Web Source |
What You May Find |
ACP
Journal Club: also known as Evidence-Based Medicine—The Journal
http://www.acpjc.org/ |
Reviews
of Important Articles and Systematic Reviews that Warrant Immediate
Attention |
Agency
for Healthcare Research and Quality (and Evidence-base Practice
Center reports)
Includes the National Guidelines Clearinghouse, plus US Services
Preventive Task Force has helpful information you can access through
here.
http://www.ahrq.gov
Here is their patient
safety page:
http://www.ahrq.gov/health-care-information/topics/topic-patient-safety.html |
Evidence
Syntheses
Guidelines
Systematic Reviews
Patient Safety Information
|
Ambulatory
Quality Alliance
Founded by AAFP, ACP, AHIP and AHRQ. Endorsed 26 performance measures
as starter set. Goal is to focus on agreed-to measures accepted
by health plans to eliminate tracking different measures for different
initiatives.
http://www.aqaalliance.org/
Quality Measures
http://www.aqaalliance.org/performancewg.htm
Individual practice
internal improvement demo flow sheets:
http://www.ama-assn.org/
Registry
http://www.aafp.org/fpm/20060400/diabetesregistry.xls
|
Performance
Measures & Tools
|
American
Academy of Family Physicians (AAFP)
AAFP Guidelines and Performance Measurement
- For Guidelines
(referred to as "Policy Statements")
http://www.aafp.org/online/en/home/policy.html
For Performance
Measures
http://www.aafp.org/about/policies/all/performance-measures.html
|
Guidelines
Performance Measures |
American
College of Physicians
http://www.acponline.org/
|
Guidelines |
American
College of Preventive Medicine
http://www.acpm.org
|
Guidelines
Evidence Syntheses |
Bandolier
http://www.jr2.ox.ac.uk/bandolier/ |
EBM
Essays |
BMJ BestTreatments
An evidence-based
resource for patients and clinicians. You can read more about it
at our newsletter: On
the Same Page™
http://besthealth.bmj.com/x/index.html |
Info
For Clinicians and Patients |
Calculators for EBM Statistical Tasks
http://ktclearinghouse.ca/cebm/practise/ca/calculators
For additional calculators listed here, search this page for "calculator" |
Tools |
California
Pharmacist Journal
We are pleased to help support an evidence-based effort by
the California Pharmacist Journal providing pharmacy interns an opportunity
to enhance their critical appraisal skills and, in turn, provide a
service to the medical decision-making community by performing evidence-based
reviews on selected studies.
As
peer reviewers and guest editors, Delfini works closely with Craig
Stern, CPhA Chair, Editorial Review Committee, and Cathi Lord, California
Pharmacist Journal Managing Editor, to provide tools and just-in-time
training along with reviewing and editing content.
With permission, we
are happy to be able to share these reviews with Delfini readers:
http://www.delfini.org/Showcase_Publication_CPhA.htm |
Critical
Appraisals |
The
Canadian Agency for Drugs and Technologies in Health (CADTH)
A good resource for evidence-based assessments of drugs,
health technologies and health systems. Frequently uses Cochrane
methodology for quality assessment of trials (based heavily on concealment
of allocation).
http://www.cadth.ca/
|
Systematic
Reviews |
Canadian Knowledge Translation Website
The Knowledge Translation (KT) Clearinghouse is a useful website for EBM information and tools. It is funded by the Canadian Institute of Health Research (CIHR) and has a goal of improving the quality of care by developing, implementing and evaluating strategies that bridge the knowledge-to-practice gap and to research the most effective ways to translate knowledge into action.
http://ktclearinghouse.ca/ |
Tools |
Cancer
Guide
Selected basic statistics from Steve Dunn.
