The Abstracts of Cochrane Reviews are available without charge and can browsed or searched.

The Cochrane Library includes:

• The Cochrane Database of Systematic Reviews - Regularly updated reviews of the effects of health care
• Database of Abstracts of Reviews of Effectiveness - Critical assessments and structured abstracts of good systematic reviews published elsewhere
• Cochrane Central Register of Controlled Trials - Bibliographic information on controlled trials
• Other sources of information including Cochrane Methods Database on the science of reviewing research and evidence-based health care

This is an excellent source of information and their registry of RCTs is larger than that of MEDLINE. Information on how reviews are prepared is provided both on the CD and on the online version.

UpToDate

The goal of UpToDate is "to become the first place that clinicians, including students, will go when they need an answer to a specific clinical question". Its objectives are that information be comprehensive, accurate, verifiable (well-referenced), easy to access, and updated regularly. Its contents include all areas of internal medicine, but the dermatology, oncology, and neurology sections are still under development.

Explicit criteria for seeking and appraising evidence are not described. However, authors of the cards are asked to include both descriptions of the most important, relevant studies, and a brief review of quantitative data.

It is available on CD and on the web. Not all content areas in internal medicine are covered in this resource. The CD is updated quarterly. A brief example is available for viewing on the website.

Textbooks

Diagnostic Strategies for Common Medical Problems

The aim of this book is to help clinicians with both critical appraisal of diagnostic tests and quantitative decision-making about diagnostic strategies. It provides information about the operating characteristics of diagnostic tests and procedures which are commonly used in clinical practice, particularly in internal medicine.

This book does not provide any information on whether the literature was systematically reviewed and critically appraised for each of the topics under discussion. References are provided in each chapter but there is no mention of the methodological rigour of these studies. The authors do provide quantification of the results of the diagnostic studies presented as sensitivities, specificities and likelihood ratios although no confidence intervals are provided. No information is provided on how often this book will be updated nor is there mention of the possibility of an electronic version which could be more easily updated. A list of its contents is available on its website. Although this book does not meet all of our criteria for inclusion on this site, we've included it because there are very few resources available to provide information on evidence-based diagnosis.

Evidence-Based Medicine: How to Practice and Teach EBM

This book is for clinicians at any stage of their training or career who want to learn how to practice and teach Evidence-Based medicine. Written for the busy practitioner; it is short, lean, and highly practical.

PDQ Evidence-based Principles and Practice. McKibbon A et al. BC Decker, Hamilton

This is an excellent introduction to the practice of EBHC and provides a concise description of the principles of EBHC. In particular, its material on searching the literature is very useful.

Web Sites

Bandolier

Bandolier is produced monthly in Oxford for the NHS R&D Directorate. It contains bullet points (hence its title) of evidence-based medicine. Internet access is free and a Spanish version is also available at:

• http://www.infodoctor.org/bandolera
• http://infodoctor.org/dolor

No information is provided on how topics are selected for discussion. A search engine for the site is provided. Other useful information provided includes information on pain research and an easy-to-use NNT calculator. The site also provides links to other good websites such as the Oxford Pain Relief website which has a database of NNTs for various analgesics.

Best BETS

Best Evidence Topics (BETs) were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is. This site allows you to browse or search a large database of BETs as well as allowing readers to submit their own.

Center for Clinical Effectiveness

This site is operated through the Monash Medical Center in Australia. It opened in 1998 with the objective of enhancing patient outcomes through the clinical application of the best available evidence about treatments. The site offers users full evidence reports on a number of topics. As well, it provides good links to similar websites, which are separated by category, making the site easy to use. Finally, the Center has a section of its website where you can actually submit clinical questions regarding patients and they will research the topic of interest and respond directly to your question.

Centre for Evidence-Based Medicine

The NHS R&D CEBM was established in Oxford as the first of several centres around the UK whose goal is to promote evidence-based health care and to provide support and resources to others trying to practice and teach EBM. The website includes an EBM Toolbox with various tools for practising and teaching EBM, the CATMaker (a software programme allowing the user to create 1-page summaries of the evidence), a calendar of EBM events, and links to other EBM sites.

Centre for Evidence-Based Mental Health

The aim of the CEBMH is to promote and support the teaching and practice of evidence-based mental health care. This site provides materials to help develop skills in practising EBMH and is aimed at users trying to provide training courses and at people wanting to improve their EBMH skills by working through some online tutorials for practising EBMH.

Links to other useful resources including the full text online journal Evidence-Based Mental Health are also available from this site. The site is regularly updated (every Friday at 6pm GMT), and the most recent additions are highlighted on the homepage. The EBMH journal is updated quarterly and runs alongside the paper version of the journal.

Centres for Health Evidence

The principal task of Centres of Health Evidence (CHE) is to package, disseminate, and present health knowledge in ways that facilitate its optimum use. Within the CHE, staff will monitor knowledge-based software and literature from a variety of public and private sources. Significant resources are identified and structured abstracts are developed to alert the user to the quality of evidence and how the needs of specific patients, practitioners and settings are addressed in these resources.

