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EBM Resources Toolkit: Scope Notes

An Answerable Clinical Question 

The four elements of the PICO Model provide a way to develop questions that can be answered using research evidence.
 
Patient/Population/Problem Who is your patient and/or what is their medical condition?
Intervention Which main intervention, exposure or action are you considering?
Comparison of intervention What are the main alternatives to compare with the intervention?
Outcomes What do you expect to accomplish, measure, improve or affect? 

*Adapted from: Sackett D., Straus S., Richardson, W., Rosenberg, W., Haynes, R. (2000). Evidence-based medicine: how to practice and teach EBM (2nd ed.). London: Churchill-Livingstone.


 

Choose Best Evidence-Based Resources 

 

Resources Tier I: Clinical Practice Guidelines & Synopses of Syntheses

1. CPG Infobase

CPG Infobase is a database of clinical practice guidelines (CPGs) and related materials that are produced or endorsed in Canada by a national, provincial/territorial or regional medical or health organization, professional society, government agency or expert panel. It offers full text access for more than half of the guidelines. 

  • Subject Scope: Includes all medical specialties. 
  • Authority: All guidelines submitted to CPG Infobase are carefully reviewed by the Canadian Medical Association to ensure that they meet the inclusion criteria. All guidelines must have been developed or reviewed in the last five years (rolling date) and must be endorsed by an authoritative Canadian organization.
  • No. journals / databases covered: Guidelines are submitted directly to CMA for inclusion in the database.
  • Content start date: 5 years back (rolling date)
  • No of items: approximately 1,200 clinical practice guidelines
  • Abstracts for: Less than 50%
  • Online Update Frequency: All guidelines must have been developed or reviewed in the last five years (rolling date)
  • Thesaurus: Yes, MeSH
  • Focus on: Clinical practice guidelines
  • Publisher: Canadian Medical Association

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2. Cochrane Library (CDSR, CENTRAL, DARE)

 
CDSR (Cochrane Database of Systematic Reviews)

Full text of regularly updated systematic reviews of the effects of healthcare. CDSR is produced by the Cochrane Collaboration – an international network of individuals and institutions committed to preparing, maintaining, and disseminating systematic reviews of the effects of health care. 

  • Subject Scope: The effects of healthcare.
  • Authority: The creation of a systematic review for the Cochrane Collaboration is a well established process that strives to produce rigorous, comprehensive and relevant studies. Selection of documents is decided on the basis of highly strict quality criteria. Each collaborative review group - formed by researchers, health care professionals, consumers and others - is registered with the Cochrane Collaboration where it gets support and advice in areas such as the best methodology for creating a valid and precise systematic review.
  • No. journals / databases covered: Searching MEDLINE, EMBASE and other databases
  • Content start date: 1996
  • No of items: 3197 complete reviews. 1744 protocols for reviews
  • Abstracts for: 100% of completed reviews
  • Online Update Frequency: Quarterly
  • Focus on: Treatment (Effectiveness and Appropriateness)
  • Publisher: The Cochrane Collaboration

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CENTRAL (Cochrane Central Register of Controlled Trials)

CENTRAL is a bibliographic database of controlled trials identified by contributors to The Cochrane Collaboration as well as by the producers of MEDLINE and EMBASE. It is part of an international effort to systematically search the world's health care journals and other sources of information, and create an unbiased source of data for systematic reviews.

  • Subject Scope: The effects of healthcare
  • Authority: CENTRAL’s principal aim is to provide an unbiased source of data for systematic reviews. Consequently, "all known controlled trials are included in CENTRAL irrespective of language of publication or where and when the studies were conducted"
  • No. journals / databases covered: Searching MEDLINE, EMBASE and other databases
  • Content start date: 1996
  • No of items: Over 500,000 citations
  • Abstracts for: 100%
  • Online Update Frequency: Quarterly
  • Focus on: Treatment (Effectiveness and Appropriateness)
  • Publisher: The Cochrane Collaboration

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DARE (Database of Abstracts of Reviews of Effects)

DARE is a database of structured abstracts of systematic reviews which have been selected and critically appraised by reviewers at the NHS Centre for Reviews and Dissemination (CRD) in York, UK and by other experts, e.g. from the American College of Physicians’ Journal Club and the journal Evidence-Based Medicine. 

