R. Brian Haynes, MD, PhD
Health Information research Unit
McMaster University, Hamilton, Ontario
Updated from the publication: Haynes RB. Advances in evidence-based information resources for clinical practice. J Pharmaceutical Care in Pain and Symptom Control 1999;7:35-49.
Astonishing as it may be (at least to patients), it has not been possible for health care practitioners to reliably and quickly look up "current best evidence" on the management of clinical problems. Recently, a number of tools and services have been developed by the advocates of evidence-based health care to provide practitioners (and patients) with access to current best evidence on an expanding range of clinical topics. These include periodic print summaries of individual studies and systematic reviews of evidence, and electronic databases of reports of original studies and evidence summaries. Traditional textbooks of clinical practice are gradually being augmented or replaced by electronic versions that are more frequently updated and more often based on current best evidence. Information technology is now being harnessed to provide ubiquitous access, including at the point-of-care, to evidence-based resources.
This article describes the general principles behind, and selected resources for, clinicians keeping up to date with best evidence for decision making, including a bibliography of current services.
Evidence-based health care; clinical decision-support; health technology; information technology; information retrieval; health informatics; clinical informatics; clinical epidemiology
R. Brian Haynes, MD, PhD, is Professor and Chair, Department of Clinical Epidemiology and Biostatistics, Professor of Medicine, a member of the Health Information Research Unit at McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada, and Editor of ACP Journal Club, Evidence-Based Medicine and Best Evidence. Address correspondence to Dr. R. B. Haynes, McMaster Health Sciences Centre, Room 2C10B, 1200 Main St West, Hamilton, Ontario L8N 3Z5, Canada, e-mail bhaynes@fhs.mcmaster.ca.
The health sciences journal literature contains the most current and detailed accounts of the testing of various phenomena and innovations related to health promotion and disease control and contains the best information available for the management of many health care problems. However, it is voluminous and not well organized or written for clinical application, and its use for solving clinical problems, therefore, is challenging even for the most persistent and knowledgeable clinician. In fact, most clinicians indicate that they feel overwhelmed by the literature and do not attempt to use it for solving clinical problems.1
Clinicians can use the clinical literature to support clinical decisions in two complementary ways: regular surveillance (or browsing) and problem-oriented searches. While the latter mode is more effective for learning, both are necessary for continuing clinical competence.
Both methods require an appreciation of the purposes of the clinical literature and a basic understanding of the strengths and weaknesses of the features of various studies for providing information that is valid and clinically applicable for questions related to the cause, course, diagnosis, and therapy or prevention of health problems.
In general, the peer-reviewed journal literature serves science rather than clinical practice: its prime function is to provide communication from scientist to scientist2 (Table 1). Most of the investigations reported in journals, even in "clinical" journals, are nondefinitive tests of hypotheses and innovations, only a small portion of which may eventually survive testing well enough to warrant routine clinical application.
Reports of definitive studies also appear in journals, constituting "scientist-to-clinician" communication, but these studies are in very small numbers. This situation is cause for both celebration and dismay. Celebration is in order because clinicians need to attend to only a small portion of the literature that otherwise would be far too large to manage. Dismay arises from the observation that journals scatter definitive studies among many preliminary investigations and the reader must diligently apply some basic rules of research (ie, do a "critical appraisal") to distinguish the definitive from the preliminary studies.
| Channel of Communication | Types of Research Report | Relative Frequency |
| scientist-to-scientist | Preliminary studies | very high |
| scientist-to-clinician | Definitive studies | very low |
| clinician-to-clinician | Systematic review articles | very low |
| clinician-to-scientist | Case reports/series | depends on journal |
| opinions and news | editorials, vignettes | high |
Table 1. Major channels of communication supported by peer-reviewed clinical journals
Clinical review articles are published even less frequently than definitive studies. These reviews constitute clinician-to-clinician communication and the new standards that are emerging for conducting and reporting systematic reviews3 greatly enhance the likelihood that they will provide valid conclusions based on the best available evidence.
Many journals also publish case reports and case series. While at first blush these might be considered clinician-to-clinician communications, these are perhaps best classified as clinician-to-scientist communications, as they provide ideas, based on careful observations of unplanned events, that need to be tested in planned investigations.
