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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z (and more EBM links, tools, and etc...)

Important Information

Cautions
Read our Health Care Information Source Cautions at Notices, a key point being that all sources should be considered to potentially vary in quality. At a minimum, we recommend you audit each topic.

Moreebm starfish

  • Stars indicate our favored sources that we use regularly, yet this should not be considered to be an endorsement of any site, nor a claim that everything in the site is of the highest quality.

  • You may need to update information from the date of the topic's search.

  • Some services may be available by subscription only.

  • About PMID Numbers
    We frequently utilize a PMID number in place of a citation. Where PMID numbers are available, enter that number into the PubMed search box to retrieve that citation and listing.

  • Other patient-resources available at our patient decision support page: On the Same Page™.

Web Source

What You May Find

ebm starfish ACP Journal Club: also known as Evidence-Based Medicine—The Journal

http://www.acpjc.org/

Reviews of Important Articles and Systematic Reviews that Warrant Immediate Attention

 Agency for Healthcare Research and Quality (and Evidence-base Practice Center reports)
Includes the National Guidelines Clearinghouse, plus US Services Preventive Task Force has helpful information you can access through here.

http://www.ahrq.gov

Here is their patient safety page:

http://www.ahrq.gov/health-care-information/topics/topic-patient-safety.html

Evidence Syntheses
Guidelines
Systematic Reviews
Patient Safety Information

Ambulatory Quality Alliance
Founded by AAFP, ACP, AHIP and AHRQ. Endorsed 26 performance measures as starter set. Goal is to focus on agreed-to measures accepted by health plans to eliminate tracking different measures for different initiatives.

http://www.aqaalliance.org/

Quality Measures
http://www.aqaalliance.org/performancewg.htm

Individual practice internal improvement demo flow sheets:
http://www.ama-assn.org/

Registry
http://www.aafp.org/fpm/20060400/diabetesregistry.xls

Performance Measures & Tools

American Academy of Family Physicians (AAFP)
AAFP Guidelines and Performance Measurement

  • For Guidelines (referred to as "Policy Statements")

http://www.aafp.org/online/en/home/policy.html

For Performance Measures

http://www.aafp.org/about/policies/all/performance-measures.html

Guidelines
Performance Measures

American College of Physicians

http://www.acponline.org/

Guidelines

American College of Preventive Medicine

http://www.acpm.org

Guidelines
Evidence Syntheses

Bandolier

http://www.jr2.ox.ac.uk/bandolier/

EBM Essays

 BMJ BestTreatments
An evidence-based resource for patients and clinicians. You can read more about it at our newsletter: On the Same Page

http://besthealth.bmj.com/x/index.html

Info For Clinicians and Patients

Calculators for EBM Statistical Tasks

http://ktclearinghouse.ca/cebm/practise/ca/calculators

For additional calculators listed here, search this page for "calculator"

Tools
California Pharmacist Journal
We are pleased to help support an evidence-based effort by the California Pharmacist Journal providing pharmacy interns an opportunity to enhance their critical appraisal skills and, in turn, provide a service to the medical decision-making community by performing evidence-based reviews on selected studies.

As peer reviewers and guest editors, Delfini works closely with Craig Stern, CPhA Chair, Editorial Review Committee, and Cathi Lord, California Pharmacist Journal Managing Editor, to provide tools and just-in-time training along with reviewing and editing content.

With permission, we are happy to be able to share these reviews with Delfini readers:
http://www.delfini.org/Showcase_Publication_CPhA.htm

Critical Appraisals

The Canadian Agency for Drugs and Technologies in Health (CADTH)
A good resource for evidence-based assessments of drugs, health technologies and health systems. Frequently uses Cochrane methodology for quality assessment of trials (based heavily on concealment of allocation).

http://www.cadth.ca/

Systematic Reviews

Canadian Knowledge Translation Website

The Knowledge Translation (KT) Clearinghouse is a useful website for EBM information and tools. It is funded by the Canadian Institute of Health Research (CIHR) and has a goal of improving the quality of care by developing, implementing and evaluating strategies that bridge the knowledge-to-practice gap and to research the most effective ways to translate knowledge into action.

http://ktclearinghouse.ca/

Tools

Cancer Guide
Selected basic statistics from Steve Dunn.

http://cancerguide.org/index.html

Statistics

Cardiovascular Disease Primary Prevention Risk Calculator

Here is the New Zealand Guidelines Group risk calculator for primary prevention of cardiovascular disease. Typically, a cardiac risk calculator provides an estimate (either 5 or 10 years) of an individual's risk of experiencing an adverse cardiac event based on specific risk factors. For example, the New Zealand risk tables provide a 5-year assessment based on an individual’s sex, diabetic status, smoking history and age. It also provides an estimate of benefit (CVD events prevented per 100 people) treated with blood pressure agents, aspirin and lipid-lowering agents for 5 years based on risk level.