  • Subject Scope: The effects of healthcare
  • Authority: CRD has a policy of using two members of staff to double check both the selection of papers and the production of abstracts. Writers are all researchers with critical appraisal skills and knowledge about systematic reviews. They are members of the CRD’s reviews team, or the Cochrane Heart Group or the Oncology Expert Panel. Abstracts are sent to the authors of each paper who may correct any inaccuracies.
  • No. journals / databases covered: Hand searching 57 journals + regular searching 12 bibliographic databases + scanning grey literature (27) and selected websites (5)
  • Content start date: 1994
  • No of items: Over 6300
  • Abstracts for: Over 4800 structured abstracts
  • Online Update Frequency: Monthly
  • Focus on: Diagnosis, Screening, Treatment
  • Publisher: Centre for Reviews and Dissemination, University of York, U.K.

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3. BMJ Clinical Evidence

A database of questions (summaries) representing nearly every clinical specialty, covering the effects of treatments and interventions. Clinical Evidence's content is driven by questions about commonly encountered or important conditions seen in primary care or ambulatory settings. It describes best available research from systematic reviews and RCTs, and if there is no good evidence it says so. It specifically aims not to make recommendations. 

  • Subject Scope: Common or important conditions seen in primary and hospital care.
  • Authority: To answer each question, contributors search the Cochrane Library, MEDLINE, EMBASE and, occasionally, other electronic databases. They appraise the evidence and summrize it. Summaries are then "peer reviewed by the section advisors, by at least two external clinicians, and by an editorial committee, including external clinicians and epidemiologists. The revised text is then extensively edited by editors with clinical and epidemiological training, and data are checked against the original study reports" (BMJ Clinical Evidence, 2017)
  • No. journals / databases covered: Searching Cochrane, MEDLINE, EMBASE, ACP Journal Club and other.
  • Content start date: 1999
  • No of items: 240 medical conditions
  • Online Update Frequency: Annually
  • Focus on: Prevention, Treatment (Advantages and Disadvantages)
  • Publisher: BMJ Publishing Group

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4. ACP Journal Club

ACP Journal Club surveys over 100 peer-reviewed medical journals to produce summaries of original studies and systematic reviews of importance for the internist or sub-specialist physician. "Succinct, accurate, and authoritative, ACP Journal Club offers busy physicians a convenient and cost-efficient way to be informed of vital clinical data" (ACP Journal Club, 2017)

  • Subject Scope: Internal Medicine (and its specialties), Family Medicine
  • Authority: ACP Journal Club's content is "carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, followed by assessment of relevance to medical practice by clinical specialists".
  • No. journals / databases covered: over 130 journals (incl.CDSR)
  • Content start date: 1991
  • Abstracts for: 100% 
  • Online Update Frequency: Bimonthly
  • Focus on: Clinical prediction guides, Continuing education, Diagnosis, Economics, Etiology, Prevention, Prognosis, Quality improvement, Treatment
  • Publisher: American College of Physicians (ACP)

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Resources Tier II: Clinical Decision Support Systems & Summaries 

 

1. Lexicomp Online

Lexicomp Online monographs include over 50 fields of information and are designed as a point-of-care drug information resource. Content is added or updated by daily surveillance of FDA and pharmaceutical industry announcements and publications. The clinical research team reviews the latest published literature within key therapeutic areas, coordinating input related to clinical guidelines, consensus statements, and clinical practice. 

  • Subject Scope: Dosings, Warnings, Adverse Reactions, Drug Interactions, Lab and Diagnostic, Poisoning and Toxicology.
  • Authority: Lexicomp Inc. has been a provider of drug information and clinical content since 1978. Content is collected and validated by an in-house team of advanced-degreed pharmacists. All monographs are peer-reviewed by external multidisciplinary groups of clinical reviewers and editors.
  • No. journals / databases covered: drug monographs
  • No of items: 11 databases and 8 clinical modules
  • Online Update Frequency: Daily
  • Focus on: Diagnosis, Drug information, Toxicology, Treatment
  • Publisher: Wolters Kluwer

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2. SumSearch II

SUMSearch 2 is a unique Internet searching system for medical evidence that is of free access on the Web. In answer to a clinician’s query, SUMSearch 2 will select the best Internet sites to search, format the query for each site, execute the search and return a single document where the list of links is organized by breadth of discussion. 

