BUMC MEDLINE Plus makes looking for clinical evidence easy. Use the Evidence Based Medicine Reviews Database (EBMR) limit option to restrict your search to references in the EBMR database. EBMR includes the complete Cochrane Database of Systemic Reviews and Best Evidence, two premier evidence-based health care resources.
The Cochrane Database of Systemic Reviews is published by the Cochrane Collaboration, an international organization whose mission is to apply evidence-based medicine principles to the review of clinical topics in the current medical research. The Cochrane Collaboration surveys the medical literature for clinically relevant and methodologically sound research, then synthesizes the data, and creates "topic reviews" for inclusion in the Cochrane Database.
Best Evidence is designed to alert clinicians to important advances in medicine by summarizing and providing commentary on evidence-based articles from the biomedical literature. Included in the database are summaries of current studies of diagnosis, cause, course, and management of a number of clinical disorders. The Best Evidence database contains two EBM publications: the ACP Journal Club and Evidence-Based Medicine.
First, classify the problem as one of:
Try using the EBMR limit option first, then try any of the hedges below to expand or supplement the results. Combine the hedge with the subject search, using the Boolean operator AND to obtain relevant articles with high validity.
| $ | truncation symbol used in textword searching |
| .pt. | publication type |
| .ti. | title word |
| .ab. | abstract word |
| .sh. | MeSH (medical subject heading) |
| exp | indicates that the subject heading will be exploded to include all related terms in that heading's tree/hierarchy |
| * | indicates that the subject heading you've selected is a major component or focus of retrieved journal articles |
| adj | adjacency – two words appearing next to each other in the title or abstract |
| and | Boolean operator used to combine search statements. Using an AND will retrieve only the records in which both search concepts appear. |
| or | Boolean operator used to combine search statements. Using an OR will retrieve records in which one or both of the search concepts appear. |
Therapy problems are questions about what treatment, if any, to give a patient, and what the outcomes of different treatment options might be. (see also Randomized Controlled Trials, further below)
If your search generates too much information, try re-combining sets using only these sets: 1 and (6 or 7 or 8).
If your search generates too little information, try re-searching #6 - 8 without the *, then recombine the results with set #1.
Also be sure to try limiting #1 to EMBR for materials from the Cochrane Database or Best Evidence.
Diagnosis problems are questions about the degree to which a particular test is reliable and clinically useful, generally asked in order to decide whether a patient would get enough benefit from the test, on average, to justify having it done. Most articles on diagnosis compare the results of the diagnostic test being studied to the results of another standard test that is regarded as being a definitive 'gold standard' test.
In order to retrieve older literature or literature that may not have been indexed to the subject headings above, the following textword combinations can be used with the search above:
Prognosis problems are questions about a patient's future health, life span, and quality of life in the event that s/he chooses a particular treatment option. For instance, how do the lifespan and quality of life of an elderly patient undergoing surgery for prostate cancer compare with those for a similar patient who chooses not to undergo the surgery?
In order to retrieve older literature or literature that may not have been indexed to the subject headings above, the following textword combinations can be used with the search above:
Also be sure to try limiting #1 to EMBR for materials from the Cochrane Database or Best Evidence.
Where mortality is a possible outcome, increase the search's sensitivity by combining exp mortality/ or exp survival analysis/ to the search strategy.
Etiology problems are questions about the relationship between a disease and a possible cause. For example, does a diet rich in saturated fats increase the risk of heart disease, and if so, by how much?
In order to retrieve older literature or literature that may not have been indexed to the subject headings above, the following textword combinations can be used with the search above:
Also be sure to try limiting #1 to EMBR for materials from the Cochrane Database or Best Evidence.
A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random chance or local variation and getting at something close to the real truth. In general, a meta-analysis may be a better guide to practice than an individual article.
In order to retrieve older literature or literature that may not have been indexed to the subject headings or publication types listed above, the following textword combinations can be used with the search above:
Also be sure to try limiting #1 to EMBR for materials from the Cochrane Database or Best Evidence.
Randomized controlled trials are the standard method of answering questions about the effectiveness of different therapies. If you have a therapy question, first look for a randomized controlled trial, and only go on to look for other types of studies if you don't find a randomized controlled trial. (see also D. Therapy & Prevention)
In order to retrieve literature that may not have been indexed to the subject headings or publication types listed above, the following combinations can be used in addition to the search above:
Also be sure to try limiting #1 to EMBR for materials from the Cochrane Database or Best Evidence.
PubMed searchers have another option for retrieving evidence based materials from the primary literature. The "Clinical Queries" option in PubMed has built-in search hedges -- nearly identical to those listed above -- which are automatically applied to your search. Four study categories--therapy, diagnosis, etiology, prognosis--are provided, and you may indicate whether you wish your search to be more sensitive (i.e., include most relevant articles but probably including some less relevant ones) or more specific (i.e. including mostly relevant articles but probably omit a few). See this table for details regarding filter categories.
