From The Archives – Ask a Librarian: What are the Key Resources for Clinical Decision Making?

August 9, 2012
Please enjoy this post from the archives dated July 14, 2010

By Aileen McCrillis, MSLIS

Faculty Peer Reviewed

In order to ensure the best-quality healthcare for patients, it is important for clinicians to consult the highest level of evidence to guide them in the decision-making process. As the volume of biomedical literature increases over time, it becomes more and more difficult for the clinician to identify the best evidence.

Many different types of clinical decision-making resources are now available to clinicians through the Internet. For example, Clin-eguide provides guidance statements, which are based upon the highest-level evidence, for common clinical questions. Filtered “secondary” resources, such as ACP’s PIER, synthesize and summarize the published evidence on a variety of topics. Unfiltered “primary” resources, such as PubMed, are biomedical literature databases that include a breadth of information with varying levels of quality. A discriminating eye is required to select the best-quality evidence from unfiltered sources.

Below is a compilation of key online resources that are available—via public Internet sites or through the NYU Health Sciences Libraries collection—that will assist clinicians in finding high-level evidence quickly and efficiently. An expanded version of this guide is available at http://hsl.med.nyu.edu/guide/evidence-based-health-care-resources

American College of Physicians (ACP) Physicians’ Information & Education Resource (PIER)

This online resource provides evidence-based and peer-reviewed clinical guidance for primary care physicians. The guidance statements are rated A, B, or C based on the level of evidence that supports the statement, with a rating of “A” representing the highest level of supporting evidence. In addition, reference citations are rated 1, 2, or 3 according to the type and quality of the study, with a “Level 1” rating representing the highest-quality type of study, such as a randomized control trial. For example, a guidance statement that has an “A” rating would be supported by “Level 1” studies. Available via the NYU Health Sciences Libraries.

Bandolier

Bandolier is an independent journal written about evidence-based healthcare. It offers a clinical “bottom-line” for select topics, as well as summarizing the published evidence. Available online free to the public at http://www.medicine.ox.ac.uk/bandolier.

BMJ Clinical Evidence

This resource summarizes the published evidence for a wide range of pre-selected clinical questions relevant to common, primary, or important preventative and therapeutic interventions. It uses a rigorous peer-review process and its content is continually updated. BMJ Clinical Evidence also highlights gaps in the evidence where little or no quality studies exist. Available via the NYU Health Sciences Libraries.

Clin-eguide

Clin-eguide offers point-of-care clinical decision-making support for disease management and drug therapy, as well as guidance concerning the clinical significance of abnormal laboratory test results. It also includes DDX tools, calculators, and patient hand-outs. Content on the site is systematically researched and continually updated. Available via NYU Health Sciences Libraries.

Cochrane Library

The Cochrane Library contains a collection of databases full of high-quality, independent evidence to inform clinical decision-making. Of particular mention is the Cochrane Database of Systematic Reviews. The Cochrane systematic reviews identify specific interventions for a disease or health problem and then review, appraise, and synthesize as many scientific studies available that concern the subject of interest. The literature reviews are structured and systematic to eliminate bias. These reviews thereby represent the highest level of clinical evidence. Other databases in the Cochrane Library include the Cochrane Central Register of Controlled Trials, Cochrane Methodology Register; Health Technology Assessment Database, and NHS Economic Evaluation Database. Available via the NYU Health Sciences Libraries.

National Guidelines Clearinghouse (NGC)

The NGC is a comprehensive database of evidence-based clinical practice guidelines issued within the past five years from various organizations, such as government agencies, specialty organizations, and professional societies. It includes abstracts about each guideline, as well as the abstracts concerning its development, and contains links to full-text articles that may be available via NYU Health Sciences Libraries. Available online free to the public at http://www.guideline.gov/.

PubMed Clinical Queries

The Clinical Queries tool in PubMed offers a user-friendly approach to evidence-based searching in Medline, the most comprehensive biomedical literature database available today. This basic interface includes specialized filters that enable the searcher to quickly locate the relevant literature on the etiology, prognosis, diagnosis, and therapy of diseases. Clinical Queries also includes a utility for finding systematic reviews and articles concerning medical genetics. The results of each search include abstracts of the relevant articles with links to full-text versions, which may be available via NYU Health Sciences Libraries. Available online free to the public at www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical.

Trip Database

This clinical meta-search engine allows the searcher to quickly find answers to his or her clinical questions by searching multiple “high-quality” information sources, including Clinical Correlations, to find the best evidence available on the Internet. Available online free to the public at http://www.tripdatabase.com/.

Up-to-Date

This site contains concise, peer-reviewed topical summaries that cover the diagnosis and treatment of diseases across all medical specialties. Up-to-Date is a great resource for quick answers to clinical questions. It includes synthesized literature reviews and expert recommendations. The interface is very easy-to-use and is also PDA compatible. Available via the NYU Health Sciences Libraries (on-site access only).

Aileen McCrillis is a Library Associate at NYU Langone Medical Center

Peer review by Neil Shapiro, MD, Editor-in-Chief, Clinical Correlations

Image courtesy of Wikimedia Commons

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