Evidence-Based Practice Tutorial
P.I.C.O.
P patient problem, population, or situation
I intervention, including an exposure, a diagnostic test, a prognostic factor, a treatment, a patient perception, and so forth.
C comparison intervention or exposure (also defined very broadly), if relevant.
O outcome(s) of interest, including a time horizon, if relevant.
Evidence Based Medicine Databases
Synthesized resources are a specialized form of secondary literature and focus on critical appraisal of a number of primary resources. They most commonly address clinical topics and appear as systematic reviews, meta-analyses, clinical practice guidelines, critically appraised topics, or decision analysis.
- Cochrane LibraryThe Cochrane Library is an online collection of high-quality, evidence-based resources designed to support healthcare decision-making. It includes several key databases, such as the Cochrane Database of Systematic Reviews (CDSR), which contains systematic reviews on healthcare interventions, and the Cochrane Register of Controlled Trials (CENTRAL), a database of randomized controlled trials (RCTs). The Cochrane Library also provides Cochrane Clinical Answers, which offer concise, evidence-based answers to specific clinical questions. Together, these resources help healthcare professionals, researchers, and policymakers access trustworthy information to inform their practice and decisions.
- DynaMedDynaMed is an evidence-based clinical decision support tool used by healthcare professionals to access up-to-date, reliable information on medical conditions, treatments, and drug information. It provides summaries of the latest research, clinical guidelines, and expert recommendations to help clinicians make informed decisions at the point of care. DynaMed covers a wide range of specialties, including internal medicine, pediatrics, cardiology, and more, making it a valuable resource for doctors, nurses, and other healthcare providers. Updated weekly.
- EBSCOhost WebEBSCOhost Web is an online research platform that provides access to a wide range of academic databases and resources. Users can simultaneously search across multiple databases to find peer-reviewed articles, conduct research, and gather reliable information for academic or professional purposes. Some key databases include Academic Search Premier, CINAHL, Business Source Premier, MEDLINE, ERIC, and PsycINFO, among others. The platform offers advanced search features, citation tools, and full-text access to many resources, making it a comprehensive tool for research in various fields such as business, health, education, social sciences, and more.
- EmbaseEmbase is a biomedical and pharmacological database that provides access to peer-reviewed literature, including journals, conference abstracts, and drug information. It is widely used by researchers and healthcare professionals for evidence-based studies, particularly in pharmacology and clinical trials, and includes international content not always found in other databases like PubMed.
- PubMedPubMed is a free, searchable database maintained by the National Library of Medicine (NLM) at the U.S. National Institutes of Health (NIH). It provides access to a vast collection of biomedical literature, including millions of citations from journals in fields like medicine, life sciences, nursing, dentistry, and health policy. PubMed includes articles, abstracts, and full-text resources related to clinical research, biomedical studies, and healthcare topics. It is widely used by researchers, clinicians, students, and healthcare professionals for accessing peer-reviewed research and staying up-to-date with the latest developments in health and medical fields.
- UpToDate
Peer-reviewed clinical information system supports point-of-care decision making. For assistance on account access, contact Jim Panacio.
Evidence Updates
Register to receive weekly email alerts from trusted providers.
- ClinicalKey Patient EducationIncludes brief overview of clinical topics plus links from professional and government agencies. Major topics available in English and Spanish.
- DynaMedDynaMed is an evidence-based clinical decision support tool used by healthcare professionals to access up-to-date, reliable information on medical conditions, treatments, and drug information. It provides summaries of the latest research, clinical guidelines, and expert recommendations to help clinicians make informed decisions at the point of care. DynaMed covers a wide range of specialties, including internal medicine, pediatrics, cardiology, and more, making it a valuable resource for doctors, nurses, and other healthcare providers. Updated weekly.
- Stat!RefSTAT!Ref is an online medical reference database that provides access to a wide range of clinical and healthcare resources, including textbooks, drug references, guidelines, and other authoritative content. It is widely used by healthcare professionals, students, and researchers to quickly find trusted information on medical conditions, treatments, drugs, and clinical practices. STAT!Ref includes content from well-known medical publishers, offering up-to-date, evidence-based resources for decision-making and learning in the healthcare field.
Levels of Evidence
Levels of Evidence (LOE) correlate to study/publication types. The pyramid represents LOEs and the sheer size of the related literature.
Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. A meta-analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results.
Systematic reviews and meta-analyses are the highest level of evidence followed by the randomized controlled trials. There are only 8000 systematic reviews in the Cochrane database compared to the over 22 million citations indexed in Medline.
Studies are experimental or observational, prospective or retrospective.
See the University of Illinois Research Design - Study Type website for clear descriptions and examples.
Different categories of questions are best answered by different research designs.
Therapy RCT preferred, otherwise: cohort study, case-control study, case series.
Diagnosis Prospective, blind comparison to a reference standard.
Etiology or Harm RCT preferred otherwise: cohort study, case-control study, case series.
Prognosis Cohort study preferred otherwise: case-control study, case series.
Clinial Trials
Phase I trials test an experimental drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase II trials test a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
Phase III trials the experimental study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the experimental drug or treatment to be used safely.
Phase IV trials are post marketing studies to delineate additional information including the drug's risks, benefits, and optimal use.
- Understanding Clinical TrialsNational Institute of Health's registry and results database of federally and privately supported clinical trials conducted in the United States and around the world.
- Clinical Trials Glossaryat ClinicalTrials.gov