Finally, clinical journals also publish nonclinical scientific articles and nonscientific articles on a wide range of topics, including news, ethics, parables, book reviews, letters, and so on. These articles leaven the literature and add enjoyment but at an opportunity cost if they distract attention from definitive studies or mislead readers into thinking they bear definitive news for clinical practice when they don't.
Clinicians, themselves, can efficiently select articles from the literature that report clinically relevant and valid evidence by screening the purpose and methods of articles using principles of critical appraisal. These principles appear in brief in Table 2 and are a streamlined version of the principles that previously have been published.4 This streamlining has been made possible by the observation that a few of the criteria can do most of the work of the full set.
Table 2. Guidelines for Critical Appraisal of Journal Articles
| Topic of Study |
| Therapy | Diagnosis | Prognosis | Causation | Reviews | |
| Criteria for appraisal | random allocation of patients to comparison groups | clearly identified comparison groups, one being free of the disorder | Inception cohort, early in the course of the disorder and initially free of the outcome of interest | clearly identified comparison group for those at risk of, or having, the outcome of interest | Comprehensive search for relevant articles |
| Outcome measure of known or probable clinical importance | objective or reproducible diagnostic standard, applied to all participants | Objective or reproducible assessment of clinically important outcomes | masking of observers of outcome to exposure | explicit criteria for rating relevance and merit | |
| follow-up of ³ 80% | masked assessment of test and diagnostic standard | follow-up of ³ 80% | masking of observers of exposure to outcome | inclusion of all relevant studies |
Recently, a number of secondary evidence-summary publications have been developed in which studies are selected and assembled in a systematic way that includes critical appraisal of the evidence3. These include ACP Journal Club, Evidence-Based Medicine, Evidence-Based Cardiovascular Medicine, Evidence-Based Mental Health, and Evidence-Based Nursing (see appendix for details). Clinicians can improve their efficiency in applying evidence from valid and applicable research by using these sources if the coverage of clinical content includes their field of practice.
Regular journal reading, either first hand or through evidence-summary journals and services, is necessary to keep up to date as journals are the first peer-reviewed source of new evidence available to most clinicians. Application of critical appraisal guidelines permits definition of the journals in ones field of practice that have the highest yield of definitive articles and allows regular review of these journals at a very swift pace. For example, for all of general internal medicine and its major subspecialties, application of the guidelines identifies just 9 core journals. The yield from these journals of articles that are worthy of detailed reading by clinicians averages one article for two issues, a manageable task.
The most potent stimulus to learning in clinical practice is the unsolved problems of our patients. To use the clinical literature to help solve these problems, one must know how to search the clinical literature effectively and efficiently. The most feasible approach for most clinical disciplines at present is to do ones own electronic searches of the clinical literature at the time the clinical problem must be solved, employing critical appraisal guidelines to select the best articles available on the topic3. Because this is a demanding task, it is likely only worth doing for problems that one encounters fairly often in ones own practice.
Fortunately, there are many affordable methods of accessing the clinical literature. The most general of these is the National Library of Medicine's MEDLINE which includes citations from over 3500 journals (see appendix). These citations are indexed with content terms and, increasingly, with methods terms (see below) that support electronic critical appraisal. Physicians can readily learn how to do searches themselves that retrieve at least as many relevant articles as the searches of trained librarians. MEDLINE is free on the internet from many sites and at least one of the free sites, PubMed, also includes pre-stored search strategies that are designed to select studies that are most likely to be relevant and valid for clinical practice (see appendix for details). When relevant citations are retrieved, the information contained in their abstracts may be sufficient for a clinical decision to be made. When there is not enough information in the abstract, the full text of the article may be available electronically through Ovid and other online services (see appendix).
The single best methods terms to include in MEDLINE searches to find high quality studies for clinical practice are these: "CLINICAL TRIAL (PT)" for treatments; "SENSITIVITY (TW)" for diagnostic tests; "RISK (TW)" for etiology; "EXPLODE COHORT STUDIES" for prognosis.
