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Evidence Based Medicine
Health: Medicine: Education
ABC Health Matters: Getting Evidence-Based Treatment
- Consumer guide to understanding and applying the concepts of evidence-based medicine to treatment.
Adaptive clinical trial designs in oncology
- Discusses the nature, types, and pros and cons of adaptive designs in oncology trials that use accumulating data to modify the ongoing trial without undermining the integrity and validity of the trial. 
Adaptive Clinical Trials: The Promise and the Caution
- Critically examines the potential benefits and disadvantages of adaptive trial designs, which use accumulating results in the trial to modify the trial's course. 
Adaptive design methods in clinical trials - a review
- A review of adaptive clinical trial design and adpative randomization, examining their impact, challenges, obstacles, and strategies for effective deployment. 
The Added Value of Confidence Intervals
- Argues for the communicative advantage of confidence intervals (CIs) over P values for statistical significance. 
Applying Evidence-Based Medicine in Actual Clinical Practice: Can We Bridge the Gap? A Review of the Literature
- Examines the effect of EBM in changing physicians’ attitude towards clinical guidelines, and describes the facilitators and barriers to implementing those clinical guidelines in clinical practice.  [PDF]
Appraisal Tools for Clinical Practice Guidelines: A Systematic Review
- Systematic review of guideline appraisal tools identifying and comparing existing tools and their relative degrees of validation. 
Appraising Systematic Reviews and Meta-analyses
- Provides criteria to use to critically appraise systematic reviews and meta-analyses, and documents some of the key pitfalls of each. 
Are randomized trials obsolete or more important than ever in the genomic era?
- Given rapid development of new genomic biomarkers, this paper explores whether and how we can make randomized trials more adaptable to a changing landscape, and whether we still need such trials at all. 
BMC Medicine | Full text | Trustworthy guidelines – excellent; customized care tools –
- Examination of how to develop trustworthy clinical practice guidelines that besides examining what is medically best also allow consistency with patients’ priorities, concerns, and preferences, thus delivering customized care at the level of individuals and their families. 
The Care and Feeding of Evidence Based Medicine
- Overview of the precepts of EBM and reflections on some current issues affecting its progress. 
CDR Systematic Reviews: Guidance for Undertaking Reviews in Health Care
- Exceptionally detailed handbook of the procedures necessary to conduct a systematic review. From the authoritative Centre for Reviews and Dissemination (CRD) at the University of York, publisher of DARE (Database of Abstracts of Reviews of Effects).
Centre for Evidence-Based Medicine
- Provides workshops, resources and background information for healthcare professionals, with research tools and educational material to download. Based at Nuffield Department of Clinical Medicine, Oxford.
Class of evidence (CoE): how does it relate to critical appraisal?
- Discussion of study validity and the assessment of different forms of bias. 
Cochrane Library Tutorial
- A twelve part nimated multi-part visual tutorial on the use and search of the Cochrane Library, developed by Oxford University.
- Learn to read clinical papers with confidence with courses on critical appraisal and evidence-based medicine
Developing clinical practice guidelines
- A 'how to' guide to the development of clinical practice guidelines, including synthesis, grading, presentation and the derivation of recommendations. 
Development of evidence-based clinical practice guidelines (CPGs): comparing approaches
- Critical review of six clinical practice guidelines development handbooks.
Ethical concerns about adaptive randomization
- Raises serious questions about the ethical propriety of adaptive designs where the probability of being assigned to one treatment versus its comparator is dependent on emerging data. 
Evaluating Guidelines: A Review of Key Quality Criteria
- A review of guideline-assessing instruments, finding that alongside the comprehensive instruments such as AGREE II and DELBI, rapid-assessment instruments can be convenient tools for gaining a quick impression of the value of a guideline. 
Evaluating the evidence for evidence-based medicine: are randomized clinical trials less flawed than other forms of peer-reviewed medical research?
- Critical review of RCT and non-RCT studies, finding that the implementation of RCT methods and the interpretation of the results can be flawed by poor trial design, observer bias, incentive bias, or simple misinterpretation. 
Evidence Based Calculator
- Free downloadable calculator computing sensitivity and selectivity, control event rates, numbers-needed-to-treat, and other evidence-based factors.
