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Evidence-Based Medicine

PubMed Tutorial

Welcome to the PubMed Tutorial. This course is designed for new and experienced users of PubMed®, the National Library of Medicine (NLM®) journal literature search system.

By the end of this course, you should be able to:

  • Understand PubMed's scope and content.
  • Understand how the Medical Subject Headings (MeSH) are used to describe and retrieve citations.
  • Build a search using MeSH and PubMed search tools (Details, Filters, History, Search Builder, etc.)
  • Manage your results using display, sort, the Clipboard, save, print, e-mail and order features and My NCBI filters.
  • Save your search strategies.
  • Link to full-text articles and other resources.
  • Use special queries and other PubMed/NCBI tools.
Source: nih.gov
Pharmacy Resource: Tutorial
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence-Based Answers to Clinical Questions for Busy Clinicians

This workbook aims to help you to find the best available evidence to answer your clinical questions, in the shortest possible time. It will introduce the principles of evidence-based practice and provide a foundation of understanding and skills in:

  • Developing questions that are answerable from the literature
  • Searching for and identifying evidence to answer your question
  • Appraising the evidence identified for quality, reliability, accuracy and relevance  
Source: monashhealth.org
Pharmacy Resource: Workbook
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Last Checked: 19/10/15 Link Error: Report It

 

 

 

Evidence-Based Practice: An Interprofessional Tutorial

Evidence-Based Practice: An Interprofessional Tutorial is an interactive, self-paced orientation to foundational evidence-based practice methodology and skills. This tool features case studies from across the health professions, an increased emphasis on critical appraisal, and improved navigability and accessibility.

This tutorial serves as a resource for learning how to use the EBP methodology and apply it to inform your clinical decision making and the care of patients. By the end of the tutorial, learners will be able to:

  • Describe the 5 steps involved in evidence-based practice
  • Identify the 4 components of PICO and apply them to a clinical problem correctly
  • Formulate a well-built clinical question
  • Define search terms
  • Appraise evidence for its validity and applicability
  • Recognize the types of information sources that may need to be consulted to find the best evidence
Source: umn.edu
Pharmacy Resource: Tutorial
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Last Checked: 12/11/13 Link Error: Report It

 

Things to know

Welcome to WeMeReC Things to know, a new resource developed following feedback from our Seminar programme. Things to know is intended to be a quick and easy to use reference, comprising concise information about specific topics.

Things to know…

Source: wemerec.org
Pharmacy Resource: Reference
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence Based Medicine Toolkit

"This is a collection of tools for identifying, assessing and applying relevant evidence for better health care decision-making. The appraisal tools are adapted from the Users' Guides series prepared by the Evidence Based Medicine Working Group and originally published in JAMA"

Source: ualberta.ca
Pharmacy Resource: Toolkit
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Smart Health Choices
Making sense of health advice
Professor Les Irwig, Judy Irwig, Dr Lyndal Trevena and Melissa Sweet

Health information can be misleading for many reasons. You cannot always rely on the popular sources of health advice, such as the media, family and friends. Even health professionals are not always well informed about the benefits and harms of tests and treatments. Sometimes new health interventions are introduced before their benefits and harms have been properly established. Conversely, years may pass before tests and treatments of proven benefit become widely used.

This book aims to help you become more informed about your health care and health decisions. It will equip you with some simple tools for distinguishing between reliable and unreliable health advice.

It is not intended to be used as a do-it-yourself guide to becoming your own doctor. We hope instead that it will encourage you to work in partnership with health professionals, whether you are seeing a doctor, psychologist or naturopath.

Source: sydney.edu.au
Pharmacy Resource: Book
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Introduction to Evidence-Based Practice

This tutorial is intended for any health care practitioner or student who needs a basic introduction to the principles of Evidence-Based Practice. Upon completion of this self-paced tutorial, you will be able to:

  • define Evidence-Based Practice (EBP)
  • identify the parts of a well-built clinical question
  • identify searching strategies that could improve PubMed searching
  • identify key critical appraisal issues that help determine the validity of a study
Source: duke.edu
Pharmacy Resource: Tutorial
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Last Checked: 12/11/13 Link Error: Report It

 

Finding and Appraising the Evidence

These modules take you through the process of how to find the evidence and then how to assess the validity and reliability of the published research in order to provide effective and efficient healthcare. The course is made up of 6 modules:

  • Overall introduction to critical appraisal
  • Finding the evidence
  • Randomised controlled trials
  • Systematic reviews
  • Economic evaluations
  • Making sense of results
Source: healthknowledge.org.uk
Pharmacy Resource: Modules
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Evidence-Based Medicine in Pharmacy Practice

Pharmacists should be well versed in EBM, so they may answer clinical questions with accuracy. EBM also allows the pharmacist to better scrutinize physician orders so as to identify a more suitable medication or a less expensive alternative.