The Cochrane Library is now a major resource of systematic reviews and trials of health care interventions. It contains four databases, the Cochrane Database of Systematic Reviews (systematic reviews done by members of Cochrane Review Groups), the Database of Abstracts of Reviews of Evidence (other published systematic reviews), the Cochrane Controlled Trials Register (a huge database of citations of trials), and the Cochrane Review Methodology Database (citations on how to do systematic reviews).
In mid-1995, a new, more specialized type of journal-based resource became available: Best Evidence, a cumulative, electronic version of ACP Journal Club and Evidence-Based Medicine, from the American College of Physicians. This provides electronic access to all of the studies that meet reasonable criteria for scientific merit and clinical content in the major clinical fields (but not subspecialties).
In Fall 1998, Ovid released the most integrated lliterature service to date: Evidence-based Medicine Reviews. This includes the Cochrane Database of Systematic Reviews, Best Evidence, MEDLINE, and over 200 full text journals, with cross linkages so that, for example, a search on MEDLINE that retrieves a clinical trial will provide a hypertext link to a Cochrane review or Best Evidence summary, if the trial has been reviewed by these services.
Textbooks such as Scientific American Medicine and UpToDate are beginning to support evidence-based decisions by providing extensive journal citation and frequent updating of the text. None of the existing general clinical texts, however, follows explicit standards for evidence or systematic review of evidence.
With the best available evidence at hand, the clinician is in a much better position to make an informed decision about managing the patient's problem. But it is important to note that, even at its best, evidence published in the clinical literature only answers questions such as "Does this medication, on average, do more good than harm among those who agree to take it in a clinical trial with special resources for encouraging patients and following them?" The question, "Should I prescribe this medication for this patient at this time?" is beyond the scope of clinical trials or of textbooks. Making the best decision for the patient requires sound judgement based on clinical expertise and knowledge of the patient's preferences in addition to evidence from research (see Figure 1).
Figure 1. Basic elements of clinical decision making5
We are beginning to see the emergence of evidence-based textbooks, compendia, and practice guidelines, which combine explicit and quantitative reviews of evidence with advice from those who have experience in managing the clinical problem at hand. These resources may well alleviate some of the need for practitioners to fend for themselves in accumulating, synthesizing, and interpreting evidence. Nevertheless, original evidence will almost always be published in advance of synthesis, and there will always be a need for the clinician to be aware of new evidence in the management of patients. This need can only be well served if clinicians learn and apply the skills required to extract and appraise the best evidence from the literature for solving specific clinical problems.
(please note: the product information and addresses below are subject to change)
ACP Journal Club. Abstracts of articles from over 100 journals of relevance to internal medicine, family medicine, obstetrics and gynecology, pediatrics, psychiatry, public health, surgery, the articles being selected according to critical appraisal criteria. Contact Subscriptions, ACP-ASIM, tel. 800-523-1546. Available in Canada from Canadian Medical Association Member Service Centre, tel. (001) 888-855-2555, or 1-613-731-8619 x 2307. Not available outside the Americas.
Evidence-based Medicine. Abstracts articles from all major clinical fields (family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, public health, surgery). Available by subscription from the BMJ (http://www.evidence-basedmedicine.com/) and CMA (see above). Not available in the Americas (contents included in ACP Journal Club).
Evidence-Based Cardiovascular Medicine. Abstracts of relevance to cardiovascular medicine. Available from Churchill-Livingstone (Harcourt Brace; Saunders).
Evidence-Based Obstetrics & Gynecology. Available from Churchill-Livingstone (Harcourt Brace; Saunders).
Evidence-Based Mental Health. Abstracts of articles of relevance to mental health care. Available from the BMJ Publishing Group (see above).
Evidence-Based Nursing. Abstracts of articles of relevance to nursing care. Available from the BMJ Publishing Group (see above), the RCN Publishing Company (tel. (44) 181-423-1066), and the Canadian Nurses Association.
Evidence-Based Healthcare. Abstracts of articles of relevance to health care managers and policy makers. Available from Churchill-Livingstone (Harcourt Brace; Saunders).