http://www.health.govt.nz/publication/new-zealand-cardiovascular-risk-charts

Risk Calculator: CVD - Primary Prevention

Centre for Evidence-based Medicine

http://www.cebm.net/

Evidence-based Resources and Tools

Clinical Evidence
A reasonable starting source for systematic reviews from the BMJ. Evidence syntheses of varying quality are available here so auditing of studies and updating is advised.

http://www.clinicalevidence.org

You may be able to get a copy free by going to http://www.unitedhealthfoundation.org. Click on "Resources."

Evidence Syntheses

Clinical Drug Trial Information
An industry sponsored effort. Read about the site below.

http://clinicaltrials.ifpma.org/clinicaltrials/no_cache/en/myportal/index.htm

New Web Site to Track Clinical Drug Trials

By TOM WRIGHT
Published: September 22, 2005
International Herald Tribune

"GENEVA, Sept. 21 - A trade group for the global drug industry said Wednesday that it would start a Web site meant to help doctors, patients and investors keep track of clinical drug trials.

But the group, the International Federation of Pharmaceutical Manufacturers and Associations, which includes big drug companies and national industry associations, stopped short of recommending that disclosures about drug trials be made mandatory.

The Web site (ifpma.org/clinicaltrials), which will help users navigate 250,000 links to other sites run by federation members and government and nonprofit groups, is a compromise, the federation's president, Daniel L. Vasella, acknowledged in an interview.

Dr. Vasella, who is chief executive of the Swiss drug giant Novartis, said that during discussions on the new Web site, some large drug makers had raised concerns about disclosing too much trial data to rivals.

As a guideline, he said that the federation believed that members should announce when trials start, and then make results available within a year of a trial's conclusion.

"Over time," he said, "what will happen is companies that don't disclose information will be scrutinized."

Selective disclosure of drug trial results has become an increasingly controversial practice, particularly in the United States, where critics of the drug industry say that companies have too often buried negative findings.

But enforcing the release of clinical trial results would be difficult because there is no global regulator, Dr. Vasella said. "The question is who will mandate."

The drug industry's main trade group in the United States, the Pharmaceutical Research and Manufacturers of America, has a policy of asking members to register when they start trials and also to publish the results.

While not all companies follow those requests, many drug makers now publish results of late-stage clinical trials on their own Web sites."


Clinical Drug Trial Information

 Cochrane Handbook
The Cochrane Handbook for Systematic Reviews of Interventions is a useful resource for all healthcare professionals doing critical appraisal of the medical literature. It was created to assist authors preparing systematic reviews (SRs) but is of great value to all of us who are assessing validity of studies. The section of interest is Part 2: General methods for Cochrane reviews.

http://www.cochrane-handbook.org/

Critical Appraisal Guidance

 Cochrane Library
A terrific resource. You can get many high quality evidence syntheses here as well. Mike makes this his first stop.

Note about Cochrane systematic reviews. A frequent problem readers have is finding Cochrane reviews published before 2005 when searching in the Cochrane Library. Cochrane updates reviews and drops the original publication date. To find the review with the original publication date you need to search from Medline (e.g., PubMed). 

http://www.cochrane.org

Evidence Syntheses

 Confidence Interval Calculations

Our new favorite! From John C. Pezzullo's Home Page, confidence intervals and a whole lot more!
http://statpages.org/ctab2x2.html

GraphPad QuickCalcs
http://www.graphpad.com/quickcalcs/NNT1.cfm

Dr. Shakespeare's Confidence Calculator
To access, copy the following into an internet search engine: http://www.theshakespeares.com/Free_statistical_software.html

Confidence Interval Calculator

 The Consort Statement: Consolidated Standards of Reporting Trials —CONSORT
"The CONSORT statement is an important research tool that takes an evidence-based approach to improve the quality of reports of randomized trials. The statement is available in six languages and has been endorsed by prominent medical journals such as The Lancet, Annals of Internal Medicine, and the Journal of the American Medical Association. Its critical value to researchers, health care providers, peer reviewers, and journal editors, and health policy makers is the guarantee of integrity in the reported results of research.