Source: uspharmacist.com
Pharmacy Resource: Journal Article
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Last Checked: 12/11/13 Link Error: Report It

 

Royal College of Obstetricians and Gynaecologists Scientific Impact Paper
How evidence can influence clinical practice

Source: rcog.org.uk
Pharmacy Resource: Scientific Impact Paper
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Last Checked: 18/08/15 Link Error: Report It

 

Series on Finding Evidence and Putting It into Practice

Keeping Up with the Medical Literature: How to Set Up a System

The best way to keep up with the medical literature is to set up a system that delivers valid, relevant information while filtering out extraneous information. Useful information is patient-oriented, practical, and innovative. Good information systems are available that are inexpensive and easy to use.

How to Find Answers to Clinical Questions

Many barriers exist to finding answers to physicians’ clinical questions. Lack of time, resources, and computer skills, as well as physicians’ environment and attitudes about problem solving, all contribute to unanswered questions. Making use of computer-based information resources can give physicians a framework for answering questions and keeping their practice consistent with the best available evidence.

Diagnosis: Making the Best Use of Medical Data

To take the best possible care of patients, physicians must understand the basic principles of diagnostic test interpretation. Pretest probability is an important factor in interpreting test results. Some tests are useful for ruling in disease when positive or ruling out disease when negative, but not necessarily both. Many tests are of little value for diagnosing disease, and tests should be ordered only when the results are likely to lead to improved patient-oriented outcomes.

Evaluating and Understanding Articles About Treatment

Each year physicians must decide which of the thousands of newly published articles they will take time to read. To determine which articles are the most clinically useful, physicians should assess their relevance, validity, and clinical importance. Using these criteria can drastically decrease the number of articles physicians need to read.

Finding High-Quality Review Articles

A wide array of resources summarizing medical information are available, and physicians must carefully choose the most trustworthy sources. Treatment decisions should be based on the best available evidence, which should be carefully critiqued for both relevance and validity. Paying particular attention to sources that use the Strength of Recommendation Taxonomy can help guide busy physicians to the most useful information sources.

Identifying and Using Good Practice Guidelines

Performance measurement and payment are increasingly linked to goals established by practice guidelines. The best guidelines are based on systematic reviews and patient-oriented evidence, use an evidence-rating system such as the Strength of Recommendation Taxonomy, and are prospectively validated. The guidelines also should have a transparent development process, identify potential conflicts of interest, and offer flexibility in various clinical situations.

Source: aafp.org
Pharmacy Resource: Journal Articles
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Last Checked: 12/11/13 Link Error: Report It

 

Learning Zone

Understanding trials and meta-analyses
Calculations and statistical stuff
Guidelines
Health economics

Source: bandolier.org.uk
Pharmacy Resource: Various
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Last Checked: 13/06/17 Link Error: Report It

 

EBM Glossary

On this page are links to definitions for the jargon words often used in medicine and the numbers and statistics used to describe it. The glossary includes terms used in epidemiology, in clinical trials, in diagnosis, in statistics, and in health economics.

For many of these terms, a simple description is all that is needed, but for others, a wider discussion may be necessary. In that case, there will be a further link to a page with that wider description and/or definition.

Source: bandolier.org.uk
Pharmacy Resource: Glossary
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Last Checked: 13/06/17 Link Error: Report It

 

Glossary of EBM Terms

Source: ktclearinghouse.ca
Pharmacy Resource: Glossary
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence-Based Medicine Definitions

Following are some basic definitions of important Evidence-Based Medicine (EBM) concepts that will help you develop your understanding of the language and methodology of EBM.

Source: nyu.edu
Pharmacy Resource: Definitions
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Jargon in Research

This article is designed to save time and give a basic introduction to terms commonly used in research papers.

Source: ncor.org.uk
Pharmacy Resource: Article
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Last Checked: 27/02/14 Link Error: Report It

 

Making Sense of Statistics

This guide is not a lesson in statistics. It provides the questions to ask and identifies the pitfalls to avoid to help us get behind news stories that use statistics.

