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University of Pittsburgh Internal Medicine Residency Program
UPMC Montefiore Hospital, N-713,
200 Lothrop Street
Pittsburgh, PA 15213
Phone: 412-692-4942
Fax: 412-692-4944
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Evidence-Based Medicine - Resident Journal Club
Megan Cunnane, MD, MSc Director, Evidence-Based Medicine Curriculum
Welcome to the Evidence-Based Medicine Resident Journal Club website! Evidence-based
Medicine (EBM) is the process of systematically reviewing, appraising, and using clinical
research findings to aid the delivery of optimal care to your patients. This website is a
resource to help you in your learning of EBM concepts while participating in your Resident
Journal Club (RJC) meetings. Below, you will find links to the PGY-2 and PGY-3 EBM curricula,
small group assignments, session topics, and other resources. We hope that you find your RJC
experience a stimulating and rewarding experience. We appreciate any feedback that you may
with regards to the EBM Curriculum or this website. Comments can be emailed to Dr. Megan
Cunnane at cunnanem@upmc.edu.
EBM-RJC Curricular Handouts
|
Page Number |
| Curricular Structure |
1 - 9 |
| Table of Contents |
1 |
| Course Overview |
2 |
| Course Outline |
3-5 |
| Small Group Assignments |
6 |
| Instructions for Resident Presenters |
7-8 |
| Instructions for Small Group Members |
9 |
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| Tools to Assist with Critical Appraisal |
10 - 25 |
| Example CATs |
10 - 13 |
| • Therapy CAT |
10 |
| • Prognosis/Risk CAT |
11 |
| • Harm/Etiology CAT |
12 |
| • Diagnosis CAT |
13 |
| Worksheets |
14 - 24 |
| • Therapy Worksheet |
14-16 |
| • Prognosis/Risk Worksheet |
17-18 |
| • Harm/Etiology Worksheet |
19-21 |
| • Diagnosis Worksheet |
22-24 |
| Other Tools |
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| • Likelihood Ratio Nomogram |
25 |
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| PGY-2 Session Topics for 2008 - 2009 |
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• Session I: An Introduction to Evidence-Based Medicine
o September 8th, 2008 |
26-37 |
• Session II: An Introduction to the Critical Appraisal of Therapy Articles
o October 6th, 2008 |
38-44 |
• Session III: Practicing the Five "A"s with Therapy Articles
o November 10th, 2008 |
45 |
• Session IV: An Introduction to the Critical Appraisal of Prognosis Articles
o December 8th, 2008 |
46-50 |
• Session V: Practicing the Five "A"s with Prognosis Articles
o January 12th, 2009 |
51 |
• Session VI: An Introduction to the Critical Appraisal of Harm Articles
o February 9th, 2009 |
52-59 |
• Session VII: Practicing the Five "A"s with Harm Articles
o March 9th, 2009 |
60 |
• Session VIII: An Introduction to the Critical Appraisal of Diagnosis Articles
o April 13th, 2009 |
61-67 |
• Session IX: Practicing the Five "A"s with Diagnosis Articles
o May 11th, 2009 |
68 |
• Session X: An Introduction to the Critical Appraisal of Systematic Reviews
o June 8th, 2009 |
69-75 |
| |
| References |
76 |
| |
| Entire Document |
1 - 76 |
| PGY-3 Session Topics for 2008 - 2009 |
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• Session I: Reviewing the Basics: Asking an Answerable Clinical Question and the Hierarchy of Evidence
o September 8th, 2008 |
26-28 |
• Session II: Acquiring Evidence: The "5S" Approach
o October 6th, 2008
o Haynes RB. Of studies, syntheses, synopses, and systems: the "5S" evolution of services for finding current best evidence. ACP Journal Club. 145(3):A8-9, 2006 Nov-Dec. (pdf file) |
29-32 |
• Session III: The Fundamentals of Study Design
o November 10th, 2008
o Grimes DA. Schulz KF. An overview of clinical research: the lay of the land. The Lancet. 359(9300):57-61, 2002 Jan 5 (pdf file). |
33-36 |
• Session IV: Randomization and Allocation Concealment
o December 8th, 2008
o K. Schulz, D. Grimes. Generation of allocation sequences in randomised trials: chance, not choice. The Lancet, Volume 359(9305):515-519, 2002 Jul 20 (pdf file). |
37-39 |
• Session V: Intention-to-Treat Analysis
o January 12th, 2009
o Montori VM. Guyatt GH. Intention-to-treat principle. CMAJ Canadian Medical Association Journal. 165(10):1339-41, 2001 Nov 13 (pdf file). |
40-41 |
• Session VI: Blinding and Loss to Follow-up
o February 9th, 2009
o Schulz KF. Grimes DA. Sample size slippages in randomised trials: exclusions and the lost and wayward. The Lancet. 359(9308):781-5, 2002 Mar 2 (pdf file). |
42-45 |
• Session VII: An Introduction to the Critical Appraisal of Systematic Reviews
o March 9th, 2009 |
46-52 |
• Session VIII: Likelihood Ratios
o April 13th, 2009
o Grimes DA. Schulz KF. Refining clinical diagnosis with likelihood ratios. The Lancet. 365(9469):1500-5, 2005 Apr 23-29 (pdf file). |
53-57 |
• Session IX: Case-Control Studies
o May 11th, 2009