CONSORT comprises a checklist and flow diagram to help improve the quality of reports of randomized controlled trials. It offers a standard way for researchers to report trials. The checklist includes items, based on evidence, that need to be addressed in the report; the flow diagram provides readers with a clear picture of the progress of all participants in the trial, from the time they are randomized until the end of their involvement. The intent is to make the experimental process more clear, flawed or not, so that users of the data can more appropriately evaluate its validity for their purposes. "

http://www.consort-statement.org/

And STARD for Standards in Reporting of Diagnostic Accuracy

Research Reporting

Consumer Reports Best Buy Drugs

The mission of the Consumer Reports Best Buy Drugs project is to provide consumers and their doctors with information to help guide prescription drug choices–based on effectiveness, a drug's track record, safety and price.

This appears to be a good source of information since it is based on the work of the Oregon Health & Science University Evidence-based Practice Center which uses a rigorous approach to evaluating science.

http://www.bestbuydrugs.org

Info For Clinicians and Patients

 Database of Abstracts of Reviews of Effects (DARE)
This site identifies potential systematic reviews and assesses for methodological quality against a set of inclusion criteria and summarizes the results.

http://www.york.ac.uk/inst/crd/

Systematic Reviews

Diagnostic Test Calculators (See also STARD for Standards in Reporting of Diagnostic Accuracy)

Delfini Diagnostic Testing Calculator
Features:
—» Natural language explanations for results. Can use with patients.
—» Provides information in percents, probabilities and odds.
—» Likelihood ratio results computed for you so you don't have to guess what is “insignificant” and what is “large.” The calculator does the interpretive work for you.
—» Bandolier number-needed-to-diagnose (NND) calculated as well.
Calculates on the basis of —
• pre-test likelihood, sensitivity and specificity
• raw data from a 2x2 table
Links to confidence interval calculator
Download Excel file here

MedCalc - User-friendly statistical software
(We like this calculator. But note that as of this writing, the number in box a disappears after you click TEST. However, if you need to print off the information, you can reinput that number.)
http://www.medcalc.org/calc/diagnostic_test.php

Center for Evidence-based Medicine Toronto (KTCEBM)
http://ktclearinghouse.ca/cebm/practise/ca/calculators/statscalc

Diagnostic Test Calculators

DIPEx
Illness information for patients, including patients talking about their experiences with illness, can be found at this site. Many of the modules are produced by professionals involved with the Cochrane Collaboration. The site provides patients with information by condition, but also through interviews with patients that you can hear directly online. It also provides information about other resources available to patients.

http://www.healthtalkonline.org/

Illness Information for Patients

 DynaMed
A frequently updated source of information for clinical questions that is a great first pass. We do have some issues with the SORT system upon which it is based. See our letter here. However, much of this work is evidence-based and many statements are graded for validity. Our usual cautions apply.

A BMJ article (BMJ 2011 Sep 23;343:d5856) reported that DynaMed is 78% faster at including evidence than EBM Guidelines, 86% faster than UpToDate, 95% faster than eMedicine, and 97% faster than Clinical Evidence.

We also know first hand that they also work hard to make information truly evidence-based, which we cannot say about many sources. As ever, we always caution that it is to be expected that there is variability everywhere so we always recommend direct critical appraisal or audit—but we love DynaMed and frequently it is a first source of clinical information for us.

http://www.dynamicmedical.com/

DynaMed Influenza Portal

Medical Information Database

Effective Health Care Bulletins

http://www.york.ac.uk/inst/crd/ehcb_em.htm

Effective Health Care's Methods Guide for Comparative Effectiveness Reviews has produced a nice guide to Assessing Harms When Comparing Medical Interventions.

Guidelines
Evidence Syntheses

Safety: Harms Assessment

Evidence-based Medicine
Journal

Evidence-Based Medicine surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Practising clinicians assess the clinical relevance of the best studies. The key details of these essential studies are included in a succinct, informative expert commentary on their clinical application.
Published bi-monthly, Evidence-Based Medicine offers comprehensive coverage of primary care medicine. It includes a wide array of clinical disciplines, including family practice, internal medicine, paediatrics, obstetrics, gynaecology, psychiatry, and surgery.

http://ebm.bmj.com/

Reviews of Important Articles

Evidence-based Practice Newsletter (includes JFP POEMS)
Requires a subscription.

http://www.ebponline.net/

Reviews of Articles Dealing with Common and Relevant Conditions

US Food and Drug Administration (FDA)
The site is huge and complex to navigate. It requires patience and persistence to find relevant information. However, for those interested in detailed information from the FDA for drugs or medical devices, the search function on the home page and the search functions on the drug and medical device pages can provide — at times — useful information.

http://www.fda.gov

FDA Advisory Committee Site: Searchable site at FDA for information from the committee.

http://www.fda.gov/

Especially useful sections are Drugs@FDA (http://www.fda.gov/search/databases.html) and the Center for Drug and Evaluation and Research (CDER; http://www.fda.gov/cder). CDER is an up-to-date source for new drug applications (NDAs) and useful background information on new drugs. The medical reviews and statistician reviews can be of great value. It is worthwhile to do a search using the generic name of the agents of interest at both of these sections, as well as the brand name.