Source: senseaboutscience.org
Pharmacy Resource: Publication
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Last Checked: 12/11/13 Link Error: Report It

 

Research methods

Pharmacists are constantly bombarded with the latest evidence for the efficacy of new drugs, the diagnoses of diseases or their causes. Indeed, we have a professional obligation to keep up to date. This first article of two is a basic guide to research methods and revises some of the common terms pharmacists may come across when reading medical literature

How to appraise a clinical paper critically

Pharmacists are constantly being asked to make judgements about the relative merits of different drugs. However, in order to make these judgements we need the ability to discern good and poor quality information about medicines. This article looks at how to decide whether or not a research paper can be used with confidence

Source: pharmaceutical-journal.com
Pharmacy Resource: Journal Articles
Register to Access Content: Yes - content available to members of RPS and paid subscribers

Last Checked: 31/07/14 Link Error: Report It

 

Beyond critical appraisal

A key foundation of evidence-based medicine (EBM) is that clinicians with appropriate training can critically appraise research papers. Techniques of critical appraisal are taught to students and have been explained in several publications.

Source: nps.org.au
Pharmacy Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

EBM Tools

Tools for each step of the EBM process

Asking Focused Questions
Finding the Evidence
Critical Appraisal
Making a Decision
Evaluating Performance
Designing Research

Source: cebm.net
Pharmacy Resource: Tools
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Critical Appraisal Checklists

Download the CASP critical appraisal checklists for:

  • Randomised Controlled Trials
  • Systematic Reviews
  • Cohort studies
  • Case-control studies
  • Qualitative studies
  • Economic evaluations
  • Diagnostic Studies
  • Clinical Prediction Rule
Source: casp-uk.net
Pharmacy Resource: Checklists
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Last Checked: 12/11/13 Link Error: Report It

 

Crib Sheets - Birmingham Critical Appraisal Skills Programme

Cribsheets are core questions that aid you to critically appraise a research paper.

Example Blank Crib Sheets

example crib sheet for an RTC
example crib sheet for an Economic Evaluation
example crib sheet for Qualitative research
example crib sheet for a Systematic Review

Source: medweb4.bham.ac.uk/websites/caspb
Pharmacy Resource: Crib Sheets
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Critical appraisal of a journal article

Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.

Source: ucl.ac.uk
Pharmacy Resource: Guide / Leaflet
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Last Checked: 19/10/15 Link Error: Report It

 

EBM Primers

Apply the theory and understanding of Evidence-Based Medicine into effective clinical practice through the use of these brief primers.

Source: umassmed.edu
Pharmacy Resource: Brief Primers
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence Based Drug Therapy - What Do the Numbers Mean?

Source: ti.ubc.ca
Pharmacy Resource: Evidence Based Therapeutics Letter
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Last Checked: 12/11/13 Link Error: Report It

 

The University of Nottingham
Subject Resources: EBP

Listed below are Reusable Learning Objects (RLOs) developed by the School of Nursing in the subject area of EBP.

RLOs are small, 'bite-sized' chunks of e-learning focussing on a particular narrow topic, containing typically 15-30 minutes of learning material.

EBP RLOs

Asking the right question
Cohort and case-controlled studies
Confidence intervals
Descriptive statistics for interval and ratio scale data
Determining the clinical importance of trial results
How to conduct a literature search
Levels of Measurement
Levels of Measurement: what you can and can't do arithmetically
Meta-analysis
Numbers needed to treat and numbers needed to harm
Positive and negative predictive value of diagnostic tests
Presenting and interpreting meta-analyses
Probability associated with inferential statistics
Qualitative and quantitative research
Qualitative Data Analysis
Referencing Books using Harvard
Referencing Journals using Harvard
Relative risk reduction and absolute risk reduction
Search strategy for locating Randomised Controlled Trials
Sensitivity and Specificity
SI Units and calculating unit changes
Steps in conducting a systematic review
Surrogate Outcomes
Types of qualitative research
Using databases to find journal articles
What are Journals?
What is a randomised controlled trial?
What is Evidence Based Practice?
Why critique research?

Source: nottingham.ac.uk
Pharmacy Resource: CE / CPD / Learning
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Last Checked: 12/11/13 Link Error: Report It

 

Statistical methods for practitioners

Welcome to our course on medical statistics. This course will cover basic statistical methods.

Learning objectives: This course will cover:

  • Summarising binary data
  • Summarising quantitative data
  • Standard errors & confidence intervals
  • Significance testing & type I and type II errors
  • Displaying data
Source: healthknowledge.org.uk
Pharmacy Resource: Course
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Last Checked: 12/11/13 Link Error: Report It

 

Statistical methods for specialists

Welcome to our course on medical statistics, which will cover advanced statistical methods.