Evidence-Based Eye Care. "Evidence-Based Eye Care provides the most time-effective, cost-efficient methods of treatment to busy clinicians. Evidence-Based Eye Care is a clinically relevant, high-quality, user-friendly, reliable source of information for practicing ophthalmologists." ISSN: 1525-8599. Available from Lippincott Williams & Wilkins. http://www.evidence-based-eyecare.com/
Clinical Evidence. Available from the BMJ Publishing Group (www.bmjpg.com/index.html <http://www.bmjpg.com/index.html>)
Dixon RA, Munro JF, Silcocks PB. The Evidence Based Medicine Workbook. Critical Appraisal for Clinical Problem Solving. Oxford: Butterworth-Heinemann. 1997.
Friedland DJ, Go AS, Shlipak MG, Bent SW, Subak LL, Mendelson T. Evidence-Based Medicine: A Framework for Clinical Practice. Stamford CT: Appleton & Lange, 1998.
Greenhalgh T. How to read a paper. The basics of evidence based medicine. London: BMJ Publishing Group. 1997.
Haines A, Donald A (eds): Getting Research Findings into Practice. London: BMJ Publishing Group. 1998:78-85.
Last JM, editor. A Dictionary of Epidemiology. 3rd ed. Oxford: Oxford University Press. For the International Epidemiological Association; 1995.
Levine M, Lexchin J, Pellizzari R. Drugs of Choice. A Formulary for General Practice. Ottawa, Canadian Medical Association, 1998. Available from Member Service Centre, Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, Ontario K1G 3Y6 888-855-2555; fax 613-731-9102; cmamsc@cma.ca.
McQuay HJ, Moore RA. An evidence-based resource for pain relief. Oxford, Oxford University Press, 1998. (ISBN 0-19-262718-X)
Black ER, Bordley DR, Tape TG, Panzer RJ. Diagnostic Strategies for Common Medical Problems. Second Edition. Philadelphia, American College of Physicians Press, 1999 (500 pages). (Product number 330300380 from the American College of Physicians.) (Due in Spring 1999.)
Ridsdale L (ed). Evidence-based Practice in Primary Care. London: Churchill Livingstone, 1998.
Sackett DL, Straus S, Richardson SR, Rosenberg W, Haynes RB. Evidence-Based Medicine: how to practice and teach EBM. 2nd ed. London: Churchill Livingstone, 2000.
Silagy C, Haines A (eds). Evidence Based Practice in Primary Care. BMJ Books, BMA House, Tavistock Square, London WC1H 9JR, UK, 1998.
Straus SE, Badenoch D, Richardson WS, Rosenberg W, Sackett DL. Practising Evidence-Based Medicine. Learner's Manual. 3rd Edition. Radcliffe Medical Press Ltd. Abingdon, Oxon, UK, 1998.
Best Evidence - cumulated contents of ACP Journal Club (since 1991) and Evidence-Based Medicine (since 1995) in an annual CD - see subscription information under ACP Journal Club (above). Also on the internet through Ovid (see below), with featured articles available for free at http://acponline.org; sales in Canada from http://www.cma.ca/catalog/bestevid.htm; and in the UK from http://www.bmjpg.com/data/ebm.htm
The Cochrane Library - see description above. Available from Update Software. In the UK: Summertown Pavilion, Middle Way, Summertown, Oxford OX2 7LG, England (tel: +44 1865 513902 (UK), fax: +44 1865 516918, e-mail: help@update.co.uk, internet: http://update.cochrane.co.uk/). In the US: Update Software Inc., 936 La Rueda Drive, Vista, CA 92084 USA, Tel: +1 760 727-6792, Fax: +1 760 734-4351, e-mail: updateinc@home.com. Commercial internet sites: http://www.update-software.com/ccweb/cochrane/cdsr.htm; http://www.hcn.net.au; http://www.ovid.com; <http://www.kfinder.com>.
SAM-CD - Scientific American Medicine on a compact disc and world wide web. Available from Healtheon/WebMD, 415 Madison Avenue, New York, NY 10017, USA. (800-545-0554); <http://www.webmd.com>.
UpToDate. Quarterly CD. Available from UpToDate Inc, 34 Washington Street #320, Wellesley MA 02481-1903, USA; tel 800-998-6374; 781-237-4788; fax781-239-0391; customerservice@uptodateinc.com; http://www.uptodate.com.