http://cancerguide.org/index.html |
Statistics |
Cardiovascular
Disease Primary Prevention Risk Calculator
Here is the New
Zealand Guidelines Group risk calculator for primary
prevention of cardiovascular disease. Typically, a cardiac
risk calculator provides an estimate (either 5 or 10 years) of an
individual's risk of experiencing an adverse cardiac event based
on specific risk factors. For example, the New Zealand risk tables
provide a 5-year assessment based on an individual’s sex,
diabetic status, smoking history and age. It also provides an estimate
of benefit (CVD events prevented per 100 people) treated with blood
pressure agents, aspirin and lipid-lowering agents for 5 years based
on risk level.
http://www.health.govt.nz/publication/new-zealand-cardiovascular-risk-charts |
Risk Calculator: CVD - Primary Prevention |
Centre
for Evidence-based Medicine
http://www.cebm.net/ |
Evidence-based
Resources and Tools |
Clinical
Evidence
A reasonable starting source for systematic reviews from
the BMJ. Evidence syntheses of varying quality are available here
so auditing of studies and updating is advised.
http://www.clinicalevidence.org
You may be able to
get a copy free by going to http://www.unitedhealthfoundation.org.
Click on "Resources." |
Evidence
Syntheses |
Clinical
Drug Trial Information
An industry sponsored effort. Read about the site below.
http://clinicaltrials.ifpma.org/clinicaltrials/no_cache/en/myportal/index.htm
New
Web Site to Track Clinical Drug Trials
By
TOM WRIGHT
Published: September 22, 2005
International Herald Tribune
"GENEVA,
Sept. 21 - A trade group for the global drug industry said
Wednesday that it would start a Web site meant to help doctors,
patients and investors keep track of clinical drug trials.
But
the group, the International Federation of Pharmaceutical
Manufacturers and Associations, which includes big drug companies
and national industry associations, stopped short of recommending
that disclosures about drug trials be made mandatory.
The
Web site (ifpma.org/clinicaltrials), which will help users
navigate 250,000 links to other sites run by federation members
and government and nonprofit groups, is a compromise, the
federation's president, Daniel L. Vasella, acknowledged in
an interview.
Dr.
Vasella, who is chief executive of the Swiss drug giant Novartis,
said that during discussions on the new Web site, some large
drug makers had raised concerns about disclosing too much
trial data to rivals.
As
a guideline, he said that the federation believed that members
should announce when trials start, and then make results available
within a year of a trial's conclusion.
"Over
time," he said, "what will happen is companies that
don't disclose information will be scrutinized."
Selective
disclosure of drug trial results has become an increasingly
controversial practice, particularly in the United States,
where critics of the drug industry say that companies have
too often buried negative findings.
But
enforcing the release of clinical trial results would be difficult
because there is no global regulator, Dr. Vasella said. "The
question is who will mandate."
The
drug industry's main trade group in the United States, the
Pharmaceutical Research and Manufacturers of America, has
a policy of asking members to register when they start trials
and also to publish the results.
While
not all companies follow those requests, many drug makers
now publish results of late-stage clinical trials on their
own Web sites." |
|
Clinical Drug Trial Information |
Cochrane
Handbook
The
Cochrane Handbook for Systematic Reviews of Interventions is a useful
resource for all healthcare professionals doing critical appraisal
of the medical literature. It was created to assist authors preparing
systematic reviews (SRs) but is of great value to all of us who
are assessing validity of studies. The section of interest is Part
2: General methods for Cochrane reviews.
http://www.cochrane-handbook.org/
|
Critical
Appraisal Guidance |
Cochrane
Library
A terrific resource. You can get many high quality evidence syntheses
here as well. Mike makes this his first stop.
Note about Cochrane systematic reviews. A frequent problem readers have is finding Cochrane reviews published before 2005 when searching in the Cochrane Library. Cochrane updates reviews and drops the original publication date. To find the review with the original publication date you need to search from Medline (e.g., PubMed).
http://www.cochrane.org |
Evidence
Syntheses |
Confidence
Interval Calculations
Our
new favorite! From John C. Pezzullo's Home Page, confidence intervals
and a whole lot more!