Evidence Based Medicine - Research and Subject Guides
- This guide, tabbed by topic, is designed to assist health care professionals and students become effective and efficient users of the medical literature; includes a resource collection and glossary. From the University of Illinois at Chicago.
Evidence Based Medicine - Talks and Resources
- Collection of fulltext copies of talks about evidence-based medicine.
Evidence Based Medicine and Clinical Practice Guidelines
- Instructional review of the processes required to create and implement an evidence-based clinical practice guideline.  [PDF]
Evidence Based Medicine Information
- A tutorial on basic concepts, including a guide to searching literature and databases. From Thomas Jefferson University, Philadelphia, USA.
Evidence in practice - EBM Part IV
- Fourth of a four-part comprehensive mini-course on Evidence-Based Medicine; covers a sample clinical scenario through the process of the art of formulating answerable clinical questions, finding evidence, critically appraising evidence, and putting evidence into practice.
Evidence-based mapping of design heterogeneity prior to meta-analys
- Demonstrates an assessment of sugar-sweetened beverages and type 2 diabetes as an example to show how the new technique called ‘evidence mapping’ can be used to organize studies and evaluate design heterogeneity prior to meta-analysis. 
- Concise review of the essential concepts and implementation of evidence-based medicine.  [PDF]
Evidence-Based Medicine: A Unified Approach
- Proposes an integration of the two approaches to evidence-based medicine, evidence-based guidelines (EBG) and evidence-based individual decision making (EBID). 
Evidence-based Medicine: Ten Top Things to Know!
- A compact primer on evidence-based medicine, from basic definitions to fundamentals principles, with tips and commentary.  [PDF]
The Evidence-based Practice Center Experience
- Guide to the Evidence-based Practice Center (EPC) program within the Agency for Healthcare Research and Quality (AHRQ). 
Evidence-Based Practice: A Practice Manual
- Details the the basic steps of evidence-based practice and provides signposts to more detailed information and assistance. Compiled by the Evidence-Based Practice Group South East and the Health Service Executive of Ireland. 
Finding Grey Literature Evidence and Assessing for Outcome and Analysis Reporting Biases When Comparing Medical Interventions
- Guidelines for when and how to search, and assess, "grey literature" (typically non-peer-reviewed conference abstracts, books, dissertations, regulatory reports, etc.) when conducting a systematic review or meta-analysis. From Agency for Healthcare Research and Quality (AHRQ). 
Global health: the importance of evidence-based medicine
- Compilation of presentations on how evidence-based medicine in resource-limited settings can be translated into improved health outcomes. 
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
- The advantages of the GRADE system for rating the quality of evidence and strength of recommendations.
GRADE: Grading of Recommendations Assessment, Development and Evaluation
- Comprehensive (74 pp., as downloadable PDF) tutorial on GRADE, the leading consensus approach to grading quality of evidence and strength of recommendations. From McMaster University. [PDF]
A guide to interpreting discordant systematic reviews
- The seminal paper on how to resolve discordance across systematic reviews, from the eminent expert Alejandro Jadad at McMaster University.  [PDF]
Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise
- Compilation of a comprehensive checklist of items linked to the relevant resources and tools that guideline developers should consider. 
The Heart of the Matter of Opinion and Evidence: The Value of Evidence-Based Medicine
- Strong defense of EBM, by reviewing practical examples of conflicting topics that evidence-based medicine has positively clarified to allow providing the best possible patient care. 
The Hierarchy of Evidence: From Unsystematic Clinical Observations to Systematic Reviews
- Summary and critical review of hierarchies of evidence, contrasting the different current approaches and noting their limitations and merits. Chapter from "Neurology: An Evidence-Based Approach".  [PDF]
How to conduct a systematic or evidence-based literature review
- Five-part author's guide to performing systematic reviews; illustrated, with examples. 
How to do a meta-analysis
- Comprehensive guide to the process of conducting meta-analysis: selecting articles, inclusion criteria, effect sizes, practical analysis execution, and estimating publication bias. From the British Psychological Society. [PDF]
How to Do Random Allocation (Randomization)
- Describes and illustrates with practical examples the concept and procedure of random allocation as used in randomized controlled trials/studies (RCTs), including simple, block and stratified randomization. 