Drugs of Choice. Ottawa, Canadian Medical Association. Available on 31/2-inch disk for Windows. Book or diskette CDN$16.95 (members), CDN$19.95 (nonmembers); Book and diskette CDN$20.95 (members), CDN$24.95 (nonmembers). http://www.cma.ca/; 1 888-855-2555, or 1 613 731-8619 x 2307
| Online Systems |
| Vendor | Product |
| National Library of Medicine 8600 Rockville Pike Bethesda, Maryland 20892 | PubMed: http://www.ncbi.nlm.nih.gov/PubMed/clinical.html Internet Grateful Med: http://igm.nlm.nih.gov/ National Information Centre on Health Services Research and Health Care Technology: http://www.nlm.nih.gov/nichsr/ |
| MEDLINE access routes | <http://www.beaker.iupui.edu/drfelix/index.html> |
| Selected CD ROM MEDLINE Systems |
| Vendor | Product |
| OIVD 333 Seventh Avenue, 6th Floor New York, New York 10001 | OVID Http://www.Ovid.com/ |
| SilverPlatter Information, Inc. 246 Walnut St, Suite 302 Newton, MA 02160-1639 | SilverPlatter - Unabridged & Clinical Subsets Also available on WWW: Physicians' Homepage, Http:// www.SilverPlatter.com/physicians |
| EBSCO Electronic Information 461 Boston Road, Unit 3D Topsfield, Massachusetts 01983 | EBSCO CD ROM - Unabridged & Subset |
| Healthcare Information Services 2335 American River Road, Suite 307 Sacramento, California 95825 | BiblioMed |
| DIALOG Information Services, Inc. 3460 Hillview Avenue Palo Alto, California 94304 | DIALOG OnDisc - Unabridged & Subset |
| ARIES Systems Corporation 200 Sutton Street North Andover, MA 01810 | ARIES Knowledge Finder - Monthly, Quarterly & Subset (best Macintosh performance) Http://www.kfinder.com |
| Evidence-filters for OVID and SilverPlatter | Http://www.ihs.ox.ac.uk/library/filters.html |
SHARR (links to most other EBM sites) http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/netting.html
NNT calculators and tools http://www.shef.ac.uk/~scharr/ir/nnt.html
Pre-test -> post-test calculator for diagnostic tests: http://www.library.utoronto.ca/medicine/ebm/tmp/
McMaster University Health Information Research Unit http://hiru.mcmaster.ca; with a collection of EBHC links at: <http://hiru.mcmaster.ca/cochrane/centres/canadian/evidence-based.htm>
Centre for Health Evidence (includes all users' guides) http://www.cche.net/principles/content_all.asp
Oxford Centre for Evidence-Based Medicine http://cebm.jr2.ox.ac.uk
Unit for Evidence-Based Practice and Policy, Department of Primary Care and Population Sciences,
University of Bergen Finding Answers to questions in EBM <http://www.uib.no/isf/people/atle/ebm.htm>
Adrienne Randolph's links to EBM, with emphasis on intensive care <http://intensivecare.com/ebm.html>
York Centre for Reviews and Dissemination search strategies for reviews and meta-analyses <http://www.york.ac.uk/inst/crd/search.htm>
Royal Free and University College London Medical School http://www.ucl.ac.uk/primcare-popsci/uebpp
Cochrane Library - UK http://www.update-software.com/clibhome/clibdemo.htm
Cochrane Library - San Diego: http://www.updateusa.com/clibpw/clibdemo.htm
University of York/NHS Centre for Reviews and Dissemination (including links to Effective Health Care and Effectiveness Matters) http://www.york.ac.uk/inst/crd/dissem.htm
Society for General Internal Medicine Medical SmartSearch (University of Texas Health Sciences Center at San Antonio) website: http://badgett.uthscsa.edu/cgi-bin/smartsearch.exe?SGIM=YES
Evidence-Based Mental Health http://www.psychiatry.ox.ac.uk/cebmh/
Bandolier http://www.jr2.ox.ac.uk/Bandolier/band50/b50-8.html
Oxford Pain Internet Site http://www.jr2.ox.ac.uk/Bandolier/painres/painpag/index.html
Mt. Sinai, NY, Dep't of Medicine Evidence-based Medicine Home Page: <http://med.mssm.edu/ebm/>
Peds Journal Club http://pedsccm.wustl.edu/EBJournal_club.html
Neonatal Cochrane Reviews: http://www.nichd.nih.gov/cochraneneonatal/