http://statpages.org/ctab2x2.html
GraphPad QuickCalcs
http://www.graphpad.com/quickcalcs/NNT1.cfm
Dr. Shakespeare's
Confidence Calculator
To access, copy the following into an internet search engine:
http://www.theshakespeares.com/Free_statistical_software.html |
Confidence
Interval Calculator |
The
Consort Statement: Consolidated Standards of Reporting Trials —CONSORT
"The CONSORT statement is an
important research tool that takes an evidence-based approach to
improve the quality of reports of randomized trials. The statement
is available in six languages and has been endorsed by prominent
medical journals such as The Lancet, Annals of Internal Medicine,
and the Journal of the American Medical Association. Its critical
value to researchers, health care providers, peer reviewers, and
journal editors, and health policy makers is the guarantee of integrity
in the reported results of research.
CONSORT comprises a checklist and flow diagram to help improve the
quality of reports of randomized controlled trials. It offers a
standard way for researchers to report trials. The checklist includes
items, based on evidence, that need to be addressed in the report;
the flow diagram provides readers with a clear picture of the progress
of all participants in the trial, from the time they are randomized
until the end of their involvement. The intent is to make the experimental
process more clear, flawed or not, so that users of the data can
more appropriately evaluate its validity for their purposes. "
http://www.consort-statement.org/
And STARD for Standards in Reporting of Diagnostic Accuracy |
Research
Reporting |
Consumer
Reports Best Buy Drugs
The mission of the
Consumer Reports Best Buy Drugs project is to provide consumers
and their doctors with information to help guide prescription drug
choices–based on effectiveness, a drug's track record, safety
and price.
This appears to be
a good source of information since it is based on the work of the
Oregon Health & Science University Evidence-based Practice Center
which uses a rigorous approach to evaluating science.
http://www.bestbuydrugs.org |
Info
For Clinicians and Patients |
Database
of Abstracts of Reviews of Effects (DARE)
This site identifies potential systematic reviews and assesses for
methodological quality against a set of inclusion criteria and summarizes
the results.
http://www.york.ac.uk/inst/crd/ |
Systematic
Reviews |
Diagnostic
Test Calculators (See also STARD for Standards
in Reporting of Diagnostic Accuracy)
Delfini Diagnostic Testing Calculator
Features:
—» Natural
language explanations for results. Can use with patients.
—» Provides
information in percents, probabilities and odds.
—» Likelihood
ratio results computed for you so you don't have to guess what is
“insignificant” and what is “large.” The
calculator does the interpretive work for you.
—» Bandolier
number-needed-to-diagnose (NND) calculated as well.
Calculates on the basis of —
• pre-test likelihood, sensitivity and specificity
• raw data from a 2x2 table
Links to confidence interval calculator
Download Excel file here
MedCalc - User-friendly statistical software
(We like this calculator. But note that as of this writing, the number in box a disappears after you click TEST. However, if you need to print off the information, you can reinput that number.)
http://www.medcalc.org/calc/diagnostic_test.php
Center
for Evidence-based Medicine Toronto (KTCEBM)
http://ktclearinghouse.ca/cebm/practise/ca/calculators/statscalc |
Diagnostic
Test Calculators |
DIPEx
Illness information for patients, including patients talking about
their experiences with illness, can be found at this site. Many
of the modules are produced by professionals involved with the Cochrane
Collaboration. The site provides patients with information by condition,
but also through interviews with patients that you can hear directly
online. It also provides information about other resources available
to patients.
http://www.healthtalkonline.org/ |
Illness
Information for Patients |
DynaMed
A frequently updated source of information for clinical
questions that is a great first pass. We do have some issues with the SORT system upon
which it is based. See our letter here.
However, much of this work is evidence-based and many statements
are graded for validity. Our usual cautions apply.
A BMJ article (BMJ 2011 Sep 23;343:d5856) reported that DynaMed is 78% faster at including evidence than EBM Guidelines, 86% faster than UpToDate, 95% faster than eMedicine, and 97% faster than Clinical Evidence.
