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Evidence-Based Medicine

Welcome to the [Title] Guide
The goals of this guide are to:
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This guide is intended for medical students and other health professionals interested in Evidence-Based Medicine resources and information.
Related Guides
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Subject Guide Editor

Jorge E. Perez

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University of Miami Miller School of Medicine Louis Calder Memorial Library
Department of Learning, Research, and Clinical Information Services
Types of Clinical Questions

Etiology: how to identify causes for disease (including its iatrogenic forms).

Diagnosis: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.

Prognosis: how to estimate our patientâs likely clinical course over time and anticipate likely complications of the disorder.

Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.

Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.

 

FROM: User's Guides to the Medical Literature: essentials of evidence-based clinical practice G. Guyatt et al (eds) New York, 2008.

Ask a Searchable Clinical Question

PICO is a useful tool for asking focused clinical questions.

PICO1.jpg

PICO clarifies the question, determines search concepts and type of study that is most appropriate to answer the question type.

PICO

P.I.C.O. Model for Clinical Questions

 

P

Patient, Population, or Problem

How would I describe a group of patients?

I

Intervention, Prognostic Factor, or Exposure

Which main intervention, prognostic factor,
or exposure am I considering?

C

Comparison or Intervention (if appropriate)

What is the main alternative to compare
with the intervention?

O

Outcome you would like to measure or achieve

What can I hope to accomplish, measure,
improve, or affect?

 

What type of question are you asking?

Diagnosis, Etiology/Harm, Therapy, Prognosis,
Prevention

 

Type of study you want to find

What would be the best study design?


 

Formulating the Clinical Question
Evidence Pyramid

evidence_pyramidsm.jpg

Study Design
  • Oxford University Study Design
    This page gives a brief comparison of the advantages and disadvantages of the different types of studies.
  • Understanding Research Study Designs
    In order to find the best possible evidence, it helps to understand the basic designs of research studies. The following basic definitions and examples of clinical research designs follow the “hierarchy of evidence”.
Levels of Evidence
  • GRADE Working Group
    Grading of Recommendations Assessment, Development and Evaluation (GRADE). The working group has developed a common, sensible and transparent approach to grading quality of evidence and strength of recommendations
  • Levels of Evidence and Grades of Recommendations
    Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence
Selecting the Resources

Evidence-based practice requires that clinicians search the literature to find answers to their clinical questions. There are literally millions of published reports, journal articles, conference proceedings, and research studies available to clinicians. Choosing the best resource to search is an important decision.

Practice Guidelines
Electronic Textbooks and Libraries
  • AccessMedicine
    Include's Harrison's Online and Goodman and Gilman's Pharmacology. McGraw-Hill's AccessMedicine.com is an innovative online resource that provides students, residents, clinicians, and researchers with instant answers to clinical questions from the most trusted sources.  Updated daily and expanded continuously, Access Medicine is designed for direct access to the information necessary for completing evaluations, diagnoses, case management decisions, conducting research, medical education, or self-assessment and board review.
  • ClinicalKey
    ClinicalKey is a clinical search engine that supports clinical decisions by making it easier to find and apply relevant knowledge.
  • E-Books available through Calder Library
    If you are unable to locate a book on this page, please go to uSearch.
Pre-Appraised Resources
  • ACP Journal Club
    The content is carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, flowed by assessment of relevance to medical practice.
  • BMJ Clinical Evidence
    Clinical Evidence describes the best available evidence from systematic review, RCTs, and observational studies when appropriate for assessing the benefits and harms of treatment.
  • DynaMed
    DynaMed is the next-generation clinical reference tool physicians can rely on for fast, easy access to point-of-care decision support. Written by a team of specialized physicians and researchers, content is updated several times daily to include information on the latest evidence-based research, providing practice-changing answers to clinical questions with optimized speed.
  • UpToDate
    Clinical decision support tool designed to answer clinical questions that arise in daily practice. Subscription database with access for UM/JMH authorized users.
Databases
  • Center for Review and Dissemination (DARE)
    Assists decision-makers by identifying and describing systematic reviews and economic evaluations, appraising their quality, and highlighting their relative strengths and weaknesses.
  • Cochrane Library
    Collection of health databases providing independent evidence to inform clinical treatment decisions and other health related decisions. Includes: Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, Health Technology Assessment Database and NHS Economic Evaluation Database.
  • PubMed Clinical Queries
    Allows you to quickly focus your PubMed search on clinical studies and systematic reviews. Find out more in our online tutorial.
Meta-Search Engines
  • Trip Database
    The TRIP Database searches across multiple Internet sites for evidence-based content. It covers key medical journals, Cochrane Systematic reviews, clinical guidelines, and other highly relevant sources.
  • SUMSearch
    SUMSearch is a metasearch engine that provides references to answer clinical questions. Simultaneously searches multiple sources of high quality with emphasis on evidence-based medicine
Calder Library Video Training Sessions

 

How to Construct a Well-Built Clinical Question (PICO)

Learn from this live Calder Library Training Session the basics of contructing the PICO question.