Critical Care Critically Appraised Topics: http://ahsn.lhsc.on.ca
Family Practice JC (POEMS): http://www.infopoems.com
Guidelines: National Guideline Clearinghouse: www.guideline.gov
Canadian Task Force on Preventive Health Care: <http://www.ctfphc.org/>
Canadian Coordinating Office on Health Technology Assessment: <http://www.ccohta.ca/main-e.html>
Critique et Practique - EBM en français: critiques of articles in the medical literature in French from the Department of Family Medicine at Laval University in Québec: <http://www.crsfa.ulaval.ca/umf/>
The Catalan Agency for Health Technology Assessment (CAHTA): <http://www.aatm.es>
Web-based Literature Search Hedges: http://www.mssm.edu/library/ebm/ebmhedges.htm
Neurosurgery http://www.brown.edu/Departments/Neurosurgery/EJC/journ.html
Institute for Clinical Evaluative Sciences Informed http://www.ices.on.ca/docs/informed.htm
ACP Journal Club http://www.acponline.org/journals/acpjc/jcmenu.htm
Evidence-Based Medicine http://www.acponline.org/journals/ebm/ebmmenu.htm
Evidence-Based Dentistry http://www.ihs.ox.ac.uk/cebd/ebdj.htm
EBM Journal (Evidence-Based Medicine en français) http://www.ebm-journal.presse.fr/ebmjournal/
Best Evidence (to order, in the US) http://www.acponline.org/catalog/cbi/best_evidence.htm?ban
Miner Library in Rochester http://www.urmc.rochester.edu/Miner/Links/ebmlinks.html
PalmTop software downloads: http://www.mtco.com/~glwoods/Default.htm
Biomednet http://biomednet.com/ (free registration)
Community of Science: http://muscat.gdb.org/repos/medl (userid and password required)
HealthGate Home Page: http://www.healthgate.com (registration required)
HealthWorld: http://www.healthworld.com/Library/search/medline.htm
Knowledge Finder http://www.kfinder.com/ (must be registered user)
NlightN MEDLINE: http://www.nln.com
Links to journal websites and fulltext journal articles: http://www.pslgroup.com/dg/medjournals.htm
http://www.nthames-health.tpmde.ac.uk/connect/journals.htm
http://www.medmatrix.org/SPages/major_journals.asp
http://www.medscape.com/
"Praxis Press" info@praxispress.com <mailto:info@praxispress.com>
"Current Practice. The Internet Source for Clinical Care" <http://current-practice.com>
"Doctor's Guide E-Mail Edition." P\S\L Consulting Group. <http://www.pslgroup.com/>
Institute for Scientific Information Personal Alert. Customized internet e-mail alerting service. ISI, 3501 Market St, Philadelphia, PA 19104, USA. Tel. 215-386-0100, 800-336-4474; Fax 215-386-2911; HTTP://www.isinet.com.
MEDLINEPLUS: National Library of Medicine's link page to patient information services, according to disease. NB: contents are NOT explicitly rated for quality; rather, they are from "credible sources". http://medlineplus.nlm.nih.gov/medlineplus
Evidence-based Medicine. A new approach to teaching the practice of medicine. Evidence-based Medicine Working Group. JAMA 1992;268:2420-5. (EBM "call-to-arms".)
(Working papers with enhancements for the series are available at <http://www.cche.net/principles/content_all.asp>.)
Guyatt GH, Rennie D. User's Guides to Reading the Medical Literature: Editorial. JAMA 1993;270(17):2096-2097.
Oxman AD, Sackett DL, Guyatt GH et al for the Evidence-Based Medicine Working Group. User's Guides to the Medical Literature: I-How to get started. JAMA 1993;270(17):2093-2095.
Guyatt GH, Sackett DL, Cook DJ et al for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: II-How to use an article about therapy or prevention A. Are the results of the study valid? JAMA 1993;270(21):2598-2601.
Guyatt GH, Sackett DL, Cook DJ et al for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: II-How to use an article about therapy or prevention B. What were the results and will they help me in caring for my patients? JAMA 1994;271(1):59-63.