We also know first hand that they also work hard to make information truly evidence-based, which we cannot say about many sources. As ever, we always caution that it is to be expected that there is variability everywhere so we always recommend direct critical appraisal or audit—but we love DynaMed and frequently it is a first source of clinical information for us.
http://www.dynamicmedical.com/
DynaMed
Influenza Portal |
Medical
Information Database |
Effective
Health Care Bulletins
http://www.york.ac.uk/inst/crd/ehcb_em.htm
Effective
Health Care's Methods Guide for Comparative Effectiveness Reviews has produced a nice guide to Assessing
Harms When Comparing Medical Interventions.
|
Guidelines
Evidence Syntheses
Safety:
Harms Assessment |
Evidence-based Medicine
Journal
Evidence-Based
Medicine surveys a wide range of international medical journals
applying strict criteria for the quality and validity of research.
Practising clinicians assess the clinical relevance of the best
studies. The key details of these essential studies are included
in a succinct, informative expert commentary on their clinical application.
Published bi-monthly, Evidence-Based Medicine offers comprehensive
coverage of primary care medicine. It includes a wide array of clinical
disciplines, including family practice, internal medicine, paediatrics,
obstetrics, gynaecology, psychiatry, and surgery.
http://ebm.bmj.com/
|
Reviews
of Important Articles |
Evidence-based
Practice Newsletter (includes JFP POEMS)
Requires a subscription.
http://www.ebponline.net/ |
Reviews
of Articles Dealing with Common and Relevant Conditions |
US
Food and Drug Administration (FDA)
The site is huge and complex to navigate. It requires patience
and persistence to find relevant information. However, for those
interested in detailed information from the FDA for drugs or medical
devices, the search function on the home page and the search functions
on the drug and medical device pages can provide — at times
— useful information.
http://www.fda.gov
FDA Advisory
Committee Site: Searchable site at FDA for information
from the committee.
http://www.fda.gov/
Especially useful sections
are Drugs@FDA (http://www.fda.gov/search/databases.html)
and the Center for Drug and Evaluation and Research (CDER; http://www.fda.gov/cder).
CDER is an up-to-date source for new drug applications (NDAs) and
useful background information on new drugs. The medical reviews
and statistician reviews can be of great value. It is worthwhile
to do a search using the generic name of the agents of interest
at both of these sections, as well as the brand name. |
Large
Database of FDA-selected Information |
Free
Medical Journals
This site contains a database of 940 online medical journals,
all of which offer some degree of free access. This site's affiliate
web site (http://www.freebooks4doctors.com)
provides links to more than 550 free medical books online.
http://www.freemedicaljournals.com |
Medical
Journals |
Global
Family Doctor — World Family Doctors Caring for People —
WONCA Online
Wonca is an unusual, yet convenient acronym comprising the first
five initials of the World Organization of National Colleges, Academies
and Academic Associations of General Practitioners/Family Physicians.
Wonca's short name is World Organization of Family Doctors. They
offer a free journal alert service.
http://www.globalfamilydoctor.com |
Medical
News
Free Journal
Alert Service |
Graph
Pad Statistical Software: QuickCalcs
There is probably a host of wonders here (for free), but we use
the 2x2 table calculator to verify p=values.
http://www.graphpad.com/quickcalcs/contingency1.cfm
This one calculates
confidence intervals and more.
http://www.graphpad.com/quickcalcs/NNT1.cfm
|
Calculator |
Health
Services/Technology Assessment Text (HSTAT)
http://www.ncbi.nlm.nih.gov/books/NBK16710 |
Technology
Assessments |
Highwire
Press
HighWire Press, of
Stanford University, maintains the online content of 332 medical
journals, including the New England Journal of Medicine and Canadian
Medical Association Journal.
HighWire's alerting
service will notify users of new content that matches their specific
interests in any HighWire-affiliated publisher's full text, or in
the Medline database.
