Welcome to the Calder Portal for Evidence-Based Medicine (EBM ) Practitioners: Evidence-Based Medicine (EBM) is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett, 1996) Evidence-Based Medicine is the practice of integrating clinical expertise, the highest quality research available, and patient values to make the best decisions for patient care. Clinicians combine their expertise with the most conscientious research and the patient’s desires and concerns to create a plan which has a better chance for adherence. The most conscientious research is usually found to be the research with the best methodology. The higher the level of evidence, the better the research. 1 This portal is designed to organize the top EBM tools in one place using the 5 steps of EBM. It is intended to support the clinical decision-making and education of medical students, residents, clinicians, and other health care practitioners.   Quick Search: Evidence Based Medicine Title Author Full Text Keyword Subject Abstract ISBN ISSN Any Step 1: Answering Your Background Questions and Framing Your Foreground Question Step 2: Searching the Literature Step 3: Critical Appraisal Step 4: Integrating Clinical Expertise Step 5: Evaluating Results Straus SE, Richardson WS, Glasziou P, and Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. (3rd edition) Churchill Livingstone: Edinburgh, 2005. Pages 3-4. Step 1: Answering Your Background Questions and Framing Your Foreground Question Answering Your Background Questions Use these resources to help answer background questions. Background questions ask for general knowledge about an illness, disease, condition, or drug. The answers to background questions are often required before properly converting need for information into an EBM answerable question.  Access Medicine Provides access to more than 50 medical e-books, including key textbooks such as Harrison's Principles of Internal Medicine, Goodman & Gilman's The Pharmacological Basis of Therapeutics, and Hurst's The Heart, with the ability to download to mobile devices. Also includes free USMLE preparation materials. DynaMed Clinical evidence-based reference with point-of-care summaries for more than 3,200 topics. MICROMEDEX A collection of drug databases with up-to-date information offered on drugs, diseases, acute care, toxicology, alternative medicine, and more. Framing 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 Outcome Step 2: Searching the Literature Previously Appraised Resources The Cochrane Library: Evidence for Healthcare Decision-Making A collection of databases that contain different types of high-quality, independently assessed evidence to inform healthcare decision-making. Includes the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and the Central Registrar of Controlled Trials. Primary Research & Journal Literature PubMed Allows users to search more than 21 million citations for biomedical literature. Clinical Queries from PubMed.gov Quickly focus your PubMed search on clinical studies and systematic reviews. Ovid MEDLINE A biomedical database with over 18 million records for biomedical abstracts referencing both human and animal research. Ovid allows easy keyword and phrase searching along with the ability to search more than just the MEDLINE database. SUMSearch  Offers real-time meta-searches of PubMed, DARE, and the National Guideline Clearinghouse. Scopus A database of abstracts and citations for scholarly journal articles, covering nearly 18,000 titles published since 1996 in the arts, medicine, physical sciences, and the social sciences. TRIP (Turning Research Into Practice) A clinical research database which offers access to high quality clinical evidence broken down by type. Includes embedded Google Translate system for quick language translation. Class Registration Become a medical information power user! Register for free classes to learn how to find the perfect article, create a bibliography in minutes, find out who cited your article, identify mentors, and download full text articles in seconds. Step 3: Critical Appraisal Once you have searched the literature and picked an article you believe will answer your question, pick the critical review worksheet that best matches your article type and critically evaluate your chosen article. UMMSM Students UM CASP Case-Controls Assessment Tool UM CASP Cohort Assessment Tool UM CASP Diagnostics Assessment Tool CASP Economic Evaluation Assessment Tool CASP Qualitative Studies Assessment Tool UM CASP RCTs Assessment Tool UM CASP Systematic Reviews Assessment Tool Miami VA Hospital (MS Word Documents) 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 Step 4: Integrating Clinical Expertise Isabel A diagnostic support tool designed to complement, not replace, clinical judgment with a checklist and topic-specific knowledge components. Physicians enter a list of symptoms and are given diagnostic possibilities to consider. Guidelines National Guidelines Clearinghouse (AHRQ) A public resource for evidence-based clinical practice guidelines. A clinical practice guideline contains systematically developed statements that include recommendations, strategies, or information that assist physicians and other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances. Included guidelines must be systemically developed by medical specialty associations or relevant professional societies, have documentation of a systematic literature search on the subject, and have full text availability. MD Consult Includes links to full-text clinical practice guideline articles published in the journals available through MD Consult, plus links to additional full text guidelines from professional and government organizations. Physicians/Clinicians Portal A "little black bag" of essential resources for practicing physicians and clinicians. Step 5: Evaluating Results In this step you evaluate your effectiveness and efficiency in executing steps 1-4 and look for ways to improve them for the next time. Portal by Vedana Vaidhyanathan, MSLS, and Emily Vardell, MLS, evardell@med.miami.edu. Last updated 10-7-2011. For assistance with any of these resources or to find out about other available research and searching options, 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, please send an email to the Reference, Education & Outreach Services department at reference@med.miami.edu. 1. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ (Clinical Research Ed.), 312(7023), 71-72.