Learning objectives: This course will cover:

  • Diagnostic tests
  • Regression analysis and correlation
  • Logistic regression
  • Survival analysis
Source: healthknowledge.org.uk
Pharmacy Resource: Course
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Last Checked: 12/11/13 Link Error: Report It

 

The interpretation of clinical trials

Clinical trials are the foundations of evidence-based treatments. Trials must be critically appraised to confirm the validity of conclusions. Further analysis is required to show if the results from the trial, where patients are carefully selected and followed up in detail, can be extrapolated to other patients and different settings. Data from additional sources including other trials, meta-analyses, practice guidelines, trusted opinions and clinical experiences modify prescribing practices.

Source: nps.org.au
Pharmacy Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Meta-analysis, collaborative overview, systematic review: what does it all mean?

Bringing together the evidence from randomised controlled trials is increasingly common. Depending on the techniques used, the process might be called a systematic review, meta-analysis or collaborative overview. All relevant trials are identified and those of a satisfactory standard are reviewed. In a meta-analysis, each trial is assessed separately and the summary statistics are then combined to give an overall result. Neither meta-analyses nor systematic reviews are a substitute for prospective clinical trials, rather, they are a complement to them.

Source: nps.org.au
Pharmacy Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Making Informed Decisions: Assessing the Strengths and Weaknesses of Study Designs and Analytic Methods for Comparative Effectiveness Research

The purpose of this document is to provide brief descriptions of both experimental and nonexperimental study designs and methods that may be used to address CER study questions. Each design or analytic topic is described, along with the strengths and limitations associated with the approach. Examples are provided to demonstrate the use of the described methods in the literature.

This document is organized into four sections: experimental study designs; experimental methods; nonexperimental study designs; and nonexperimental methods.

Source: npcnow.org
Pharmacy Resource: Publication
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Last Checked: 13/11/13 Link Error: Report It

 

PRISMA

PRISMA stands for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. It is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses.

The aim of the PRISMA Statement is to help authors improve the reporting of systematic reviews and meta-analyses. We have focused on randomized trials, but PRISMA can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. PRISMA may also be useful for critical appraisal of published systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review.

The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram.

Source: prisma-statement.org
Pharmacy Resource: Statement and Checklist
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Last Checked: 13/11/13 Link Error: Report It

 

Finding What Works in Health Care: Standards for Systematic Reviews
Institute of Medicine

The IOM's standards address the entire systematic review process, from locating, screening, and selecting studies for the review, to synthesizing the findings (including meta-analysis) and assessing the overall quality of the body of evidence, to producing the final review report.

Source: iom.edu
Pharmacy Resource: Report Brief and Standards
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Last Checked: 13/11/13 Link Error: Report It

 

The CONSORT Statement

CONSORT, which stands for Consolidated Standards of Reporting Trials, encompasses various initiatives developed by the CONSORT Group to alleviate the problems arising from inadequate reporting of randomized controlled trials (RCTs).

The CONSORT Statement comprises a 25-item checklist and a flow diagram, along with some brief descriptive text. The checklist items focus on reporting how the trial was designed, analyzed, and interpreted; the flow diagram displays the progress of all participants through the trial.

Source: consort-statement.org
Pharmacy Resource: Statement and Checklist
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Last Checked: 13/11/13 Link Error: Report It

 

Interpreting risks and ratios in therapy trials

To appreciate the significance of clinical trial results, clinicians need to understand the mathematical language used to describe treatment effects.

Source: nps.org.au
Pharmacy Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

What’s the difference between risks and odds?

Odds are… different from risks! To understand odds ratios, we first need to tease out what is meant by odds (for those who are not already familiar with placing bets at the race track).

Odd ratios uncovered

To recap from last month, risks measure the number of events as a proportion of the total - if ten out of total 100 suffer a bad event the risk is 1/10 - while odds compare the number of events to the number free from an event, so would be 10/90 or 1/9.

Source: nntonline.net
Pharmacy Resource: Articles
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Last Checked: 12/11/13 Link Error: Report It

 

P-Values: What Are They?

P-values are commonly included in the results sections of randomised controlled trials (RCTs), but what is a p-value and how should it be interpreted?

Source: bjpcn-respiratory.com
Pharmacy Resource: Journal Article
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Last Checked: 12/11/13 Link Error: Report It

 

Meta-analysis: Its strengths and limitations

This article introduces the basic concepts of meta-analysis and discusses its caveats, with the aim of helping clinicians assess the merits of the results. We will use several recent meta-analyses to illustrate the issues, including a controversial one with potentially far-reaching consequences.

Source: mdedge.com
Pharmacy Resource: Journal Article
Register to Access Content: Yes - registration is FREE

Last Checked: 19/06/17 Link Error: Report It

 

Sense About Systematic Reviews

Scientists use systematic review to interpret the results of individual studies in the context of other research that has been done. They can end confusion, by pooling data from different studies, highlight where there is enough evidence and where more evidence is needed and can give new insights into the research.