To access, copy the
following into an internet search engine: http://highwire.stanford.edu/
|
Medical
Journals |
IBS
— The Delfini Irritable
Bowel Syndrome (IBS) Guideline Resource Kit:
"Explicit" Evidence-based Clinical Practice Guidance
IBS
Resource Center |
Clinical
Practice Guideline: "Explicit" Evidence-based Method for
IBS |
ICSI:
Institute for Clinical Systems Improvement
ICSI is an independent
collaborative that helps its members provide evidence-based health
care services to patients. Comprised of 58 medical groups and sponsored
by six Minnesota health plans, ICSI unites diverse stakeholders
to deliver patient-centered and value-driven care, established in
1993 by HealthPartners, Mayo Clinic and Park Nicollet Health Services,
and sponsored by HealthPartners.
To access, copy the
following into an internet search engine: http://www.icsi.org/ |
Guidelines
Evidence-based recommendations |
Informed
Health Online
Evidence-based information for patients, clinicians and
others — summarizes systematic reviews from Cochrane (abstracts
of Cochrane Reviews are available without charge).
http://www.informedhealthonline.org |
Info
For Clinicians and Patients |
National Academy of Medicine (formerly Institute of Medicine or IOM) Reports
The Academy provides a vital service by working outside the framework
of government to ensure scientifically informed analysis and independent
guidance. It's mission is to serve as adviser to the
nation to improve health. It provides unbiased, evidence-based,
and authoritative information and advice concerning health and science
policy to policy-makers, professionals, leaders in every sector
of society, and the public at large.
http://www.nationalacademies.org/hmd/Reports.aspx
|
Information
and Advice Concerning Health and Science Policy |
JCAHO — Joint Commission on Accreditation of Healthcare
Organizations
http://www.jointcommission.org/
|
Performance
Measures |
Medicare
http://www.medicare.gov/ |
Drug
Pricing Comparisons |
MEDLINEplus
for Patients
Medline Plus provides
extensive, “authoritative” information from National
Library of Medicine, the National Institutes of Health and other
trusted sources on over 650 diseases and conditions. Included are
a medical encyclopedia and a medical dictionary, extensive information
on prescription and nonprescription drugs, health information from
the media, and links to thousands of clinical trials. There is no
advertising on the site, nor does MEDLINEplus endorse any company
or product.
Caution: Although the site uses criteria, there is no critical appraisal
of the information for validity.
Key criteria for information
and links include:
- Quality, authority
and accuracy of content (again, caution because there
is no critical appraisal of the information for validity).
- The source of
the content is established, respected and dependable. A list
of advisory board members or consultants is published on the
site.
- The information
provided is appropriate to the audience level, well-organized
and easy to use.
- Information
is from primary resources (i.e., textual material, abstracts,
web pages).
- Lists of links
are evaluated/reviewed/quality-filtered.
- The primary purpose
of the web page is educational.
- Information is current
or an update date is included.
- Registration is
not required to view the information on the site.
http://www.medlineplus.gov |
Info
For Clinicians and Patients |
National
Cancer Institute
http://www.nci.nih.gov
|
Cancer
Information |
National
Committee for Quality Assurance (NCQA) HEDIS Effectiveness of Care
Measures
http://www.ncqa.org/
|
Performance
Measures |
National
Guidelines Clearinghouse
http://www.guideline.gov |
Guidelines
Performance Measures
|
National
Institute for Health and Clinical Excellence (NICE)
A nice (no pun intended) British site for technology assessments.
http://www.nice.org.uk/Guidance |
Technology
Assessments |
National
Quality Forum
Endorsement of consensus-based
national standards for measurement and public reporting of healthcare
performance data. “Seed” performance measures for hospital
care, safe practices, children’s health care, diabetes care
and other practices are available from NQF.
http://www.qualityforum.org/home.htm
|
Performance
Measures |
National
Quality Measures Clearinghouse
http://www.qualitymeasures.ahrq.gov/
|
Performance
Measures |
Netting
the Evidence
http://www.nettingtheevidence.org.uk/ |
Links
to Useful EBM Resources |
New
Zealand Guidelines Group
This is a great first stop for guidelines. They know and use the
"explicit" guideline development method.
