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Finding Clinical Evidence
Background Questions
Foreground Questions
Question Types or Domains
Types of Literature
Sources of Clinical Information
Sources of Clinical Information
Sources of Clinical Information
Cochrane Library
Cochrane Library
ACP Journal Club
Clinical Evidence (BMJ)
Clinical Practice Guidelines (CPGs)
PubMed
MEDLINE
Retrieving Relevant Literature
Medline Searching
Can’t Find Evidence?
Presenter Change
The Cochrane Collaboration, Evidence-based Medicine and Critical Appraisal
Clinical Research, Epidemiology and Evidence-based medicine
The Origins
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Archie Cochrane
Archie Cochrane
Clinical Research: The state of Affairs
Cochrane Collaboration
Cochrane Collaboration
EBM and Critical Appraisal
Critical Appraisal and EBM: the current state of affairs
Pediatrics and Informatics: the problem
The Problems:
The Problems:
Pediatric EBM: using best evidence to make better decisions
Pediatric Informatics: sources of information
EBM: the practice
EBM
IOM Report:
Evidence Users
The Challenge
Practicing Evidence Based Pediatrics
Building a System of Evidence
Clinical Practice Guidelines
Web page
Developing a Guideline Recommendation
Cochrane Library
Example: Acute Asthma
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EBM, the practice:
Evidence-based Medicine
Pediatric Informatics: the scenario
Pediatric Informatics: a clinical problem
Question Types
Pediatric Informatics: the anwerable clinical question - “PICO”
Pediatric Informatics: an answerable clinical question
Mapping the Question
Pediatric Informatics: the Search
Cochrane Library
Cochrane Library
Cochrane Library
Search
Cochrane Library
A Comparison of nebulized Budesonide, IM Dexamethasone, and placebo for moderately severe croup. Johnson, DW et.al. NEJM 1998; 339:498-503.
Johnson, DW, et.al. NEJM 1998;339:498-503
Medline: access options
Medline
To Retrieve Relevant Literature from such a huge database….
What evidence-based medicine is:
Eminence - based medicine
What evidence-based medicine is:
EBM
I. Individual Clinical Expertise:
II. Best External Evidence:
III. Patients’ Values & Expectations
Clinical Evidence: Therapy
Which trials are randomized? Which are observational?
Clinical Evidence: Diagnosis
Clinical Evidence: Prognosis
Clinical Evidence: Harm
Clinical Evidence: Applicability
Critical Appraisal:
What EBM is not:
Evidence-Based Medicine:
Evidence-Based Medicine:
We needn’t always carry out all 5 steps to provide E-B Care
Types of health care professional
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Equipoise: Innovation vs. Science
Questions?
Randomized

1. Barbarie Hill - 2. Kieran J. Phelan, MD, MSc

1. Finding Clinical Evidence - 2. The Cochrane Collaboration, EBM, Critical Appraisal