Evidence-Based Medicine Finds a Home on the Internet

Abstract

Evidence-based medicine aids busy clinicians in dealing with the information overload created by thousands of medical publications with extremely variable content. The discipline relies on randomized clinical trials as the basic building block of medical knowledge. The evolution and maturation of evidence-based medicine can be seen in the increasing amount of easily understood information available to clinicians. McMasters University is one of the established homes of evidence-based medicine, and its web site, http://hiru.mcmaster.ca, is perhaps the best place to begin an investigation of evidence-based medicine. According to the McMaster's group, “evidence-based health care promotes the collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments and facilitate cost-effective health care.” The maturity of evidence-based health care can be appreciated by reviewing the broad and deep substance of their projects. The Cancer Care Ontario-Program in Evidence-Based Care brings this topic to oncologic care. The Guidelines Appraisal Project represents an effort to bring health care professionals together to promote the development and use of practice guidelines. The Health Evidence Application and Linkage Network (HEALNet) collaborates with health care decision-makers and other private and public sector partners to facilitate the transfer of its research to users. The McMaster Evidence-Based Practice Center is under contract with the U.S. Agency for Healthcare Research and Quality to make recommendations to governments, professional organizations, and consumers based on cost-effective analysis of health care topics. The GUIDE Project (Gaining a better Understanding of the role the Internet on Decisions based on Evidence) facilitates the identification and anticipation of opportunities and problems created by the rapid growth of the Internet. Systematic Reviews The Canadian Cochrane Network & Centre supports the Cochrane collaboration, an international organization that brings systematic reviews to clinical practice. The Cochrane Collaboration (www.update-software.com/Cochrane/default.HTM) embodies the bulk of practical evidence-based medicine available on the Internet. The Database of Systematic Reviews contains full-text articles reviewing the efficacy of health care. The articles are either systematic reviews or meta-analyses. The abstract section is open to all Internet users, and posts concise abstracts of systematic reviews by reviewers at the NHS Centre for Reviews and Dissemination at the University of York, England. This large collection of clinical abstracts is extremely useful to the active clinician. It is easy to find yourself looking at one abstract after another. The abstracts themselves could be used as handouts to give to a select group of your patients as part of your determining what the patient's preferences are. For example, it may be useful for the patient to see that the side effects of antibiotics almost negate the modest beneficial effect that antibiotics have on bronchitis. Besides allowing the clinician to practice evidence-based medicine, informed patient preference increases the likelihood of achieving high patient satisfaction. The Bandolier site (www.jr2.ox.ac.uk/bandolier) is a British site that originated in 1994 as a print publication to bring evidence-based medicine to general practitioners in Britain. Bandolier scans PubMed and the Cochrane databases for new systematic reviews and meta-analyses, and publishes interesting and sensible reviews. One of the criticisms of evidence-based medicine is that its conclusions can be misapplied if used only in the service of cost-cutting. This site was created as a reaction to societal forces in England, including the National Health Service, that apply medical tenets broadly across patient populations without regard to the uniqueness of individual patients and circumstances. Many will find their skepticism born of experience to be refreshing and the fact that their opinions are based on the science of evidence-based medicine reassuring. BestBETs' BETs (Best Evidence Topics) are produced from the emergency medicine department of Manchester Royal Infirmary, UK. The three hundred articles reviewed on the site (www.bestbets.org) are pertinent to the practice of emergency medicine. The TRIP (Turning Research into Practice) (www.tripdatabase.com) database contains information from 61 sites of high-quality information. A search for bronchitis returns 32 citations. The search returns are sorted into several categories, including evidence-based, query-answering services, peer-reviewed journal, guidelines, eTextbooks, and experimental links to clinical queries on PubMed. Bringing Research to Clinicians The Journal of Family Practice (www.jfampract.com/display_archives.asp?YEAR=POEMs) posts critical evaluations of randomized trials, systematic reviews, and meta-analyses. They have posted 95 reviews known as POEMs (Patient-Oriented Evidence that Matters.) The University of Sheffield's School of Health and related Research's Netting the Evidence (www.shef.ac.uk/˜scharr/ir/netting/net.html) has the most comprehensive set of Internet links related to evidence-based medicine. One of the main goals of evidence-based medicine is to bring good research to clinicians. The Internet provides the perfect medium for the busy clinician to access this information. You will be handsomely rewarded for familiarizing yourself with these sites.Table: Evidence-Based Medicine Sites on the Internet