1. Primary vs. Secondary Sources for Evidence-Based Medicine SohailBajammal October13, 2011

2. Objectives Differences between primary & secondary sources of evidence Overview of popular secondary sources

3. 5A

4. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 Computerized decision support system Evidence-Based Guidelines & Textbooks Secondary Critically-Appraised Journal Articles & Abstracts Systematic Reviews RCTs, Cohort, Case control, Case series Primary Expert Opinion: Classical Textbooks

5. Searching for evidence Case report, Case series, Case-Control, Cohort, Randomized Trial DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009

6. Studies(Primary Sources)

7. Primary Sources Original articles Through databases: MEDLINE, EMBASE Using: PubMed, OVID You have to retrieve and appraise the articles Strength (pyramid) of evidence

10. MeSH (Medical Subject Headings)

11. It is a “strategy” Low Back Pain Treatment OR OR Low Back Ache Management Acute OR OR Low Backache Therapy AND AND OR OR "Low Back Pain"[Mesh] Surgery

15. We will talk more aboutSEARCH STRATEGYin Research Methodology

16. PubMed Tutorials 16

19. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13

20. In: Glasziou P, Del Mar C: Evidence-based Practice Workbook: Bridging the gap between health care research and practice. Blackwell Publishing - BMJ Books. 2007. PP 3-13

21. Pyramid of Evidence http://library.downstate.edu/EBM2/2100.htm

25. Tough Job If you have to do the critical appraisal for every single article you read  Tough BUT You need to learn about it in details for the sake of research

26. Don’t say there is “no evidence” Instead Weak evidence You might not have looked thorough enough

27. Absence of evidence is not the evidence of absence

28. Satisficing ‘‘where busy clinicians will be satisfied with the information they can readily summon, while sacrificing quality for convenience” Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and ‘‘satisficing.’’ Bioethics Forum. 2002;18:7–15.

29. Usefulness of information Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.

31. Secondary Sources

32. Syntheses(Systematic Reviews)

33. Syntheses The authors have done the work for you Hopefully: They asked a good question They searched the literature systematically (keywords & MeSH) They identified the studies and assessed their quality This is called Systematic Review If they did statistical combination of results, this is called Meta-analysis

34. How to search for “Syntheses”? Same databases: MEDLINE, EMBASE Cochrane Library

35. PubMed

37. Available at UQU

42. Are all syntheses good? You still have to appraise the quality of these systematic reviews and meta-analyses

44. Synopses(Critically Appraised Abstracts)

45. Synopses Physicians with training in research methodology: Read the articles Assess their quality Summarize them for you Many sources: Database of Abstracts of Reviews of Effects (DARE) ACP Journal Club Evidence-based sections in many journals Others: DynaMed, EvidenceMatters, EssentialEvidence

54. DAREDatabase of Abstracts of Reviews of Effects

59. SummariesEBM TextbooksEBM Guidelines

60. EBM Textbooks UpToDate

66. Guidelines Types of guidelines: Consensus Evidence-based Use the limiting features in the website

67. Guidelines NICE: National Institute for Health & Clinical Excellence SIGN: Scottish Intercollegiate Guidelines Network NGC: National Guideline Clearinghouse

77. Are all guidelines good quality?

86. Systems

87. Systems This is the ultimate goal Computerized decision support Too sophisticated for us to think about now

93. Paid Services DynaMed EvidenceMatters EssentialEvidence Plus

94. Available at UQU DynaMed

105. Evidence Matters

121. EssentialEvidencePlus

131. Meta Search (Many-in-one) NHS Evidence TripDatabase Google Scholar

132. NHS Evidence

137. TRIPDatabase

146. Google Scholar

148. Broad Term  Lots of irrelevant results

150. They will email you when new article cites this article

151. Searching for evidence DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009

152. Next Weeks Critical Appraisal of: Therapy Systematic Review Diagnosis Prognosis