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Information Pyramid

Information Pyramid. UpToDate, Dynamed, FIRSTConsult, ACP PIER ACP Journal Club Evidence Based Ophthalmology Cochrane and other Systematic Reviews (OVID EBMR) MEDLINE Searches with Clinical Queries.

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Information Pyramid

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  1. Information Pyramid UpToDate, Dynamed, FIRSTConsult, ACP PIER ACP Journal Club Evidence Based Ophthalmology Cochrane and other Systematic Reviews (OVID EBMR) MEDLINE Searches with Clinical Queries SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36

  2. Critically Appraised Content

  3. Appraisal Required by User

  4. UpToDate Expert opinion and evidence-based, clinical decision support tool 60,000 pages of original text 7,000 topics in primary care and internal medicine 3,000 expert contributors Available at large medical institutions, Indian Health Service and VA hospitals Not available at NSU

  5. DynaMed Evidence-based, clinical decision support tool 2,000 up-to-date clinical topic summaries Information on etiology, directed history & physical findings, differential diagnosis, prognosis, treatment, and prevention Links to most common ICD-9 Codes Available at NSU

  6. ACP PIER Evidence-based, clinical decision support tool 330 disease modules, 11 videos, and 14,000 pages of medical condition and diagnostic text with graphs and tables Integrated with STAT!Ref Available at NSU; Search Stat!Ref

  7. FIRSTConsult Evidence-based, clinical decision support tool 1,500 diagnoses, 600 medical conditions, 300 signs & symptoms Differential diagnosis tool based on chief complaint Video clips of surgical procedures Not Available at NSU

  8. ACP Journal Club Expert summaries of original studies and systematic reviews from 150 journals Value-added abstracts commented on by clinical experts Commentaries on context, methods, and clinical applications of findings Available at NSU; Search All Evidence Based Medicine Reviews

  9. Evidence Based Ophthalmology Quarterly journal includes reviews of 24 critically relevant articles from ocular literature Editorial board comprised of practicing physicians with expertise in epidemiology and clinical trials Available at NSU; Search NSU Journals@Ovid

  10. Cochrane DSR Systematic reviews conducted by world-wide research group Limited to studies of prevention and therapeutic interventions Eyes & Vision Research Group Available at NSU; Search All Evidence Based Medicine Reviews

  11. MEDLINE Searches Limit search results to study type Double blind randomized controlled trials Randomized controlled trials Clinical trials In OVID, limit by Clinical Queries Appraise study for validity and relevance

  12. Hierarchy of Information Resources Primary Literature Original Studies MEDLINE in Ovid and MD Consult Secondary Literature Narrative Reviews MD Consult and MEDLINE Systematic Reviews Cochrane Database of Systematic Reviews; All Evidence Based Medicine Reviews Evidence-Based Summaries ACP Journal Club Evidence-Based Ophthalmology (Journal) Clinical Decision Support Tools Dynamed ACP Pier

  13. Primary (Original) Studies Articles that report results of original research investigations Conclusions supported by data and reproducible methodology Good Source: MEDLINE (OVID)

  14. Review Articles Background articles that provide an overview of current research Integrate recent advances with accepted practice Summarize – not original works May mix opinions/bias of the authors with evidence Good Source: MD Consult

  15. Systematic Review Analyzes data from several primary studies to answer a specific clinical question Provides search strategies and resources used to locate studies Includes specific inclusion and exclusion criteria (results in less bias) Meta-Analysis (subclass) statistically summarizes results of several individual studies Good Source: Cochrane DSR; All Evidence Based Medicine Reviews

  16. Characteristics of Information Retrieval for Patient Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid, and available at point of care Developing search strategies that are feasible within time constraints of clinical practice

  17. Source: Martin, S. A., Shreeve, S. & Prislin, M. (1999). Development of a longitudinal patient-care oriented informatics curriculum featuring web-based instructional and assessment tools.  Association of American Medical Colleges Annual Meeting. ©Sandra A. Martin

  18. Evidence Based Medicine The incorporation of the highest quality of information, derived from scientific study, into the context of clinical care Steps Defining an evidence-based question Identifying and critically appraising the best available scientific evidence to answer the question Deciding on the most appropriate course of action for a given patient

  19. Evidence Based Questions Four basic types of clinical questions: Diagnosis Treatment/prevention Etiology Prognosis Certain types of clinical studies constitute highest level of evidence for each type of question

  20. Randomized controlled trials are considered the best studies for assessing therapeutic interventions. Source:  Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

  21. Levels of Evidence Grade the quality of evidence based on the design of the clinical study Variety of hierarchies in use Other variables to consider Factors other than design strengthen validity Researcher’s reputation Randomized controlled trials do not always exist to answer some questions Base decisions on next highest level of evidence Identify research gaps

  22. American Academy of Family Physicians Rating System Level A Systematic reviews of randomized controlled trials including meta-analyses Good-quality randomized controlled trials Level B Good-quality nonrandomized clinical trials Systematic reviews not in Level A Lower-quality randomized controlled trials not in Level A Other types of study: case control studies, clinical cohort studies, cross sectional studies, retrospective studies, and uncontrolled studies Level C Evidence-based consensus statements and expert guidelines

  23. Additional Information Sandra A. Martin, M.L.I.S. Health Sciences Resource Coordinator Optometry Subject Librarian John Vaughan Library Room 305B marti004@nsuok.edu – 918.444.3263

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