Which resource you use to find an answer to your question will be determined by what kind of question you're asking. If you're asking a background question, the online textbook UptoDate will be useful.
All of the resources are good for foreground questions, although some are more useful to one type of question than another.
All resources are available from the EBP Resource Page at the Medical Research Library of Brooklyn . Some resources discussed are licensed by the Library and require a user id and password to identify appropriate users.
The Cochrane Library is the place to go for systematic reviews. The reviewers are thorough and exhaustive in their searches, finding both published and unpublished studies. Their analysis is detailed and presents the latest in the current research on a particular topic. The Cochrance Library deals almost exclusively with issues of therapy. They have begun to analyze research related to screening and so far have worked with the major cancers.
The Cochrance Library is available to licensed users only. To use the link below you must have a SUNY Downstate ID card.
How to Search
Enter your search terms in the search box under "SEARCH IN THIS TITLE" and click on the blue button labeled "Go". You can choose to search by keyword (all text), title, or author using the pull-down menu beneath the search box. You can also search using MeSH term by clicking on the link for "MeSH Search".
Select the review you want to read by clicking on its title. The first item to display is the abstract. Select other sections of the record using the navigation bar on the left of the screen.
How to Read an Entry
Each entry in the Cochrane Library begins with an abstract which summarizes the data. The background statement is a brief sentence that summarizes what the research has to say on a particular intervention. The Search Strategy, Selection Criteria, and Data Collection and Analysis sections tell how the evidence was located, collected, and summarized. The Main Results are presented in statistical form with appropriate confidence intervals. Finally, the specialist who wrote up the review presents the conclusions to be drawn from the research.
Each section is explored in greater depth in the full text of the review.
Cochrane Library Help
Connect to the Cochrane Library
How to Search
To search for an article in a particular issue, click on the blue box labelled "Past Issues" and navigate to the date you wish to view.
To search for articles on a particular topic, click on the blue box labelled "Search". Enter your search terms in the search box. You can then select which domain you are looking for information in (therapy, diagnosis, prognosis, etc). Click on the brown button labeled "Go". Select the article you wish to read from the the list of results.
How to Read an Entry
Each entry in the ACP Journal Club starts with a clinical question to be answered. The design of the study, setting, and patients tested are described. The nature of the intervention and the outcomes measured are listed. The main results are discussed and summarized in a conclusion. Results are also presented in a table listing the appropriate statistics for the type of question explored and includes confidence intervals. Each entry ends with a commentary from a specialist in the field who puts the study in clinical context. Most of the later entries have a link directly to the PubMed record of the original citation.
Screening presents a special dilemma for the specialist interested in evidence-based practice. In terms of screening, UptoDate, and the Cochrane Library present some help. Recognizing the difficulty in finding good screening studies, certain organizations have worked to put this information together in a single place.
There are two sections of the EBM Resource Page that are useful in gathering information on screening tests. The section on Guidelines allows you to search clinical practice guidelines on a variety of topics from goverment agencies and professional associations. The brief summary of each guideline presents that agency's recommendations and evidence supporting the recommendations. The complete summary presents a thorough discussion of methodologies for collecting data, methods for implementing the recommendations and the possible harms of implementing the recommendations.
The section on Prevention and Screening provides links to goverment agencies that recommend and support screening guidelines. Each site presents recommendations and the evidence that supports them. Much of the information comes from the same souces as the US Preventive Taskforce's guidelines site.
These free resources are available to all users.
One of the criteria for using a particular study in evidence-based practice it its currency. As more studies are done, more information comes forward on a particular intervention. This is particularly important in the instance of therapy where harms often are discovered in much later research. Although secondary and tertiary resources make every effort to have the most complete up-to-date information, it is your responsibility to explore all avenues.
To bring information from a secondary or tertiary resource forward:
1. Locate the record for the original reference in PubMed. ACP Journal Club and Clinical Evidence provide direct links to the PubMed record. In other instances, you will need to search for the original record (see the section on Searching PubMed ).
2. Click on the link labeled "Related Articles". This runs the original article through an algorithm that finds articles of a similar nature. Articles are listed by relevance with the original article appearing first.
3. To find the most recent articles on this topic, click on the box labeled "Sort" and select "Pub Date" (Publication Date). Then click on the grey button labeled "Display". This will re-sort your results.
Note: Not all articles retrieved this way will fit the rigorous criteria required for evidence-based practice. The most you can say is that you know what a particular valid study reported and subsequent research/opinion either bears it out or contradicts it.
Sometimes, you may be researching a topic that is not represented in our secondary or tertiary resources. Or you may want to find more up-to-date information than is available in those resources. You will have to conduct a search of Medline to find the primary resources as reported in the medical literature. The resource available at the Medical Research Library is PubMed, the free interface made available by the National Library of Medicine. The basic techniques described may also be applicable to searching Medline through other sources (such as OVID).
CINAHL - In order to find the best evidence in nursing or allied health literature, access CINAHL from the Library's Information Resource page. To find evidence in this database, perform your search as usual and limit it by the Special Interest Category (click on the button at the bottom of the page) and choose Evidence Based Practice.
Those interested in Evidence-Based Practice in nursing and the allied health services should also check the Nursing and Allied Health section on the Library's EBM Resource Page .
PSYCINFO - The best way to find good evidence in psychology literature is to do a "fielded search" in PsycINFO. Enter the desired level of evidence (Meta Analysis, Empirical Study, Clinical Trial, Double Blind Design, Quantitative Study) and then select the field Form/Content Type. It may also be necessary to enter the level of evidence or some of the other "filters" discussed in the section on PubMed searching.
Those interested in Evidence-Based Practice in mental health care should also check the Mental Health section on the Library's EBM Resource Page .
Using the Internet
There is much good health information available on the Internet. There is also much health information on the Internet that is false, misleading, or potentially dangerous. As increasing numbers of patients become familiar with the Internet, they will often look for information themselves. Increasingly, people are looking for information on homeopathic, complementary or alternative therapies. The Library's EBM Resource Page offers examples of the best in terms of Patient Education and Complementary Medicine .
The Library's EBM Resource Page also offers resources available for the specialists in the fields of geriatrics, pediatrics, and emergency medicine. These sections may offer specialized resources such as Topic Reviews specific to those specialties.