Caution: Some
guidelines are developed using consensus and, therefore, may be
biased.
http://www.health.govt.nz/about-ministry/ministry-health-websites/new-zealand-guidelines-group
They also have a great
risk calculator for primary prevention of cardiovascular disease:
http://www.health.govt.nz/publication/new-zealand-cardiovascular-risk-charts |
Guidelines |
Physician
Consortium for Performance Improvement
http://www.ama-assn.org/
|
Performance
Measures |
PubCrawler — an Update Alerting Service for PubMed and GenBank
"It goes to the
library. You to go the pub." ™
http://pubcrawler.gen.tcd.ie/ |
PubMed
Alerting Service |
Pub
Med for Clinical Staff
We love! It just gets better and better, and easier and easier.
A continual stop!
Caution: You must critically appraise this information for
validity and usability.
http://www.PubMed.gov |
Primary
and Secondary Studies
Evidence Syntheses
Guidelines
Performance Measures |
The
STARD Initiative — Standards for Reporting of Diagnostic Accuracy
Towards Complete and Accurate Reporting of Studies on Diagnostic
Accuracy
"To improve the accuracy and completeness of reporting
of studies of diagnostic accuracy in order to allow readers to assess
the potential for bias in a study and to evaluate the generalisability
of its results....Evaluation of research depends on complete and
accurate reporting. If medical journals adopt the checklist and
the flow diagram, the quality of reporting of studies of diagnostic
accuracy should improve to the advantage of clinicians, researchers,
reviewers, journals, and the public."
You can read the article
here: http://bmj.bmjjournals.com/cgi/content/full/326/7379/41
And about the statement
here: http://www.clinchem.org/info_ar/STARD_Checklist.pdf
See also Consort Statement: Consolidated Standards of Reporting Trials |
Diagnostic
Testing |
Statistical Help
Steve Simon PhD aka "P. Mean"
http://www.pmean.com/index.html
From his former life—
STATS:
STeve's Attempts to Teach Statistics
Children's Mercy Hospitals and Clinics, Kansas City, MO
We think this is wonderfully clear and beautifully written information
on a number of important EBM issues, thanks to and courtesy of Steve
Simon, PhD.
http://www.childrens-mercy.org/stats/ (Don't know why, but sometimes you will get a "page cannot
be displayed" notice. Hit the back button, and click the link
again. This usually works.)
Also search this page for "calculator" |
Statistical
Education on Selected EBM Topics |
SUMSearch
Searches numerous sources for clinical guidelines, narrative and
systematic reviews, articles in NLM (PubMed).
To access, copy the
following into an internet search engine: http://sumsearch.uthscsa.edu/
|
Guidelines
Reviews
Articles |
Turning
Research into Practice (TRIP)
http://www.tripdatabase.com/
|
Guidelines
Evidence Syntheses |
US
Preventive Services Task Force (USPSTF)
An independent panel of primary care systematically reviews
the evidence of effectiveness and develops recommendations for clinical
preventive services.
http://www.ahrq.gov/health-care-information/topics/topic-us-preventive-services-task-force-uspstf.html |
Guidelines
& Clinical Recommendations on Prevention & Screening |
User's
Guide to the Medical Literature
http://jamaevidence.com/resource/520 |
Tips
on Critical Appraisal |
Veterans
Administration
Another site for guidelines from some really terrific people. We
understand that a lot of their work has been applauded by the IOM.
http://www.healthquality.va.gov/ |
Guidelines |
World
Family Doctors Caring for People — WONCA Online
Wonca is an unusual, yet convenient acronym comprising the first
five initials of the World Organization of National Colleges, Academies
and Academic Associations of General Practitioners/Family Physicians.
Wonca's short name is World Organization of Family Doctors. They
offer a free journal alert service.
http://www.globalfamilydoctor.com |
Medical
News
Free
Journal Alert Service |
More
really nice sets of EBM links available at... |
University
of California San Diego BioMedical Library
http://libraries.ucsd.edu/locations/bml/ |
More... |
Dr.
Brian Alper's EBM Web Page: A guide of evidence based and clinically
relevant websites — Another cool set of links.
http://www.myhq.com/public/a/l/alper/ |
More... |