Large Database of FDA-selected Information

Free Medical Journals
This site contains a database of 940 online medical journals, all of which offer some degree of free access. This site's affiliate web site (http://www.freebooks4doctors.com) provides links to more than 550 free medical books online.

http://www.freemedicaljournals.com

Medical Journals

Global Family Doctor — World Family Doctors Caring for People — WONCA Online
Wonca is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. Wonca's short name is World Organization of Family Doctors. They offer a free journal alert service.

http://www.globalfamilydoctor.com

Medical News

Free Journal Alert Service

 Graph Pad Statistical Software: QuickCalcs
There is probably a host of wonders here (for free), but we use the 2x2 table calculator to verify p=values.

http://www.graphpad.com/quickcalcs/contingency1.cfm

This one calculates confidence intervals and more.
http://www.graphpad.com/quickcalcs/NNT1.cfm

Calculator

Health Services/Technology Assessment Text (HSTAT)

http://www.ncbi.nlm.nih.gov/books/NBK16710

Technology Assessments

Highwire Press

HighWire Press, of Stanford University, maintains the online content of 332 medical journals, including the New England Journal of Medicine and Canadian Medical Association Journal.

HighWire's alerting service will notify users of new content that matches their specific interests in any HighWire-affiliated publisher's full text, or in the Medline database.

To access, copy the following into an internet search engine: http://highwire.stanford.edu/

Medical Journals

IBS — The Delfini Irritable Bowel Syndrome (IBS) Guideline Resource Kit:
"Explicit" Evidence-based Clinical Practice Guidance

IBS Resource Center

Clinical Practice Guideline: "Explicit" Evidence-based Method for IBS

ICSI: Institute for Clinical Systems Improvement

ICSI is an independent collaborative that helps its members provide evidence-based health care services to patients. Comprised of 58 medical groups and sponsored by six Minnesota health plans, ICSI unites diverse stakeholders to deliver patient-centered and value-driven care, established in 1993 by HealthPartners, Mayo Clinic and Park Nicollet Health Services, and sponsored by HealthPartners.

To access, copy the following into an internet search engine: http://www.icsi.org/

Guidelines
Evidence-based recommendations

 Informed Health Online
Evidence-based information for patients, clinicians and others — summarizes systematic reviews from Cochrane (abstracts of Cochrane Reviews are available without charge).

http://www.informedhealthonline.org

Info For Clinicians and Patients 

National Academy of Medicine (formerly Institute of Medicine or IOM) Reports
The Academy provides a vital service by working outside the framework of government to ensure scientifically informed analysis and independent guidance. It's mission is to serve as adviser to the nation to improve health. It provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large.

http://www.nationalacademies.org/hmd/Reports.aspx

Information and Advice Concerning Health and Science Policy

JCAHO — Joint Commission on Accreditation of Healthcare Organizations

http://www.jointcommission.org/

Performance Measures

Medicare

http://www.medicare.gov/

Drug Pricing Comparisons

MEDLINEplus for Patients

Medline Plus provides extensive, “authoritative” information from National Library of Medicine, the National Institutes of Health and other trusted sources on over 650 diseases and conditions. Included are a medical encyclopedia and a medical dictionary, extensive information on prescription and nonprescription drugs, health information from the media, and links to thousands of clinical trials. There is no advertising on the site, nor does MEDLINEplus endorse any company or product.

Caution: Although the site uses criteria, there is no critical appraisal of the information for validity.

Key criteria for information and links include:

  • Quality, authority and accuracy of content (again, caution because there is no critical appraisal of the information for validity).
    • The source of the content is established, respected and dependable. A list of advisory board members or consultants is published on the site.
    • The information provided is appropriate to the audience level, well-organized and easy to use.
    • Information is from primary resources (i.e., textual material, abstracts, web pages).
    • Lists of links are evaluated/reviewed/quality-filtered.
  • The primary purpose of the web page is educational.
  • Information is current or an update date is included.
  • Registration is not required to view the information on the site.

