Thinking critically about “the evidence”

As a medical librarian, I spend a lot of time with reports of the evidence — studies, guidelines, systematic reviews — upon which evidence-based practice stands.

Recent postings in Dr. Marya Zilberberg’s Healthcare, etc. highlight the need for critical analysis of “evidence-based guidelines” and the studies from which they are built, particularly as the guidelines become the basis for current practice, reimbursement, and our judgment of what constitutes “good medicine.”


Evidence-based web design

Do any of us still get to write our own library web pages?  Now that the Internet & intranets are mainstream instead of “fringe” the way they were back when libraries first embraced them, my hospital’s IT and marketing departments aren’t so sure they want the library doing its own thing …

Regardless of whether we do it ourselves, or someone else designs and writes pages for us, Six Revision’s article 10 Usability Tips Based on Research Studies presents well-thought-out information to assist in developing websites that are easy to use.  The article debunks some “common knowledge” rules (“3-click rule,”  “above-the-fold rule”) as well as giving pointers on fonts, white space, readability, where to place information on the page, navigation, and getting the small details right.  For each tip, links are provided for sources and further reading.

Thanks to

UpToDate, and Twitter

Laika’s MedLibLog posts an article summarizing a blog-and-twitter discussion of  UpToDate in How Evidence Based Is UpToDate really?

The post presents a variety of opinions, as well as taking a brief look, from an evidence-based point of view, at a study cited on UpToDate’s webpage relating improved patient outcomes to hospitals’ use or non-use of UpToDate. (Laika gives it a grade C: retrospective, observation based, half of the authors are from UpToDate.)

I found the use of Twitter almost as interesting as the topic of the post;  a resource that seems to be more “main-stream” every day. In my town, one can follow the weather and news reporters’ tweets as another stream of information.

via The Krafty Librarian

New JAMA Users Guide

JMLA Case Studies in Health Sciences Librarianship brings to our attention a new series of Users’ Guide articles:  How to use an article about genetic association. The first article provides background information; the second discusses judging the validity of a study; and the third discusses applying results to the care of patients.

Attia J, Ioannidis JP, Thakkinstian A, McEvoy M, Scott RJ, Minelli C, Thompson J, Infante-Rivard C, Guyatt G. How to use an article about genetic association: A: Background concepts. JAMA. 2009 Jan 7;301(1):74-81. PMID: 19126812

Attia J, Ioannidis JP, Thakkinstian A, McEvoy M, Scott RJ, Minelli C, Thompson J, Infante-Rivard C, Guyatt G. How to use an article about genetic association: B: Are the results of the study valid? JAMA. 2009 Jan 14;301(2):191-7. PMID: 19141767

Attia J, Ioannidis JP, Thakkinstian A, McEvoy M, Scott RJ, Minelli C, Thompson J, Infante-Rivard C, Guyatt G. How to use an article about genetic association: C: What are the results and will they help me in caring for my patients? JAMA. 2009 Jan 21;301(3):304-8.

Evidence Based Practice Tutorial for Nurses

I recently learned of an Evidence Based Practice Tutorial for Nurses created by Penn State which I think is definitely worth checking out! It can be accessed free here: This was a collaborative project between the Penn State Libraries and the Department of Nursing at the Penn State Milton S. Hershey Medical Center.

The aim of the tutorial is to walk nurses and nursing students through the 4 steps of EBP: 1) Forming a Clinical Question; 2) Finding the Best Evidence; 3) Appraising Results for Validity and Usefulness; and 4) Applying Findings to Clinical Practice and Evaluating Professional Performance.

In addition to detailed descriptions and examples of these four steps, there is some great additional information. The tutorial provides two clinical examples that participants can work through (worksheets are provided), using the principles and steps of EBP. Users can also learn about the Evidence Triad, Information Resources Pyramid, Appraisal Tools, and EBP Terminology. There is also a list of suggested readings.

This was the ACRL Instruction Section’s PRIMO (Peer-Reviewed Instruction Materials Online) site of the month in June, 2008. An interview with some of the creators of this tutorial is available here.

CINAHL Clinical Queries now available

Press release from EBSCO:

In response to customer feedback, and through collaboration with
McMaster University, the EBSCOhost versions of CINAHL, CINAHL
Plus, CINAHL with Full Text, and CINAHL Plus with Full Text now
offer the ability to employ Clinical Queries as part of any search.

Clinical Queries, designed for clinician use, allow users to limit
searches with specific search strategies, to aid in retrieving
scientifically sound and clinically relevant study reports indexed
in CINAHL databases. Searches can be refined using specific search
strategies designed to produce results in five research areas:

  • Therapy – High Sensitivity
  • Prognosis
  • Review
  • Qualitative
  • Causation (Etiology)

As research may require different emphasis, three strategies are provided for each area.

  • High Sensitivity is the broadest search, to include ALL relevant material. It may also include less relevant materials.
  • High Specificity is the most targeted search to include only the most relevant result set, may miss some relevant materials.
  • Best Balance retrieves the best balance between Sensitivity and Specificity.

Please visit EBSCO’s Support Site ( to learn about all of EBSCO’s products, search among thousands of FAQs, download Flash tutorials, Help Sheets or User Guides, or communicate with EBSCO’s Technical Support Representatives online, via EBSCO’s Support Form, or by telephone:

In the United States and Canada:(800) 758-5995
Outside of the United States and Canada: access code, (800) 3272-6000


Marcie Brown
Technical Communications Manager
EBSCO Publishing
10 Estes Street
Ipswich, MA01938

Clinical Questions

One challenge I’ve faced in developing evidence-based practice classes and tools is coming up with appropriate clinical questions to use for examples.

NLM has a tool to help with this challenge: a databank of clinical questions, at

The ClinicalQuestions Collection is a growing repository of questions that have been collected from healthcare providers in clinical settings across the country. The questions are submitted by investigators who wish to share their data with other researchers. The database stores only questions; it does not contain the answers to these questions. The site does not make judgments about the validity or appropriateness of these questions, but rather serves as a repository of questions for others to study and analyze. We hope that this collaborative process will generate a rich set of varied healthcare provider questions, thereby fostering additional research in this area. 

— About Clinical Questions Collection 

The collection is searchable and browsable.  Search options include limiting by specialty (Internal Medicine, Pediatrics, Family Practice), patient sex or age group, and disease or condition.

Update: In February 2010, I was advised that the link to the database was broken. On checking with the NLM Helpdesk, I’m told that the Lister Hill Center is no longer supporting this database. The Clinical Questions Collection is now archived behind the firewall and no longer available to the public.