I-SPY 2 may change how clinical trials are conducted
- Describes I-SPY, a groundbreaking dynamic adaptive randomization model for accelerating both identification and regulatory approval of effective investigational agents. 
Improving Clinical Trial Efficiency: Thinking outside the Box | 2015 Educational Book | Meeting Libr
- Improving Clinical Trial Efficiency: Thinking outside the Box
Inconsistent selection and definition of local and regional endpoints in breast cancer research
- Review of which locoregional endpoints are used in studies of breast cancer, and how these endpoints and their components are defined. 
Introduction to Evidence Based Medicine
- Slide presentation given to second year medical students on the principles of evidence-based medcine. From the Faculty of Medicine at McGill University (Montreal, Canada). [pdf]
Introduction to Evidence-Based Medicine
- A self-paced tutorial on the principles and processes, designed for healthcare practitioners and students. From the Duke University Medical Center, Durham, USA.
Introduction to Evidence-Based Medicine (EBM)
- A five minute tutorial, with inbuilt self-assessment, from the Boston University Medical Library.
Introduction to Evidence-based Practice
- Provides a summary of the principles, processes, and foundations of evidence-based decision making. Chapter from "Evidence-based Practice Across the Health Professions".  [PDF]
Introduction to Meta Analysis
- Comprehensive guide to conducting a meta-analysis, including a detailed case study (43 pp.).  [PDF]
The Levels of Evidence and their role in Evidence-Based Medicine
- The origin of levels of evidence and their relevance to the EBM, with examples drawn from the field of plastic surgery. 
Meta-analyses: what they can and cannot do
- Critical examination of the pros and caveats about meta-analysis, and how the limitations can be overcome; also includes a illustrative case vignette. From CEB, the Basel Institute for Clinical Epidemiology and Biostatistics. 
Meta-analysis as Evidence: Building a Better Pyramid
- Critically examines the issue of what category of evidence should be placed at the peak of the evidence-based hierarchy/pyramid, either the randomized clinical trial (RCT), or the systematic review with meta-analysis (SR/MA), then outlines how to improve the value of meta-analytic evidence. 
Meta-analysis in medical research
- An introduction to and rationale for meta-analysis, including presentation, interpretation, and biases. 
Meta-analysis: Its strengths and limitations
- Critical examination of key issues of study identification and selection; publication, search and selection bias; results heterogeneity, and data analysis. 
Meta-analysis: pitfalls and hints
- Practical guidelines for minimizing the risk of conducting a mediocre meta-analysis and for supporting researchers to accurately evaluate the published findings. 
- Resources and including evidence-based guidelines for primary care providers . From The Royal Australian College of General Practitioners (RACGP).
Navigating the Maze
- The University of Virginia School of Medicine presents a guide to using web-based medical search engines, with links to the major resources.
The need for caution in interpreting high quality systematic reviews
- Practical lessons on the highly variable quality of systematic reviews themselves, with an illustrative case study showing how different systematic reviews on the same question can arrive at opposite conclusions. 
Observational and interventional study design types; an overview | Biochemia Medica
- Review of the strengths and weaknesses of observational versus interventional study design. 
Observational Evidence and Strength of Evidence Domains: Case Examples
- Demonstrates how observational studies may provide moderate- to (rarely) high-strength evidence in systematic reviews. 
Patterns of ‘leakage’ in the utilisation of clinical guidelines: a systematic review -- Mickan et al
- A systematic review of barriers to guideline implementation through an examination of rates of awareness and agreement and adoption and/or adherence, along with a call for recommendations to improve guideline adherence.
The PICO strategy for the research question construction and evidence search
- How to use the PICO Strategy for the construction of an appropriate research question and review of the literature.
- Interative tips from the Center for Evidence-Based Medicine on formulating clinical questions and conducting critical appraisals, accompanying the text "Evidence-based Medicine: How to Practice and Teach EBM".
Principles of evidence based medicine - EBM Part I
- First of a four-part comprehensive mini-course on Evidence-Based Medicine; covers basic EBM principles and motivation.
