Welcome to the Calder Portal for Evidence-Based Medicine (EBM ) Practitioners: Prior to Step 1: Answer Your Background Questions Step 1: Frame Your Foreground Question Step 2: Searching the Literature Step 3: Critical Appraisal Other EBM Tools Tools to Help Write/Create Systematic Reviews How Do We Actually Practice EBM? The full-blown practice of EBM comprises five steps: Step 1: converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question. Step 2: tracking down the best evidence with which to answer that question. Step 3: critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice). Step 4: integrating the critical appraisal with our clinical expertise and with our patient's unique biology, values and circumstances. Step 5: evaluating our effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them both for the next time. Straus SE, Richardson WS, Paul Glasziou, and Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. (3rd edition) Churchill Livingstone: Edinburgh, 2005. Pages 3-4. Prior to Step 1: Answer Your Background Questions: Use these resources to help you answer background questions. Background question ask for general knowledge about an illness, disease, condition or thing. Background questions typically ask - who, what, where, when , how & why - about things like - a disorder, test, treatment, or other aspect of health care. You often need the answers to background questions before you can properly convert your need for information into an EBM answerable question. Harrison's Principles of Internal Medicine Online DynaMed UpToDate 5-Minute Clinical Counsult MICROMEDEX (Drug Information) Natural Standard (Complementary & Alternative Medicine) Guidelines guidelines.gov MD Consult Practice Guidelines ACP Medicine (login: polly  password: calder) More E-Textbooks by Subject or by Title Step 1: Frame Your Foreground Question: Foreground questions ask for specific knowledge to inform clinical decisions or actions. EBM uses highly structured well-formed robust clinical questions to frame and outline the specific foreground question before beginning to search for evidence. Skipping this step usually leads to finding information that is too broad to be applied to your specific clinical case. Different groups and disciplines use variations of the standard PICO rubric to build a clinical question but all include the core elements - Patient/Problem, Intervention, Comparison and Outcome. Step 2: Searching the Literature: Previously Appraised Resources Cochrane Database of Systematic Reviews (DSR) ACP Journal Club Cochrane Database of Abstracts of Reviews of Effects (DARE) Primary Research & Journal Literature MEDLINE - PubMed OR OvidSP Use Medline to search the journal literature for the most current clinical and medical research available on the planet. Most of you recognize the main search interface but some of the specialized search interfaces PubMed provides includes: Search by Clinical Study Category - Therapy, Etiology/Harm, Prognosis, Diagnosis or Clinical Prediction Guides Find Systematic Reviews - finds citations for systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, concensus development conferences, and guidelines CAM on PubMed - finds complementary and alternative medicine citations in PubMed Cancer Topic Searches - literature searches finding citations on more than 100 different cancer topics Health Service Research (HSR) Queries - helps find citations relating to health care quality or to health care costs Medical Genetics - finds citations related to various topics in medical genetics Step 3: Critical Appraisal: Once you have searched the literature and picked an article you believe will answer your question, pick the critical review form that best matches your article type and critically evaluate your chosen article. UMMSM M-1s & M-2 UM CASP Case-Controls Assessment Tool UM CASP Cohort Assessment Tool UM CASP Diagnostics Assessment Tool UM CASP RCTs Assessment Tool UM CASP Systematic Reviews Assessment Tool Miami VA Hospital Clinical Decision Analysis Clinical Manifestations of Disease Clinical Practice Guidelines Clinical Prediction OR Decision Rule Decision Rule OR Clinical Prediction Diagnostic Test Disease Probability for Differential Diagnosis Economic Analysis Harm Overview Prognosis Qualitative Methods Screening Therapy Other EBM Tools: Here are some other EBM Resources you may want to explore if the above resources don't seem as helpful as you would like.. BestBets NHS Economic Evaluation Database ReleMed SUMSearch TRIP (Turning Research Into Practice) Tools to Help Write/Create Systematic Reviews Cochrane Central Register of Controlled Trials Cochrane Methodology Register Health Technology Assessment QUOSA Information Manager RefWorks For assistance with any of these resources, or to find out about other available research and searching options you can browse the library's full website, come by the library's Reference Desk or call the Reference, Education & Outreach Services department at (305) 243-6648 We always want your feedback! To suggest additions, corrections or changes to the content of the Calder Portal for EBM Practitioners page, please send an emal to the Reference, Education & Outreach Services department at reference@med.miami.edu