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Finding answers to questions in evidence based
medicine (EBM)
By Atle Klovning
1. Formulate a searchable question
2. Search
3. Critical
appraisal
Finding answers to
clinical questions is a great challenge, and Scott Richardson's contribution to forming structured 4-part questions as
described below, is a prerequisite.
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1. Who?
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2. What?
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3.
Alternatively?
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4. Outcome?
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In children
with acute otitis media
aged 2-4 years
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Antibiotics
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No treatment except paracetamol
Once daily regimens
Nasal decongestants
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No pain after two
days?
Side-effects
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In men with
cancer of the prostate
younger than n 70 years
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Staging with MRI
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Gleason scoring
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Predictive
value?
Likelihood ratio?
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2. Search
When "looking for answers", use the sources in the
priority listed below, structured into a "7-step way for finding best evidence":
1 The Cochrane library
- the ultimate choice, a multinational effort systematically organizing
information
2 Secondary Journals
- "let others critically appraise and present articles"
3 MEDLINE
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one of many databases which are free and with different interfaces that
might help you
4 Primary Journals
on the web, often searchable, and often in flutist .pdf versions
5 Guidelines
on the web, well aware of the varying quality
6 Internet
- the distressingly, unsorted information megaworld where no quality filtering
exists
7 Mailbases
for posting questions I still have not found an answer to
3. Critical appraisal
Basically, critical appraisal is based on 3 steps:
1. Internal validity (How well is this study performed?)
2. Results (What does it show?)
3. External validity (Can I use it?)
4. EBM for beginners
Those who need a general introduction into EBM, I have organized
general
link sites which serve as educational starting points into
the EBM world.
Many of us are disillusioned by the overwhelming information now available
at our fingertips at the computer- and do not know where or how to start
looking for answers to their questions. As a result of my own failures
and struggling, I have tried to compile a ranking list of where to look.
Searching
1. The Cochrane
library
Remember that if you are are looking quality assessed RCTs, you need
to add "and CCTR" when looking for a publication type, unless you also
want to search the full CCTR, called CENTRAL.
2. Secondary journals
These are the journals where someone has read a paper, summarised and
critically appraised it, giving you a bottom-line to share in the decision-making
with your patient.
3. MEDLINE
Other Medline
interfaces
These are Norwegian sites for searching books, papers, the net etc.:
KnowledgeFinder
Medline
Here is the wonderful spot where you can just write your 4-part question, like
"In children, what is the best treatment of nocturnal enuresis?" and
voila, by means of fuzzy logic it is turned into a search. The results are
presented as a list where the assumed most relevant papers are listed first,
instead of chronologically as in ordinary Medline. It requires subscription
today
4. Primary journals
General journals
Epidemiology
Laboratory journals
Family medicine journals
5. Guidelines
6. Internet
7. Mailbases
Mailbases are useful for following debates on issues of interest toy ou,
and questions may be posted to the list members, but you are expected
to have
done your homework and searched on your own before posting your question.
There are over 2000 lists at:
MailbaseElectronic
Mailing List Service
Try joining the Evidence-based health list:
http://www.jiscmail.ac.uk/cgi-bin/wa.exe?SUBED1=evidence-based-health&A=1
General link sites which are great educational
starting points into the EBM world
Author:
Dr. Atle Klovning, MD
First published: 01
November, 1997
Last editorial revision: 02 Feb, 2004
Last technical revision: 19 March, 2001
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