Progress in Evidence-Based Medicine
- Assessment of where we stand in evidence-based medicine as of 2008.
Proposal for Standardized Definitions for Efficacy End Points in Adjuvant Breast Cancer Trials: The STEEP System
- Standard definitions for efficacy end points and events in early-stage adjuvant breast cancer clinical trials, from Memorial Sloan Kettering. 
R in Clinical Research
- Presentation on the use of the R statistical package in Evidence-Based Medicine, especially in Clinical Research, intended mainly for, but not limited to, Bio-statisticians, especially those using SAS.
Random Allocation in Controlled Clinical Trials: A Review
- An update on and clarification of various random allocation techniques, especially simple randomization, blocking, stratified random allocation, and minimization, and a critique of non-random approaches. 
The random allocation process: two things you need to know
- Describes the random allocation process, and the associated methods of allocation concealment. 
A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine
- Clinical trial comparing a blended learning (BL) versus didactic learning (DL) approach for teaching EBM, concluding that a multifaceted approach incorporating BL may be best suited for medical students. 
Randomised controlled trials and population-based observational research
- Reviews the distinct roles, occasional tensions, and relative strengths and limitations of RCTs versus population-based observational studies, proposed as complementary forms of research. 
Rating Evidence in Medical Literature
- An overview of several evidence grading systems, including the Oxford Center for Evidence-Based Medicine, the U.S. Preventive Services Task Force, and the journal of the American Academy of Family Physicians. From the AMA Virtual Mentor project. 
Reading And Critically Appraising Systematic Reviews And Meta-Analyses
- The cautions needed in reading and conducting a systematic review, especially strong on sensitivity analysis, meta-regression, sub-group analysis, publication bias and missing data. 
Research Trends in Evidence-Based Medicine: A Joinpoint Regression Analysis of More than 50 Years of Publication Data
- A bibliometric analysis examing the scientific productivity of EBM research and publication trends over decades. 
A review of grading systems for evidence-based guidelines produced by medical specialties
- Compares and evaluates the optimum grading system (SIGN, GRADE, GATE and NSF-LTC) for the type of guideline being developed or question being addressed by a specialist society. 
The Role of Experience in an Evidence-Based Practice
- Drs. Gordon Guyatt and Mark Tonelli participate in this Expert Roundtable Discussion to address how they see the role of expert opinion changing in the evolving framework of what is now considered the outmoded “evidence-based hierarchy” popularized over the past 20 years. 
Statistical Inference by Confidence Intervals: Issues of Interpretation and Utilization
- Argues that confidence intervals are underutilized, and shows that interval estimation is a valuable form of statistical inference with certain advantages over conventional hypothesis testing based on tests of significance. 
Statistical methods for evidence-based medicine: the diagnostic test. Part I
- Part I of a two part series on how to select and interpret diagnostic tests to confirm or exclude a diagnosis, using a full working example. [PDF]
Statistical methods for evidence-based medicine: the diagnostic test. Part II
- Part II of a two part series on how to select and interpret diagnostic tests to confirm or exclude a diagnosis, using a full working example.
The statistical significance of randomized controlled trial results is frequently fragile: a case for a Fragility Index
- Discusses how significant results of many RCTs hinge on very few events, and suggests that reporting the number of events required to make a statistically significant result nonsignificant (the Fragility Index) in RCTs can allow for more informed decisions about the confidence warranted by reported RCT results. 
Survival End Point Reporting in Randomized Cancer Clinical Trials: A Review of Major Journals
- Evaluation of the reporting of survival end points in cancer RCTs. 
Systematic review and meta-analysis methodology
- Detailed exposition of all the critical procedures of conducting SRs and MAs, with invaluable tips and guides, including on the use of the Cochrane automatic SR/MA software tool RevMan.
Systematic Review and Meta-analysis: When One Study Is Just not Enough
- Discusses the strengths and limitations of narrative and systematic reviews and meta-analyses and how to critically appraise them. 