CHE promotes the practice of evidence-based health by presenting these knowledge-based resources and summaries to health professionals via Internet-based technologies located in their clinical settings. Resources from places such as the university libraries are brought to users through CHE desktops. Lastly, CHE facilitates training for health professionals to optimize their understanding and use of evidence-based health in addition to the technologies that carry the content.

This web site hosts the User’s Guides to the Medical Literature produced by JAMA.

Clinical Evidence

Clinical evidence is a six monthly, updated compendium of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. It provides a concise account of the current state of knowledge, ignorance and uncertainty about the prevention and treatment of a wide range of clinical conditions based on thorough searches of the literature. It summarises the best available evidence and focuses on the effects of preventative and therapeutic interventions as demonstrated by randomised trials and systematic reviews of such trials.

EPIQ (Effective Practice, Informatics & Quality Improvement)

EPIQ (Effective Practice, Informatics & Quality Improvement) was established in 2002 to support effective evidence-based practice, health informatics and quality improvement initiatives in the health and disability support sectors. EPIQ is a collaboration of academics, clinicians and other health sector professionals and replaces EPI (the Effective Practice Institute). Whereas EPI’s main focus was on evidence-based practice, EPIQ will continue this work but will also include streams in quality improvement and the use of informatics platforms for delivering evidence-based advice, for assessing and improving quality and for basic and applied research.

Evidence-Based Medicine

Evidence-Base Medicine is a journal released every other month which alerts clinicians of important advances in general and family practice, internal medicine, surgery, psychiatry, pediatrics and obstetrics and gynecology. This is accomplished by selecting from the biomedical literature those original and review articles whose results are most likely to be true and useful. The articles are also summarised in abstracts and a commentary by a clinical expert is added. This site contains an large archive of articles organized by both category and date as well as useful links to other evidence-related websites.

Evidence-Based Mental Health

Evidence-Base Mental Health is a journal released four times a year which alerts clinicians working in the field of mental health of important and clinically relevant advances in treatment, diagnosis, aetiology, prognosis/outcome research, quality improvement, continuing education, economic evaluation and qualitative research.. This is accomplished by selecting original and review articles whose results are most likely to be accurate and clinically useful. The articles are also summarised in abstracts and a commentary by a clinical expert is added. This site contains an large archive of articles organized by both category and date as well as useful links to other evidence-related websites.

Evidence-Based Nursing

Evidence-Base Nursing is a journal released four times a year which alerts practising nurses of important and clinically relevant advances in treatment, diagnosis, aetiology, prognosis/outcome research, quality improvement, continuing education, economic evaluation and qualitative research.. This is accomplished by selecting original and review articles whose results are most likely to be accurate and clinically useful. The articles are also summarised in abstracts and a commentary by a clinical expert is added. This site contains an large archive of articles organized by both category and date as well as useful links to other evidence-related websites.

Evidence-Based Pediatrics

This site is a resource for evidence-based pediatrics provided through the University of Michigan. The site includes a list of CATs, a CAT template (step by step guide on how to create a CAT), guidelines for starting a journal club and links to other websites. Another feature of this site is that it provides the user with a search engine (in the Search this Site section) so that the user can filter through irrelevant information and find what they are looking for quite easily.

Evidence-Based Practice Centers

The Agency for Health Care Policy and Research (AHCPR) has 12 centers in the United-States for developing evidence reports and technology assessments of diagnostic and therapeutic interventions used in a variety of clinical conditions. The partners of AHCPR use the products of Evidence-Based Practice Centers to develop and implement practice guidelines and other clinical quality improvement tools. The site contains evidence reports as well as links to each of the 12 centers across the US.

McMaster Health Information Research Unit

The goal of HIRU is to improve the effectiveness and efficiency of health care by providing innovative evidence-based information products and systems to health professionals, patients, policy makers, and the public. It is involved in a number of initiatives including being the location for: a national centre for the Cochrane Collaboration; HEALNet; an Evidence-based Practice Centre; Cancer Care Ontario and a variety of evidence-based publications.

National Library of Medicine’s Health Services/Technology Assessment Text (HSTAT)

This site is basically a very detailed search engine. It contains holdings from the AHCPR support guidelines, the AHCPR technology assessments and reviews, ATIS (HIV/AIDS technical information), NIH Warren G. Magnuson Clinical Research Studies, NIH Consensus Development Program, PHS Guide to Clinical Preventative Services (1989) and SAMHSA/CSAT Treatment Improvement Protocol (TIP).

NHS Centre for Reviews and Dissemination

The NHS Centre for Reviews and Dissemination (CRD) is the sibling of the UK Cochrane Centre and has the goal of producing reviews concerning the effectiveness and cost-effectiveness of healthcare interventions. It provides access to several databases including a database of structured abstracts of good quality systematic reviews (DARE) which comment on the methodological features of published reviews and summarise the author’s conclusions and any implications for health practice. It also provides the full text Effective Health Care Bulletin which is a bi-monthly bulletin for decision-makers that examines the effectiveness of a variety of health care interventions. Effective Health Care bulletins are based on a systematic review and synthesis of research on the clinical effectiveness, cost-effectiveness and acceptability of health service interventions. This is carried out by a research team using established methodological guidelines, with advice from expert consultants for each topic.