Jaeschke R, Guyatt GH, Sackett DL et al for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: III-How to use an article about a diagnostic test A. Are the results of the study valid? JAMA 1994;271(5):389-391.
Jaeschke R, Guyatt GH, Sackett DL et al for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: III-How to use an article about a diagnostic test B. What are the results and will they help me in caring for my patients? JAMA 1994;271(9):703-707.
Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: IV-How to use an article about harm. JAMA 1994;271(20):1615-1619.
Laupacis A, Wells G, Richardson S, Tugwell P for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: V-How to use an article about prognosis. JAMA 1994;272(3):234-237.
Oxman AD, Cook DJ, Guyatt GH for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: VI-How to use an overview. JAMA 1994;272(17):1367-1371.
Richardson WS, Detsky AS for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: VII-How to use a clinical decision analysis A. Are the results of the study valid? JAMA 1995;273(16):1292-5.
Richardson WS, Detsky AS for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: VII-How to Use a clinical decision analysis B. What are the results and will they help me in caring for my patients? JAMA 1995;273(20):1610-13.
Hayward RS, Wilson MC, Tunis SR, Bass EB, Guyatt GH for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: VIII. How to use clinical practice guidelines. A. Are the recommendations valid? JAMA 1995;274(7):570-4.
Wilson MC, Hayward R, Tunis SR, Bass EB, Guyatt GH for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: VIII. How to use clinical practice guidelines. B. What are the recommendations and will they help you in caring for your patients? JAMA 1995;274(20):1630-2.
Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: IX. A method for grading health care recommendations. JAMA 1995;274(22):1800-4.
Naylor CD, Guyatt GH, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: X. How to use an article reporting variations in the outcomes of health services. JAMA 1996;275:554-8.
Naylor CD, Guyatt GH, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature: XI. How to use an article about a clinical utilization review. JAMA 1996;275(18):1435-9.
Guyatt GH, Juniper E, Heyland DK, Jaeschke R, Cook DJ. Users' Guides to the Medical Literature: XII. How to use articles about health-related quality of life. JAMA 1997;277:1232-7.
Drummond MF, Richardson WS, O'Brien BJ, Levine M, Heyland D. Users' Guides to the Medical Literature: XIII. How to use an article on economic analysis of clinical practice: A. Are the results of the study valid? JAMA 1997;277(19):1552-7.
O'Brien BJ, Heyland D, Richardson WS, Drummond MF. Users' Guides to the Medical Literature: XIII. How to use an article on economic analysis of clinical practice: B. What are the results and will they help me in caring for my patients? JAMA 1997;277(22):1802-6.
Dans A, Dans LF, Guyatt GH, Richardson S, for the EBM Working Group. Users Guides to the Medical Literature XIV. How to decide on the applicability of clinical trial results to your patient. JAMA 1998;279(7):545-9.
Mulrow C, Cook DJ, Davidoff F. Systematic reviews: Critical links in the great chain of evidence. [Editorial] Ann Intern Med 1997;126(5):389-91.
Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: Synthesis of best evidence for clinical decisions. Ann Intern Med 1997;126:376-80.
Hunt DL, McKibbon A. Locating and appraising systematic reviews. Ann Intern Med 1997;126:532-8.
Badget RG, O'Keefe MO, Henderson MC. Using systematic reviews in clinical education. Ann Intern Med 1997;126(11):886-91.
Cook DJ, Greengold NL, Ellrodt AG, Weingarten SR. The relation between systematic reviews and practice guidelines. Ann Intern Med 1997;127;210-16.
Mulrow C, Cook D. Integrating heterogeneous pieces of evidence in systematic reviews. Ann Intern Med 1997;127(11):989-95.
Lau J, Ioannidis JPA, Schmid CH. Eds: Mulrow C, Cook DJ. Quantitative synthesis in systematic reviews. Ann Intern Med 1997;127:820-826.
Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. Ann Intern Med 1997;127:531-7.
Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.
Bero LA, Jadad AR. How consumers and policymakers can use systematic reviews for decision making. Ann Intern Med 1997;127:37-42.
Guyatt GH, Jaeschke R, Heddle N, Cook DJ, Shannon H, Walter S. Basic Statistics for Clinicians: I. Hypothesis testing. Can Med Assoc J 1995;152:27-32.