- Essentials of systematic reviews, and a step-by-step guide for how to conduct one. From Library Services of King's College, London.  [PDF]
Systematic Reviews and Meta-analyses
- Exceptional learning resource: a comprehensive (300+ pp. as slides) course on the systematic review process, on their strengths and limitations, with step-by-step guidance, examples and case studies on how to perform a quality systematic review. In six downloadable (as PDFs) lessons, from McGill University.
Systematic reviews and meta-analyses: a step-by-step guide
- Detailed guidance on how to conduct a systematic review or meta-analysis, with accompanying lectures developed by the University of Edinburgh's Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE).
Systematic reviews and meta-analysis of preclinical studies
- Discusses and details the important concept of conducting systematic reviews and meta-analyses for preclinical (in vitro and in vovo) research. 
Teaching Critical Appraisal of Medical Evidence
- Presents three practical methods for actively teaching critical appraisal skills in an evidence-based medicine curriculum. 
Tips for Learners of Evidence-Based Medicine: Measures of Precision
- Explains the use of confidence intervals in testing hypotheses. From the Canadian Medical Association Journal. [English and French]
Tips for Learners of Evidence-Based Medicine: Relative Risk Reduction
- Describes how to estimate a treatment's effectiveness and explains the concepts of risk reduction, and number needed to treat. From the Canadian Medical Association Journal. [English and French]
Tips for Teachers of Evidence-Based Medicine: Adjusting for Prognostic Imbalances (Confounding Variables) in Studies on Therapy or Harm
- Teaching tips on confounding variables and the statistical adjustment for differences in prognostic variables. From the Evidence-Based Medicine Teaching Tips Working Group.
Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability
- Teaching tips on the use of clinical prediction rules in applying evidence consistently in everyday clinical practice. From the Evidence-Based Medicine Teaching Tips Working Group.
Tips for Teachers of Evidence-based Medicine: Making Sense of Diagnostic Test Results Using Likelihood Ratios
- Teaching tips on using likelihood ratios. From the Evidence-Based Medicine Teaching Tips Working Group.
Tips for Teachers of Evidence-Based Medicine: Understanding Odds Ratios and Their Relationship to Risk Ratios
- Discriminates odds from risks, and the nature of an odds ratio as an alternative to a risk ratio. From the Evidence-Based Medicine Teaching Tips Working Group.
Trials and Tribulations of Systematic Reviews and Meta-Analyses
- Guidance on some of the major limitations besetting systematic reviews (including limited datasets, unpublished data, and both statistical and clinical heterogeneity). 
Understanding randomised controlled trials - EBM Part II
- Second of a four-part comprehensive mini-course on Evidence-Based Medicine; covers the purpose, design and different types of RCTs.
Understanding systematic reviews and meta-analysis - EBM Part III
- Third of a four-part comprehensive mini-course on Evidence-Based Medicine; covers the principles, methodology and appraisal of systematic reviews and meta-analyses, including use of odds ratios and relative risks.
Use of Multiple Endpoints and Approval Paths Depicts a Decade of FDA Oncology Drug Approvals
- Explores the historic use of different endpoints, and the associated degree of regulatory flexibility shown, by the FDA to support regular and accelerated approval of cancer drugs. 
The Usefulness of Systematic Reviews of Animal Experiments for the Design of Preclinical and Clinical Studies
- Details how the design, conduct, and analysis of animal experiments may be optimized through the use of systematic reviews. 
What is "quality of evidence" and why is it important to clinicians?
- Reviews multiple alternative systems for rating the quality of evidence and the strength of recommendations.
Worth Adapting? Revisiting the Usefulness of Outcome-Adaptive Randomization
- Describes the potential superiority in well-defined cases of adaptive randomization which allocates more patients to the better treatments as the data accumulates in the trial. 
Evidence based medicine: increasing, not dictating, choice
- A defense of evidence-based medicine from the perspective of women's health concerns. (January 06, 2007)
Evidence-Based Medicine in Iberoamerica: Problems and Possible Solutions
- Discussion of the applicability of evidence-based medicine in Latin American countries. (August 30, 2005)
Evidence-Based Medicine: Useful Tools for Decision Making
- An article from the Medical Journal of Australia explains the basic processes and concepts, with descriptions of common computer-assisted research tools. (January 01, 2001)
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