Source: senseaboutscience.org
Pharmacy Resource: Publication
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence-informed decision-making

Supporting healthcare individuals

EIDM1 - Overview
EIDM2 - Dealing with information overload
EIDM3 - How individuals make decisions
EIDM4 - Shared decision making with patients

Source: webarchive.org.uk
Pharmacy Resource: e-Learning
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Last Checked: 23/04/15 Link Error: Report It

 

Using Evidence in Decision-Making

Evidence-based practice is an approach to decision-making that integrates the best available evidence with clinical expertise and patient values.

Source: monashhealth.org
Pharmacy Resource:
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Last Checked: 12/11/13 Link Error: Report It

 

Guide to Scientific Research Papers

This brief guide highlights the types of studies published in the scientifi c and medical literature and is intended to help in their interpretation.

Source: hsis.org
Pharmacy Resource: Brief
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Last Checked: 12/11/13 Link Error: Report It

 

Searching the Literature for Evidence-Based Medicine

Welcome! In this interactive narrated tutorial, you will learn how to effectively search for evidence-based medicine literature that will help in your clinical decision making.

Learning Objectives

After completing this learning module, you should be able to:

  • Formulate a well-built clinical question
  • Describe the levels of best evidence in scientific literature
  • Identify how PubMed defines the search terms you enter into a search
  • Formulate a search in the MeSH Database and run the search in PubMed
  • Find the highest levels of evidence using PubMed Clinical Queries
  • Find Randomized Controlled Trials in PubMed
  • Create filter tabs using PubMed's My NCBI
  • Find systematic reviews using the Cochrane Library database
Source: ucsf.edu
Pharmacy Resource: Module
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Last Checked: 12/11/13 Link Error: Report It

 

What is ...? series

The What is …? series aims to demystify some of the terminology, techniques and practices used to assess and act upon clinical and economic evidence in healthcare.

The series is being revised and expanded throughout 2014 to keep pace with changes in thinking and hot topics in evidence-based healthcare.

The series communicates key issues and concepts to readers in a concise and accessible format. It is also a great addition to any training course, ensuring you and your colleagues achieve a complete understanding of healthcare terminology and practices.

Source: whatisseries.co.uk
Pharmacy Resource: Articles
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Last Checked: 04/11/14 Link Error: Report It

 

Tips and tricks in performing a systematic review

Why do, and what to do when starting a systematic review

Preliminary evidence gathering: snowballing and reverse snowballing

Reference management and identifying search terms and keywords

Building a PICO search strategy

Source: nih.gov
Pharmacy Resource: Journal Articles
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Last Checked: 12/11/13 Link Error: Report It

 

Publication Bias: A Brief Review for Clinicians

In this review we define publication bias, how it affects the results of systematic reviews, how it can be detected and minimized, and how it can be prevented.

Source: mayoclinicproceedings.org
Pharmacy Resource: Journal Article
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Last Checked: 12/11/13 Link Error: Report It

 

Should my patient buy that "miraculous cure" advertised on the internet or in a magazine?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

The internet, magazines and other media allow people to make claims for medicines that can seem dubious. It is not possible to individually evaluate every medicine marketed, but the aim of this Q&A is to provide a set of general points to help you when patients come to you for advice. It is a structured way of thinking about some of the important issues.

Source: sps.nhs.uk
Pharmacy Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

When Is Evidence Sufficient?

Traditional conceptualizations of evidence-based medicine rely heavily on randomized controlled trials. Although initiatives to broaden definitions of evidence have been advanced, they generally have not tied evidentiary criteria formally and quantitatively to the benefits and costs involved in a decision to adopt or reject an intervention. Decision analysis provides a framework for combining information to inform the adoption decision in this anner. Value-of-information analysis, a related methodology, helps to determine whether it is worthwhile to collect additional information as well as the type of research that would be most helpful.

Source: content.healthaffairs.org
Pharmacy Resource: Journal Article
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Last Checked: 12/11/13 Link Error: Report It

 

Critical appraisal of Drug advertising

In this article we provide a quick guide to some of the issues to consider when reading drug advertising material or talking to pharmaceutical representatives.

Source: bpac.org.nz
Pharmacy Resource: Journal Article
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Last Checked: 12/11/13 Link Error: Report It

 

Evidence based medicine matters

Evidence based medicine is the key to the success of modern healthcare. This booklet, by Sense About Science and the Academy of Medical Royal Colleges contains case studies of 15 of the game changers in evidence based medicine.

Source: senseaboutscience.org
Pharmacy Resource: Booklet
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Last Checked: 12/11/13 Link Error: Report It

 

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