  • Subject Scope: The effects of health care, Life sciences (relating to medicine) Medicine, Nursing, Dentistry, Veterinary medicine, Health care system, and Preclinical sciences
  • Authority: SUMSearch 2 only searches Internet sites that contain evidence written by qualified professionals. Most of the links come from the National Library of Medicine, (from USA), the Database of Abstracts of Reviews of Effects (DARE), and the National Guideline Clearinghouse (from USA). It also queries the Merck Manual, the Canadian Taskforce on Preventive Health Care, the US Food and Drug Administration and a few other sites.
  • No. journals / databases covered: searching MEDLINE, DARE, National Guidelines Clearing House and other.
  • Thesaurus: Yes MeSH when searching PubMed
  • Focus on: North American coverage. Those of the sites it searches
  • Publisher: University of Texas Health Science Center, USA

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3. TRIP Database

Trip Database is a database of links to evidence-based healthcare resources available free on the Internet. 

  • Subject Scope: Life sciences (relating to medicine) Medicine, Nursing, Dentistry, Veterinary medicine, Health care system, and Preclinical sciences
  • Authority: High quality resources that allow unhindered access are selected by the creator of the database and then reviewed by a clinician to check for clinical applicability.
  • No. journals / databases covered: searching PubMed and other free Web sites.
  • Content start date: 1997
  • Online Update Frequency: Monthly
  • Publisher: TRIP Database Ltd.

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4. AccessMedicine

AccessMedicine provides access to the complete text and illustrations from 65 Medical titles, including Harrison’s Principles of Internal Medicine. Provides information necessary to complete evaluations, diagnosis and case management decisions as well as pursuing research, medical education and self assessment.

  • Subject Scope: Internal Medicine (and its specialties)
  • Authority: Updated frequently and expanded continuously by world renowned physicians
  • No. journals / databases covered: 65 medical titles
  • Online Update Frequency: Daily
  • Thesaurus: Yes - MeSH
  • Focus on: Basic science, Pathophysiology, Diagnosis and Treatment
  • Publisher: McGraw-Hill

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5. ClinicalKey

ClinicalKey is an evidence-based, point-of-care tool, designed to provide clinical answers to physicians.

  • Subject Scope: Health care, and Medicine
  • Authority: As a division of Elsevier Health Science, MD Consult is advised by the team of Publishers from the Global Medicine and Surgery unit on appropriate content. The aim being "to secure the most trusted resources for online clinical information for physicians in a given specialty".
  • No. journals / databases covered: Over 500 journals, 800 books, and 9000 videos of surgical procedures and techniques
  • Content start date: 1997
  • Online Update Frequency: Daily
  • Thesaurus: Yes
  • Focus on: Current medical developments, Diagnosis and Treatment
  • Publisher: Elsevier

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6. RxTx

RxTx provides authoritative drug and therapeutic information supported by the Canadian Pharmacists Association. 

  • Subject Scope: Drug and/or therapeutic information 
  • Authority: The therapeutic content is "developed by an editorial team of outstanding physicians and pharmacists from across Canada who have combined their experience and expertise to develop a condition-oriented model that reflects common and accepted practices using an evidence-based approach. This authoritative source of information offers comparative and evaluative information on treatment options for more than 250 common medical conditions, easy-to-use decision algorithms and tables of drug choices. Based on the best available medical evidence and acclaimed by healthcare professionals worldwide" "Each therapeutic topic from Compendium of Therapeutic Choices (CTC) and Compendium for Minor Ailments (CTMA) is written by an expert author and is based on the best available evidence. CPhA employs a rigorous review process to ensure that the information is accurate and unbiased. Content is extensively reviewed and validated by skilled CPhA clinical editors and by external reviewers who are recognized experts (physicians and pharmacists) in their particular clinical area."
  • Focus on: Drugs, Therapy
  • Publisher: The Canadian Pharmacists Association (CPhA)

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7. STAT!Ref

STAT!Ref provides access to select group of healthcare electronic textbooks, including Stedman's Medical Dictionary and EBMcalc, as well as recent Medical News, Evidence Alerts, and nursing podcasts. 