This site is a great resource but does not have a search engine. There is also no mention of how often the site is updated.

Ovid EBM

Ovid’s goal is "to support and improve information access for researchers, clinicians, and students in scientific, medical, and academic communities worldwide by providing innovative and interlinked text retrieval software and database solutions."

Ovid provides access to a variety of resources including bibliographic databases (such as MEDLINE, EMBASE and CINAHL); more than 300 full text journals; and other clinical information products such as Evidence Based Medicine Reviews (EBMR) and some textbooks. This year, Ovid will also include Clinical Evidence which is a bi-annual compendium of evidence of the benefits and harms of some common clinical interventions. Ovid is fully integrated and a single search engine is used for all the databases and full text journals. Access to the various databases is purchased separately.

EBMR contains material from Best Evidence (which includes the contents of ACP Journal Club and Evidence Based Medicine) and the Cochrane Database of Systematic Reviews. It combines Best Evidence and the Cochrane Database into a single, fully searchable database with links to both MEDLINE and Ovid full-text journals. Because the databases are interlinked, users can begin a search in MEDLINE and link from MEDLINE citations to the abstract and commentary for the relevant article in Best Evidence, to the full text article, and to relevant Cochrane Reviews. Alternatively, MEDLINE searches can be limited to articles retrieved from Best Evidence.

Ovid EBMR is a great resource but it must be purchased separately from Journals@ovid. Clinical Evidence, when it is available on line, will also need to be purchased separately from EBMR. Ovid EBMR is updated quarterly.

Physiotherapy Evidence Database (PEDro)

PEDro is an initiative of the Centre for Evidence-Based Physiotherapy (CEBP) and has been developed to give physiotherapists and others rapid access to bibliographic details and abstracts of randomised controlled trials, and systematic reviews of randomised controlled trials, in physiotherapy. Most trials on the database have been rated for quality to help you quickly discriminate between trials which are likely to be valid and interpretable and those which are not.

Most English-language randomised controlled trials and systematic reviews in physiotherapy are on the database. Trials and reviews in other languages are represented, but probably less comprehensively.

Information is also provided on how to critically appraise the trials that have been identified. Links to other useful websites are also provided. There is no information on how often the database is updated.

PubMed

PubMed is an Internet interface for MEDLINE. It is a project developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM), located at the National Institutes of Health (NIH). It has been developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journals at Web sites of participating publishers. Publishers participating in the PubMed project supply the NLM with formatted citations prior to or at the time of publication, and NLM adds them to the PubMed search system. If the publisher has a WWW site that offers full text of its journals, PubMed provides links to that site. In addition, PubMed provides a WWW Citation Matcher service, which allows publishers (or other outside users) to match up their own citations to PubMed entries, using bibliographic information such as journal, volume, issue, page number, and year. This permits publishers to link from references in their published articles directly to entries in PubMed.

Using the ‘Clinical Queries’ feature in PubMed, you can restrict retrieval to articles that are most likely to asnwer your clinical question. This specialized search is intended for clinicians and has built-in search "filters" based largely upon Haynes RB et al. Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you may indicate whether you wish your search to be more sensitive (i.e., include most relevant articles but probably including some less relevant ones) or more specific (i.e. including mostly relevant articles but probably omit a few). PubMed is updated continuously as information is received from the publishers.

Resources for Practicing Evidence-Based Medicine

This site specializes in pediatric critical care (intensive care) medicine. It teaches the user how to use evidence-based medicine (e.g. how to critically appraise medical literature, how to use and calculate relevant statistics and how to use systematic reviews). The site also contains links to websites providing CATs, evidence-based medicine groups, databases/directories, journal clubs as well as teaching resources.

SumSearch (formerly SmartSearch)

SumSearch is a ‘meta-searching service’ that searches the following resources:

1. Textbook. The default textbook to search is the Merck Manual.
2. MEDLINE for review articles and editorials from high quality, general journals that have full texts available.
3. National Guideline Clearinghouse from the Agency for Health Care Policy and Research (AHCPR)
4. Database of Abstract of Reviews of Effectiveness (DARE)
5. MEDLINE for original research.

Depending of the focus requested SUMSearch will search PubMed with the highest sensitivity filters developed by Haynes et al. SUMSearch will also do focused searches depending on the type of information requested. For example, if the question being searched is one about the physical examination, SUMSearch will search the database Bedside Diagnosis.

SUMSearch is easy to use and when the information is retrieved it is sorted by where it was found. For example, it mentions that for broad discussion the information found in the Merck Manual might be useful but it may not be as up-to-date as original published articles located using MEDLINE. It does not provide any information on the search filters it uses.

Trip Database

The TRIP Database searches over 75 sites of high-quality medical information. The TRIP Database gives you direct, hyperlinked access to the largest collection of ‘evidence-based’ material on the web as well as articles from premier on-line journals such as the BMJ, JAMA, NEJM etc.