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Pat Martin / Taubman Medical Lib Pat Martin / Taubman Medical Lib rary / 2006 rary / 2006 Evidence-Based Evidence-Based Medicine Medicine Time Saving Steps Time Saving Steps
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Pat Martin / Taubman Medical Library / 2006Pat Martin / Taubman Medical Library / 2006
Evidence-Based Evidence-Based MedicineMedicine
Time Saving StepsTime Saving Steps
Adapted from R. Brian Haynes, Of studies, synthesis, synopses and systems: the “4S’ evolution of services for finding current best evidence. ACP Journal Club, 134(2)
March/April 2001, pp A-11-A-13.
From the top down…
Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality
As close as we can get…Frequently updated electronic
textbooksRegularly updated clinical practice
guidelinesThese lack the ideal functionality
to filter the evidence based on patient characteristics
From the top down…
Synopses: Synopses of individual studies and reviews
ACP Journal Club
It’s a matter of time…
From the top down…
Syntheses: Summaries based on rigorous searches for evidence
Cochrane Library
Ovid EBMR
From the top down…
Original Studies:
Randomized control trials
Clinical trials
Comparative studies
Multicenter studies
Epidemiological studies
Case:
78 year old divorced African American man who presents with his third episode of major depression after a myocardial infarct. He previously responded to nortriptyline. After his last cardiac event, however, he
developed conduction delay such that tricyclics are now contraindicated.
You need to treat and must consider treatment options.
Question 1: Is there pharmacological intervention which is safer than tricyclic antidepressants in this 78 year old man, post-MI?
Question 2: In a 78 year old man, s/p MI with recurrent major depressive disorder, would psychotherapy treatment vs. a trial of
antidepressant medication be effective?
From the top down…
Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality
Frequently updated electronic textbooks such as ACP MedicineACP Medicine is a continually updated,
evidence-based reference of internal medicine.
Regularly updated clinical practice guidelines
www.lib.umich.edu/taubman
From the top down…
Systems: The best, most recent evidence linked through the patient record – ideal but not yet a reality
Frequently updated electronic textbooks such as ACP MedicineACP Medicine is a continually updated,
evidence-based reference of internal medicine.
Regularly updated clinical practice guidelinesUMHS guidelinesNational Guidelines Clearinghouse
www.guideline.gov
From the top down…
Synopses: Synopses of individual studies and reviews
ACP Journal Club
From the top down…
Syntheses: Summaries based on rigorous searches for evidence
Cochrane Library
Ovid EBMR
From the top down…
Original Studies:
Randomized control trials
Clinical trials
Comparative studies
Multicenter studies
Epidemiological studies