  • Subject Scope: Nursing and Medicine as well as over 50 healthcare disciplines
  • Authority: STAT!Ref offers authoritative evidence-based databases such as ACP Journal Club, ACP Medicine, MedCalc and select titles from a wide variety of publishers and societies. 
  • Publisher: Teton Data Systems

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8. DynaMed Plus

DynaMed Plus is a decision-support tool for the rapid point-of-care delivery of evidence-based guidance to physicians. It is formed by several modules and includes illustrations, tables and supplemental updates.

  • Subject Scope: Specialty content includes Allergy, Cardiology, Critical Care, Dermatology, ENT (Ear, Nose, and Throat), Emergency Medicine, Endocrinology, Gastroenterology, Gynecology, Hematology, Infectious Diseases, Nephrology, Neurology, Obstetrics, Oncology, Orthopedics & Sports Medicine, Pediatrics, Primary Care, , Psychiatry, Pulmonary Medicine, Rheumatology, Surgery, Vascular Medicine
  • Authority: "The DynaMed Editorial Team employs a rigorous editorial process to produce evidence-based topics that physicians rely on...All members of the internal team are trained in DynaMed's evidence-based approach to critical appraisal of the medical literature and are provided with informatics support to systematically survey the medical literature on a daily basis."
  • Online Update Frequency: Daily
  • Focus on: Diagnosis, Treatment
  • Publisher: EBSCO Health

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9. UofT Libraries Catalogue

As an affiliated teaching hospital with the University of Toronto, the Sinai Health System Libraries collection is searchable in the University of Toronto Libraries Catalogue

The UofT Libraries system was ranked as one of the top three in North America next to Harvard and Yale as of 2014, holding "more than 12 million volumes in 341 languages, millions of electronic resources in various forms." Using the catalogue is free but getting full-text articles or books may or may not be free. Consult with your librarian to learn more!

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10. Essential Evidence Plus

Essential Evidence Plus provides summaries (POEMs - Patient-Oriented Evidence that Matters) of most relevant and valid information for clinicians in the primary care setting.

  • Subject Scope: Internal medicine, obstetrics and gynecology, pediatrics, primary care.
  • Authority: Essential Evidence Plus applies very strict rules when selecting research studies to be summarized. Each original article is critically assessed by a board of editors for relevance and validity following the international criteria developed by the Evidence-Based Medicine Working Group. Summaries (POEMs) are written taking into account the board of editor’s comments. All POEMs are reviewed and approved by all editors before their inclusion in the database.
  • No. journals / databases covered: over 100 journals+ searching Cochrane, 738 guideline summaries, 207 clinical decision rules, 1116 diagnostic test calculators, 5-minute Clinical Consult, ICD-9 and other tools.
  • Content start date: 1994
  • No of items: Over 2,400 POEMs
  • Online Update Frequency: 3 times/year + daily e-mail alerts
  • Focus on: Diagnosis and Treatment
  • Publisher: InfoPOEM

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11. Micromedex

A series of peer-reviewed clinical information databases to assist clinicians promote the best clinical practices and help reduce the overall cost of care. It combines authoritative, evidence-based content with flexible technology. The final selection of databases available to the user depends on subscription conditions. 

  • Subject Scope: Clinical toxicology, complementary and alternative medicine, emergency and critical care medicine, industrial hazard risk assessment, and pharmacology.
  • Authority: An international board of over 450 practicing clinicians, toxicologists, and environmental health and safety professionals ensure the full text documents are unbiased, thoroughly researched, evaluated and referenced based on the world’s leading literature. All documents undergo an update cycle, which further ensures continued accuracy and relevance to current practice.
  • No. journals / databases covered: Searching MEDLINE, EMBASE, Cochrane and other databases.
  • No of items: over 30 databases
  • Online Update Frequency: Quarterly
  • Thesaurus: Yes
  • Focus on: Diagnosis, Drug information, Toxicology and Treatment
  • Publisher: The Thomson Corporation

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Back to Tier I


 

Resources Tier III: Bibliographic databases

 

1. EBSCO CINAHL Complete

EBSCO CINAHL Complete is primarily a bibliographic database of nursing and allied health literature. It indexes journal papers, books, books chapters, pamphlets, pamphlet chapters, dissertations, government publications, audiovisuals, software, proceedings, and unpublished material.

