Practice Evidence Based Medicine - Practice Tips 2

PRACTICE EVIDENCE BASED MEDICINE


Use the Cochrane.org database. The Cochrane initiative was started about 20 years ago with the goal to provide Obstetricians in the UK with the best possible evidence in their field. It has developed into a global movement that fosters evidence based ObGyn by choosing a specific question, searching for available literature, eliminating insufficient studies, analyzing the remaining ones in detail, and summarizing the results. These summaries are available as “abstracts” and they are free on the Cochrane website. If you subscribe to the service you receive the complete analysis, which is not really necessary for everyday work. The Cochrane database is the best available evidence in our field - anywhere.


Use “Pubmed”, the free search engine that gives you access to 12+ million publications of the National Library of Medicine. Use the “limits” feature to customize your searches. To get the web address simply enters “Pubmed” in the Google search engine search field.


Consider a subscription to “UpToDate”, my favorite medical database. Test it with their a free 10-day trial on the net. At $500 for subscription for an individual it is more expensive than “MD Consult”, but definitely worth the money. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search, just great content!. They also have a patient information section, which I recommend to all my patients to avoid them falling prey to weird Internet rumors. Patients appreciate guidance and advice from you in that regard. It is faster to look up things on uptodate than on MD Consult, which at the moment takes quite some time to load. Check your hospital library to see if they have it and if not, ask them to get it.

Uptodate also has a very very nice feature: they have a section on "what is new in....and the section on ObGyn then reports about 10 important developments in the last year. Very nice, easy tool to keep up and make sure you have not missed anything during the last year!

Another alternative, somewhat less expensive, but it has drawbacks – not my favorite. I let my subscription expire last year. It is “MD Consult”, a database of medical information – essentially everything you need. It’s a cooperation of the 4 or 5 largest medical publishers in the country. Costs around $220 a year and is fully searchable. MD Consult gives you 40 standard textbooks including the Gabbe as well as full text articles of the “Clinics of North America” and the Mosby “Year Books” and numerous medical and scientific journals – a great steal from whichever angle you look at it. They also offer decent patient information leaflets, although they are not too well presented, do not have drawings or photos and are a little dry. If you are a customer of PIAM (Physicians Insurance Agency of Massachusetts) it’s free, if you are a member of the Canadian Medical Association it’s free, and if you have links to a major medical center it is possible that they offer it for free to their attendings – ask.

Drawbacks are: takes a looooong time to load, especially if you want to just look at or print out a patient instruction leaflet quickly. Also, their search function is a little clumsy and difficult, unforgiving in terms of spelling errors and just not as easy as we expect after using Google for a while.


Get the book “Clinical Evidence”, which was developed by the BMJ Publishing Group, publishers of the 160 year old “British Medical Journal” – it’s free if you request it from, who would have thought so, United Health. You can register to have the follow-ups sent to you for free too. It is presents pretty bare bones results evidence based medicine, and as such worth having. The book includes a CD with the complete text that you can load onto your computer and use it with full search capabilities.

To obtain book and CD, go to
http://www.clinicalevidence.org/ orWrite to the United Health FoundationWilliam W. McGuire, MDChairman, United Health FoundationMN008-T500 PO Box 1459Minneapolis, MN 55440-1459Or email him under uhfce@uhc.com


Also check out http://cebm.jr2.ox.ac.uk/ ---- the British Centre for Evidence based medicine.
Try the national guideline clearinghouse, guideline.gov.


And of course, google the term “evidence based medicine” and see what you get.