o Grimes DA. Schulz KF. Bias and causal associations in observational research. The Lancet. 359(9302):248-52, 2002 Jan 19 (pdf file). |
58-60 |
• Session X: Levels of Evidence and Grades of Recommendation
o June 8th, 2009
o CEBM. Levels of Evidence and Grades of Recommendation. |
61 |
| References |
62 |
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| Entire Document |
1 - 62 |
EBM-RJC Resources
Evidence Resources: Pre-Filtered
| Decision support tools/Point-of-care references |
| Name of reference |
What is it? |
What does it contain? |
Pros |
Cons |
Other comments |
| Clinical Evidence Published by BMJ |
Summary of prevention and treatment of various conditions, based on searches and appraisal of available literature |
Original studies and systematic reviews which editors have found to be clinically relevant and methodologically rigorous
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Reviews only well-designed studies, small, easy to search
Direct link to evidence
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Limited number of conditions reviewed |
Intervention 'categories': beneficial likely to be beneficial trade off benefits/ harms unknown effectiveness unlikely to be beneficial likely to be harmful |
| PIER Physicians' Information and Education Resource Published by ACP pier.acponline.org |
Limited mostly to therapy studies; many relevant therapy questions have not been addressed by systematic reviews (but may still be found in the CCTR) |
Original studies and systematic reviews which editors have found to be clinically relevant and methodologically rigorous |
Reviews only well-designed studies, small, easy to search
Direct link to evidence |
More comprehensive than Clinical Evidence |
Provides grade of recommendation/level of evidence |
| UpToDate University of Pittsburgh hsls website |
Summary of prevention and treatment of various conditions, based on searches of available literature |
Reviews of many relevant topics, usually written by experts, with references to high-quality articles |
Good overview of topic, with full references to many articles |
Literature not appraised for quality
Updated only quarterly
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Easily accessible |
FIRSTConsult Published by Elsevier www.firstconsult.com
or through University of Pittsburgh hsls website |
Summary of prevention and treatment of primary care conditions,based on searches and appraisal of available literature |
Original studies and systematic reviews which editors have found to be clinically relevant and methodologically rigorous |
Evidence combined with "clinical pearls" from clinical experts |
Only primary care topics |
Provides grade of recommendation/level of evidence |
Evidence Resources: Pre-Filtered and Unfiltered
| Synopses of the literature |
| Name of reference |
What is it? |
What does it contain? |
Pros |
Cons |
Other comments |
| Cochrane Database Published by Cochrane Collaboration http://www.cochrane.org or through University of Pittsburgh hsls website |
Database which contains systematic reviews of randomized, controlled trials and observational trials (although these are few) |
Three databases: Cochrane database of systematic reviews (CDSR), Database of Reviews of Effectiveness (DARE), Cochrane Controlled Trials Registry (CCTR) |
Source of rigorous evidence for answering therapy questions (systematic reviews are at the top of the "hierarchy") |
Limited mostly to therapy studies; many relevant therapy questions have not been addressed by systematic reviews (but may still be found in the CCTR) |
CDSR: systematic reviews completed by Cochrane collaborators DARE: systematic reviews completed outside of the collaboration CCTR: list of many randomized controlled trials |
| ACP Journal Club Published by ACP http://www.acpjc.org or through University of Pittsburgh hsls website |
Critical appraisals and summaries of recent literature |
Brief and critical reviews of individual research articles which authors consider to clinically relevant and methodologically rigorous |
Easy to read format Clinical "bottom line"
Expert summary and commentary |
Only select journals considered as source of evidence |
Excellent tool for "keeping up with the literature" that is published in well-known journals
Critical appraisal methods are transparent |
| Unfiltered |
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| MEDLINE through Univesrsity of Pittsburgh hsls website |
Bibliographic database maintained by US National Library of Medicine; contains over 11 million citations |
Wide range of clinical and preclinical studies in the health sciences arena |
Extremely comprehensive |
Extremely comprehensive: can be cumbersome to search
Need to know how to use MeSH terms |
PubMed and Ovid are two different search engines which are used to access MEDLINE;
PubMed is more current than OVID |
Other EBM Resources and Links
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