  • Subject Scope: The effects of healthcare
  • Authority: N/A
  • No. journals / databases covered: over 1650 journals + audiovisuals, books, dissertations, government publications, pamphlets, software
  • Content start date: 1937.
  • No of items: Over 3.6 million records.
  • Online Update Frequency: Weekly
  • Thesaurus: Yes, CINAHL (it follows MeSH structure)
  • Focus on: Nursing
  • Publisher: EBSCO

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2. Ovid Embase

Ovid EMBASE is a major biomedical and pharmacological database. EMBASE aims to offer access to the "most up-to-date information about medical and drug-related subjects".

  • Subject Scope: Basic biological research, Biomedical engineering and instrumentation, Drug research, Pharmaceutics, Pharmacology, Pharmacoeconomics and Toxicology, Environmental, Occupational and Public health, Forensic science, Health policy and management, Human medicine (clinical and experimental), Psychiatry, Substance dependence and abuse.
  • Authority: Scientific and editorial quality are important factors for journal assessment. Journals should generally be subject to peer review, although some non peer-reviewed serials (e.g. newsletters, see below) on core topics may also be considered. The inclusion of references with journal articles is also taken into consideration as a quality indicator.
  • No. journals / databases covered:  > 5000 journals.
  • Content start date: 1974.
  • No of items: Around 11 million citations
  • Online Update Frequency: Weekly.
  • Thesaurus: Yes, EMTREE (updated annually)
  • Focus on: Drug information, European and African coverage.
  • Publisher: Elsevier Science

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3. Ovid Medline

Ovid MEDLINE provides over 23 million references to journal articles and abstracts in biomedicine, allied health and clinical sciences in approximately 40 languages. 

  • Subject Scope: Life sciences (relating to medicine) Medicine, Nursing, Dentistry, Veterinary medicine, Health care system, and Preclinical sciences
  • Authority: Most journals are selected based on advice received from the Literature Selection Technical Review Committee, a National Institutes of Health (NIH)-chartered advisory committee of external experts. Other journals are assessed by an array of NIH and outside experts or organizations. Scientific merit of the content is the primary consideration for selection.
  • No. journals covered: Over 5,600 journals
  • Content start date: 1946 - present
  • No. of records: 18,000,000+
  • Abstracts for: 79% of citations
  • Online Update Frequency: Weekly
  • Records Added Annually: Approximately 700,000
  • Thesaurus: Yes MeSH (updated annually)
  • Publisher: National Library of Medicine (NLM), USA

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4. PubMed

  • Subject Scope: Life sciences (relating to medicine), Medicine, Nursing, Dentistry, Veterinary medicine, Health care system, Preclinical sciences and other Natural Sciences.
  • Authority: Most journals are selected based on advice received from the Literature Selection Technical Review Committee, a National Institutes of Health (NIH)-chartered advisory committee of external experts. Other journals are assessed by an array of NIH and outside experts or organizations. Scientific merit of the content is the primary consideration for selection.
  • No. journals / databases covered: Over 4600 journals
  • Content start date: 1950 (as OLD MEDLINE)
  • No of items: over 17 million citations
  • Online Update Frequency: Daily
  • Thesaurus: Yes MeSH (updated annually)
  • Focus on: Biomedicine
  • Publisher: U.S. National Library of Medicine (NLM)

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5. PsycINFO

  • Subject Scope: Psychology, Behavioural and Social Sciences 
  • Authority: Experts from the American Psychological Association peer-review the indexed research content
  • No. journals / databases covered: 2,500 journals covered 
  • Content start date: 1597 - present, with comprehensive coverage from the 1880s
  • No of items: 4,238,209 records 
  • Online Update Frequency: Updated twice weekly
  • Publisher: American Psychological Association

 

6. Web of Science

  • Subject Scope: Sciences, social sciences, arts, and humanities
  • Authority: "Content is carefully evaluated and selected, meeting high standards in areas such as impact, influence, timeliness, peer review, and geographic representation. These standards assure users of superior results that cannot be matched by a free search engine or less selective database."
  • No of items: 59 million records
  • Content start date: 1898/01/01 to present
  • Online Update Frequency: Daily
  • Publisher: Thomson Reuters

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Back to Tier II