions submitted by readers into periodic updates to the blog, with the intent of fostering discourse about techniques for addressing complex information-related issues in the health sciences.

Hospital Library Section of MLA
The hospital librarians' wiki is sponsored by the Hospital Libraries Section of the Medical Library Association. The purpose is to provide a sandbox in which we can share best practices in a forum that is easily accessed, archived, searched, and modified. Everyone is invited to participate. Anyone can add content to existing pages by "Editing This Page."

HLWiki

Health Library Wiki from UBC

Clinical cases and Images Blog

Clinical Cases and Images is a useful resource that brings together various pearls of medical wisdom and aims to bridge the gap between clinical theory and practice (http://clinicalcases.blogspot.com). This well organised site contains a good collection of case histories, with links to imaging, and clinical examination and procedure websites, making this a feature rich site with a strong focus on clinical learning.

Librarians' Rx

A blog featuring items of interest to librarians working in Canadian health sciences libraries. This site was created by Denise Koufogiannakis, Collections and Acquisitions Coordinator for the University of Alberta Libraries. It is now maintained by Trish Chatterley, Academic Intern at the John W. Scott Health Sciences Library, University of Alberta.

ganfyd.org

The free medical knowledge base that anyone can read and any registered medical practitioner may edit. Ganfyd is a collaborative medical reference by medical professionals and invited non-medical experts. The site is based around the wiki format, enabling true sharing of knowledge. Please join and help us to create a great source of information and experience!

Evidence Based Medicine Resources

A long list which seems both useful and comprehensive.

Nursing Research - Show me the evidence

The Saint Joseph Hospital(Orange, California) Nursing Research Blog will communicate the nursing research activities at SJO to staff. Communications may include, but are not restricted to, announcements of Nursing Grand Rounds, Nursing Journal Clubs, Nursing EBN classes, ongoing nursing research and relevant medical library announcements and news. Secondly, this blog will serve as an open discussion forum for nurses and librarians interested in evidenced based nursing.

Sinai EM Journal Club

Example of a blog used to report on Journal Club topics and discussion. (not updated since 2007 but a good example)

EBM and Clinical Support Librarians@UCHC

A blog for UCHC graduate students, faculty and librarians about their use of clinical literature, Web 2.0, sources, strategies

Course Evaluation: Knowledge retention

schardt — Mon, 11 Aug 2008 07:31:38 CDT

Evaluation of a workshop on evidence-based medicine for social insurance physicians
Evidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine. Aims We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations.
Conclusions The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.

Instruments for evaluating education in evidence-based practice. a systematic review
JAMA September 6, 2006; 296(9):1116-1127

Validation of the Fresno test of competence in evidence based medicine
BMJ February 8, 2003; 326:319-321
This article includes a link to the tests and a grading rubric.
We used a slightly modified version for our EBM Course pre-test. (see attachment below comments)

Berlin Questionnaire
Do short courses in evidence based medicine improve knowledge and skills? Validation of the Berlin questionnaire and before and after study courses in evidence based medicine.
BMJ December 7, 2002; 325:1338-1341

3. Appraising the evidence

schardt — Wed, 02 Jul 2008 13:00:03 CDT

Rules of thumb for critical appraisal:

the first rule in critical appraisal is to focus on how the data was collected and not on how it was analyzed

if the raw data or simple stats do not suggest an effect, then the effect found by sophisticated statistics is unlikely to be important in practice.

from: Michael Power, Clinical Knowledge Summaries Service www.cks.library.nhs.uk

Critical Appraisal and Other EBM Worksheets Dartmouth College

Includes PICO (Clinical Question), critical appraisal, applying to patient, and CAT worksheets - in pdf and Word format.

Critical Appraisal Worksheets Duke University

These worksheets are based on the JAMA articles. In Word and PDF.

Expanded critical appraisal sheet (with explanations) for THERAPY. Duke Unviersity

Evaluation of studies of treatment or prevention interventions. Evidence Based Nursing Oct 2000; 3:100-102.

Excellent explanation of the critical appraisal questions.

A simple method for evaluating the clinical literature. Flaherty RRJ. Fam Pract Manag. 2004 May;11(5):47-52.

Critical Appraisal of the Literature

Miser WF. J Am Board Fam Pract 12(4):315-333. Good article walking you through the EBM process with 2 cases. (Free from Medscape; requires registration)

Consort statement The CONSORT Statement is intended to improve the reporting of a randomized controlled trial (RCT), enabling readers to understand a trial's design, conduct, analysis and interpretation, and to assess the validity of its results. It emphasizes that this can only be achieved through complete transparency from authors. This site provides lots of useful information explaining validity concepts.

Study Design Concepts - http://academics.ashs.edu/faculty/mkronenfeld/EBM powerpoints/Study_designRCB.ppt A difficult challenge in teaching EBM to clinical students is teaching the methodological and statistical concepts needed to be able to read and understand research studies. This is especially true in clinical programs where the students are training to be clinicians, not researchers. Here is the link to the PowerPoint presentation developed by the biostatician who co-teaches EBM with me for our physician assistant students. (Submitted by Mike Kronenfeld;
This presentation was developed by Dr. Curtis Bay for the Fall, 2006 EBM class for the Physician Assistant Program at the A.T. Still Univ. of the Health Sciences – Mesa Campus.)

See also -- Is this study valid?

See also -- What are the results? (statistics)