Guyatt GH, Jaeschke R, Heddle N, Cook DJ, Shannon H, Walter S. Basic Statistics for Clinicians: II. Interpreting study results: Confidence intervals. Can Med Assoc J 1995;152:169-73.
Jaeschke R, Guyatt GH, Shannon HS, Walter SD, Cook DJ, Heddle N. Basic Statistics for Clinicians: III. Assessing the effects of treatment: Measures of association. Can Med Assoc J 1995;152:351-7.
Guyatt GH, Walter S, Shannon H, Cook DJ, Jaeschke R, Heddle N. Basic Statistics for Clinicians: IV. Regression and correlation. Can Med Assoc J 1995;152:497-504.
Health Services Research Group. Standards, guidelines and clinical policies. CMAJ 1992;146:833-7.
Health Services Research Group. A guide to direct measures of patient satisfaction in clinical practice. CMAJ 1992;146:1727-31.
Health Services Research Group. Quality of care: 1. What is quality and how can it be measured? CMAJ 1992;146:2153-8.
Health Services Research Group. Quality of care: 2. Quality of care studies and their consequences. CMAJ 1992;147:163-7.
Health Services Research Group. Outcomes and management of health care. CMAJ. 1992;147:1775-80.
Carter A. Background to the "guidelines for guidelines" series. Can Med Assoc J. 1993;148:383.
This article begins a series in the CMAJ on guidelines on the development of evidence-based practice guidelines.
This is an occasional series in JAMA providing quantitative information on aspects of clinical examination.
Some examples:
Sackett DL. A primer on the precision and accuracy of the clinical examination. JAMA 1992;267:2645-2648.
Sackett DL, Rennie D. The science of the art of the clinical examination. JAMA 1992;267:2650-2.
Williams JW, Simel DL. Does this patient have ascites? How to divine fluid in the abdomen. JAMA 1992;267:2645-8.
Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992;268:760-5.
Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. Is this patient taking the treatment as prescribed? JAMA 1993;269:2779-81.
Williams JW, Simel DL. Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. JAMA 1993;270:1242-6.
Grover SA, Barkun AN, Sackett DL. Does this patient have splenomegaly? JAMA 1993;270:2218-2221.
Sauvé JS, Laupacis A, Ostbye T, Feagan B, Sackett DL. Does this patient have a clinically important carotid bruit? JAMA 1993;270:2843-5.
Detsky AS, Smalley PS, Chang J. Is this patient malnourished? JAMA 1994;271:54-8.
Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Does this dizzy patient have a serious form of vertigo? JAMA 1994;271:385-8.
Goldstein LB, Matchar DB. Clinical assessment of stroke. JAMA 1994;271:1114-20.
Naylor CD. Physical examination of the liver. JAMA 1994;271:1859-65.
Kitchens JM. Does this patient have an alcohol problem? JAMA 1994;272:1782-87.
Holleman DR, Simel DL. Does the clinical examination predict airflow limitation? JAMA 1995;273:313-19.
Siminoski K. Does this patient have a goiter? JAMA 1995;273:813-17.
Reeves RA. Does this patient have hypertension? How to measure blood pressure. JAMA 1995;273:1211-18.
Turnbull JM. Is listening for abdominal bruits useful in the evaluation of hypertension? JAMA 1995;274:1299-1301.
Cook DJ, Simel DL. Does this patient have abnormal central venous pressure? JAMA 1996;275:630-4.
Wagner JM, McKinney WP, Carpentar JL. Does this patient have appendicitis? JAMA 1996;276:1589-94.
Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA 1997;277:564-71.
Badgett RG, Lucey CR, Mulrow CD. Can the clinical examination diagnose left-sided heart failure in adults? JAMA 1997;277:1712-19.
Bastian LA, Piscitelli JT. Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination? JAMA 1997;278(7):586-91.
Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997;278(17):1440-5.
Margolis P, Gadomski A. Does this infant have pneumonia? JAMA 1998;279(4):308-13.
Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS. Does this patient have deep vein thrombosis? JAMA 1998;279(14):1094-9.
Whited JD, Grichnik JM. Does this patient have a mole or a melanoma? JAMA 1998;279(9):696-701.
