EBM Librarian - Recently Updated Pages

EBM Teaching Tools

schardt — Thu, 04 Sep 2008 09:13:32 CDT

Class Exercises

Disciplines: Scenarios/Resources

EBM Curriculum

Course Evaluation: Knowledge Retention

Presentations

Resources:

100+ resources for teaching without textbooks

Medical Education wiki

EB Nursing

schardt — Thu, 04 Sep 2008 09:04:10 CDT

Tutorials:

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.

Quantitative Research:

Series in BMJ reviewing qualitative studies

Is this study valid?

schardt — Thu, 04 Sep 2008 09:02:41 CDT

Therapy:

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

What's New- What's Cool

schardt — Tue, 26 Aug 2008 08:53:46 CDT

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.

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

EBM Tutorials

schardt — Tue, 22 Jul 2008 06:53:06 CDT

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.

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.

Other sources

brandi.tuttle — Thu, 17 Jul 2008 11:32:41 CDT

Other sources for scenarios to use as teaching 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:

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.

EBM Conferences

schardt — Thu, 03 Jul 2008 07:24:29 CDT

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)

EBM for Librarians

UIC Library of the Health Sciences at Peoria, IL. July 16, 17, and 18.

Introduction to EBM: Research Design and Searching Tools - July 16, 2008.

Appraising the Evidence for Validity: Diagnosis & Therapy - July 17 & 18, 2008.

Earn 21 MLA CE Credits.

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. (map of registered participants)

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.

Dartmouth Summer Institute in Evidence-Based Mental Health

Dartmouth College, Hanover, NH. This 2.5-day course utilizes small group sessions with hands-on, case-based training. We introduce the evidence-based process using topics in the areas of child, adolescent, adult and geriatric mental health. Librarians are welcome!

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 10 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.

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)

Internal Med

schardt — Mon, 16 Jun 2008 13:47:18 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: The patient is a 73-year-old white woman who was admitted to the hospital with heart failure. She is a compliant patient and seldom misses her medications. On admission, her medications were furosemide 40 mg po qd, enalapril 20 mg po bid, simvastatin 10 mg po qd, and aspirin 325 mg po qd. She usually functions at a NYHA class II level, but she now has had two admissions for congestive heart failure in the past 4 months. On this admission, a myocardial infarction has already been ruled out and she remains in sinus rhythm. She has normal renal function with a serum creatinine of 0.7 mg/dL. The patient is particularly concerned about staying out of the hospital because she is very active in her community, lives alone, and has no one to care for her pets and plants. The resident asks the team if digoxin would help shorten her hospital stay or keep her from being readmitted. You are asked to do a PubMed search and bring the answer to morning rounds.
P female, 73, heart failure with history of MI
I digoxin
C
O reduce length of stay or likelihood of readmission
T therapy
T RCT

SEARCH Strategy: heart failure, congestive ANd digoxin AND hospitalization
clinical queries

TEACHING Tips: have go to MeSH to look at length of stay, move up to tree to Hospitalization which would include all terms we are interested in
_______________________________________________
Case: An 18 year old male with no significant past medical history is brought to the Emergency Department by Life Flight after a high-speed motorcycle accident. He was in excellent health before the accident. He is admitted to the SICU in a non-responsive state with multiple severe injuries, including multiple fractures and head trauma. After two days in the SICU, the patient is still in a coma from the traumatic brain injury.

The resident also notes that the patient has been started on dexamethasone, which is commonly used to control cerebral edema in cases of multiple head trauma, and asks you if there is good evidence that steroids will help his overall outcome and reduce the risk of death. As the two of you are walking out of the unit, you meet his parents, and they ask you what their son’s “chances of returning to his normal self” are after being in a coma for two days.

P brain injury, head trauma
I dexamethasone, steroids
C none
OImprove mortality, other outcomes
T Therapy
T RCT

SEARCH Strategy: (brain injury OR head trauma) AND (dexamethasone OR steroids OR corticosteroids)
Clinical queries: therapy/narrow

TEACHING Tips: talk about including both head injury terms as well as broadening the search out with steroids and corticosteroids

_______________________________________________
Case: Patient is a 73 year old female in good health with normal cholesterol levels and no chronic diseases. However she comes to the clinic because she is starting to notice that she is forgetting things more often and having problems balancing her checkbook and playing brain teaser games with her grandchildren. Her husband says he hasn’t notice anything different about her. But she’s fearful that she might be “getting Alzheimer’s Disease”. She said her neighbor told her that Lipitor is supposed to help with the symptoms or maybe even prevent Alzheimer’s disease. She wants your advice. Would this help? You recall a few patients complaining about memory problems while on statins but don’t know the data on reducing the risk of AD or associated cognitive symptoms. You tell her you’ll get back to her. You ask her about any other medications she might be on and she tells you that she is taking Sporanox for a toe nail infection.