http://www.medlineplus.gov

Info For Clinicians and Patients

National Cancer Institute

http://www.nci.nih.gov

Cancer Information

National Committee for Quality Assurance (NCQA) HEDIS Effectiveness of Care Measures

http://www.ncqa.org/

Performance Measures

National Guidelines Clearinghouse

http://www.guideline.gov

Guidelines
Performance Measures

National Institute for Health and Clinical Excellence (NICE)
A nice (no pun intended) British site for technology assessments.

http://www.nice.org.uk/Guidance

Technology Assessments

National Quality Forum

Endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data. “Seed” performance measures for hospital care, safe practices, children’s health care, diabetes care and other practices are available from NQF.

http://www.qualityforum.org/home.htm

Performance Measures

National Quality Measures Clearinghouse

http://www.qualitymeasures.ahrq.gov/

Performance Measures

Netting the Evidence

http://www.nettingtheevidence.org.uk/

Links to Useful EBM Resources

 New Zealand Guidelines Group
This is a great first stop for guidelines. They know and use the "explicit" guideline development method.

Caution: Some guidelines are developed using consensus and, therefore, may be biased.

http://www.health.govt.nz/about-ministry/ministry-health-websites/new-zealand-guidelines-group

They also have a great risk calculator for primary prevention of cardiovascular disease:

http://www.health.govt.nz/publication/new-zealand-cardiovascular-risk-charts

Guidelines

Physician Consortium for Performance Improvement

http://www.ama-assn.org/

Performance Measures

 PubCrawler — an Update Alerting Service for PubMed and GenBank

"It goes to the library. You to go the pub."

http://pubcrawler.gen.tcd.ie/

PubMed Alerting Service

 Pub Med for Clinical Staff
We love! It just gets better and better, and easier and easier. A continual stop!

Caution: You must critically appraise this information for validity and usability.

http://www.PubMed.gov

Primary and Secondary Studies
Evidence Syntheses
Guidelines

Performance Measures

The STARD Initiative — Standards for Reporting of Diagnostic Accuracy
Towards Complete and Accurate Reporting of Studies on Diagnostic Accuracy
"To improve the accuracy and completeness of reporting of studies of diagnostic accuracy in order to allow readers to assess the potential for bias in a study and to evaluate the generalisability of its results....Evaluation of research depends on complete and accurate reporting. If medical journals adopt the checklist and the flow diagram, the quality of reporting of studies of diagnostic accuracy should improve to the advantage of clinicians, researchers, reviewers, journals, and the public."

You can read the article here: http://bmj.bmjjournals.com/cgi/content/full/326/7379/41

And about the statement here: http://www.clinchem.org/info_ar/STARD_Checklist.pdf

See also Consort Statement: Consolidated Standards of Reporting Trials

Diagnostic Testing

 Statistical Help

Steve Simon PhD aka "P. Mean"

http://www.pmean.com/index.html

From his former life

STATS: STeve's Attempts to Teach Statistics
Children's Mercy Hospitals and Clinics, Kansas City, MO
We think this is wonderfully clear and beautifully written information on a number of important EBM issues, thanks to and courtesy of Steve Simon, PhD.

http://www.childrens-mercy.org/stats/ (Don't know why, but sometimes you will get a "page cannot be displayed" notice. Hit the back button, and click the link again. This usually works.)

Also search this page for "calculator"

Statistical Education on Selected EBM Topics

SUMSearch
Searches numerous sources for clinical guidelines, narrative and systematic reviews, articles in NLM (PubMed).

To access, copy the following into an internet search engine: http://sumsearch.uthscsa.edu/

Guidelines
Reviews
Articles

Turning Research into Practice (TRIP)

http://www.tripdatabase.com/

Guidelines
Evidence Syntheses
 

 US Preventive Services Task Force (USPSTF)
An independent panel of primary care systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

http://www.ahrq.gov/health-care-information/topics/topic-us-preventive-services-task-force-uspstf.html

Guidelines & Clinical Recommendations on Prevention & Screening

 User's Guide to the Medical Literature

http://jamaevidence.com/resource/520

Tips on Critical Appraisal

Veterans Administration
Another site for guidelines from some really terrific people. We understand that a lot of their work has been applauded by the IOM.

http://www.healthquality.va.gov/

Guidelines

World Family Doctors Caring for People — WONCA Online
Wonca is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. Wonca's short name is World Organization of Family Doctors. They offer a free journal alert service.

http://www.globalfamilydoctor.com

Medical News

Free Journal Alert Service

More really nice sets of EBM links available at...

University of California San Diego BioMedical Library

http://libraries.ucsd.edu/locations/bml/

More...
Dr. Brian Alper's EBM Web Page: A guide of evidence based and clinically relevant websites — Another cool set of links.

http://www.myhq.com/public/a/l/alper/
More...

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