P - elderly, female with memory loss and possible cognitive problems
I - Lipitor or statins
C- none
O - prevent Alzheimer's Disease or dementia; improve cognitive function
T- therapy/prevention
T-RCTor cohort study

TEACHING Tips: Use of MeSH to check drugs under statins- Pharmacological Action; use the Tree structure to use a broader term for Alzheimers (Dementia...Cogniive Disorders); use MeSH for cohort studies (everyone looks under limits!); use of textword "prevent" to get at the subheading.
_______________________________________________

Case: The patient is a 68-year-old AA male who has well-controlled hypertension, hyperlipidemia (on a statin) and GERD. He has a h/o MI 2 years ago with a reduced ejection fraction (EF) of 30% (i.e. left ventricular dysfunction). His functional status is NYHA Class III CHF. He is on aspirin, Atenolol, and an ACE-Inhibitor at the time of admission. He expresses concern that, given the state of his heart, he will not survive to see his grandson graduate from law school in 3 years. However, he also states that the quality of his life is important to him, specifically he does not wish to spend time in the hospital or live his life if he cannot be active and interact with his family. Your attending tells you that the implantation of a cardiac defibrillator can decrease all cause mortality in these kinds of patients. However the resident says that ICD have significant costs and risk associated with them. They both turn to you and ask you to gather the current evidence so they can help the patient make a good decision.

P - elderly male, history of myocardial infarction, reduced ejection fraction of 30%
I - ICD
C- none
O - quality of life, mortality
T- therapy
T-RCT

SEARCH Strategy: myocardial infarction AND (ejection fraction OR "Ventricular Dysfunction, Left"[MeSH]) AND implantable defibrillator
Then use Therapy-->Narrow Clinical Query

TEACHING Tips: reduced ejection fraction doesn't map, using MeSH Database search ejection fraction and choose ventricular dysfunction, left (this is the main issue). use clinical queries to find relevant studies

_______________________________________________

Case: In elderly patients with normal LDH and signs of cognition problems, does Lipitor or other statins reduce the risk of Alzheimers disease or dementia?

P cognition problems, normal cholesterol
I lipitor or other statins
C
O reduce alzheimers risk
T therapy, prognosis
T RCT or cohort

SEARCH Strategy: alzheimers disease AND Delirium, Dementia, Amnestic, Cognitive Disorders
to get at types of studies use therapy narrow clinical query or AND in cohort study to above strategy

TEACHING Tips: use MeSH Database to move up the tree to include more than just Alzheimer disease
_________________________________________________________________________________

AB is a 16 year old female who was diagnosed with a rare, highly aggressive cancer last year. She has been undergoing intensive chemotherapy for several months and seems to be in remission. But the treatment has left her overwhelmed and depressed. It will take the insurance company 6 weeks to approve visits to a psychiatrist. In the meantime she is feeling worse and falling into a deep funk. Her parents ask you for help and suggest that Prozac might help her. They tell you they have seen this advertised in magazines. You, however, are aware of the controversy with SSRIs and need to carefully review the evidence before responding to her parents.

Teaching Tip: good example of why it's important to check DETAILS; good example of how MeSH doesn't always map correctly (SSRI); good use of limits and clinical queries
____________________________________________________________________________________

You are a medical student rotating in the ED. This is the first day of the rotation. The first case is a 34 year old male complaining of lower abdominal pain, nausea and vomiting. The team suspects appendicitis and asks you as the new student which is the better diagnostic tool – a scan or an ultrasound? You are overcome with a feeling of uncertainty and a strong urge to review the literature and find some impressive evidence to bring back to your Chief.

Teaching Tip: good example of Boolean, mapping and clinical queries
____________________________________________________________________________________

You are evaluating a 27 yo female who has trouble with migraines. She has daily headaches and is known to overuse abortive medications. She currently uses ibuprofen and if that doesn't work she uses Imitrex. She has tried nortriptyline 25mg before bedtime for the past month without success for prevention. She has no other medical problems and is not taking other medications & is not pregnant. VS are normal.

Teaching Tip - good scenario for generating a variety of clinical questions

Welcome

schardt — Mon, 16 Jun 2008 13:23:35 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

Lindsey Glynn
Health Sciences Library
Memorial University of Newfoundland

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

EBCP Workshop

schardt — Mon, 16 Jun 2008 13:22:36 CDT

EBCP Workshop at McMaster University

EBCP Workshop Resource page

2008 Workshop materials and handouts:

From Neera - RefWorks file of articles on small group learning, PBL, group processes & teaching tips

2007 Workshop materials and handouts:

From Connie:
EBM Resources comparison chart (see attachments below comments)

EBM Resources: Organization of Evidence (see attachments below comments)

Question building and formulating the search [template] (see attachments below comments)

EBM Jeopardy [PowerPoint] (see attachments below comments)

Saving searches in PubMed; MyNCBI

Setting up filters in PubMed: MyNCBI

Table of Content email delivery via PubMed

PubMed MyNCBI

The Librarian tutors for the 2006 workshop:

2006 EBCP workshop

Read Dean Gustini's blog entries from 2006: First impressions Interium report Final report

What are the results? (statistics)

schardt — Mon, 16 Jun 2008 13:15:51 CDT

General overview of statistical concepts:

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 thisseries 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://academics.ashs.edu/faculty/mkronenfeld/EBM powerpoints/PA Stats.ppt

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

Steve 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...

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.

Presentations

schardt — Fri, 06 Jun 2008 08:12:56 CDT

From the Centre for Evidence Based Medicine: PowerPoint presentations

Powerpoint presentations used in workshops at the CEBM. You are free to use and modify these, but CEBM asks you to acknowledge the original author in your presentations.

Improving Journal Club Presentations

ACP Journal Club 2007 147(1):A-8-9.

2. Acquiring the evidence

schardt — Wed, 04 Jun 2008 14:58:30 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:

Useful MeSH for EBM

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

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.