UpToDate | Cochrane Database | ACP Journal Club | PubMed Clinical Queries

Before we look at searching techniques and sample searches for our four key resources, it is helpful to compare what each has to offer, as well as their potential limitations. Many efforts are still underway to develop the “ultimate” EBM literature tool. Ideally, there would be one easy-to-use, reasonably priced comprehensive resource that would provide point-of-need, evidence-based information for clinical decision-making. Until such a resource is developed, it is important to know what is currently available for finding high-quality background and foreground information. Remember to consult the detailed resource table or list of resource links for other possible choices.

UpToDate

Who produces this information?

The UpToDate company (Wellesley, MA) in cooperation with major medical societies and over 3,000 physician authors

What is the primary content of this resource?

UpToDate addresses clinical issues in the form of topic reviews, using relevant evidence from core medical journals and other key resources. Physician authors synthesize and summarize information on their topics and provide specific recommendations. The content is peer-reviewed and updated regularly.

What is the unique value of this resource?

UpToDate provides “concise, practical answers” at the point of care that are evidence-based and peer-reviewed. In addition, searching is clear and straightforward.

What are the limitations of this resource?

UpToDate is primarily of interest to practitioners of adult internal medicine and its subspecialties. Clinicians in other specialty areas will not find much of interest. (note: some new collections, such as Pediatrics, are currently under development)

UpToDate Sample Search

Cochrane Database of Systematic Reviews

Who produces this information?

The Cochrane Database of Systematic Reviews (CDSR) comes from the international Cochrane Collaboration, an organization of over 7000 health professionals, researchers, scientists and consumers from approximately 80 countries. There are 50 Cochrane review groups. Each Cochrane group analyzes focused clinical questions, assessing the best research evidence to analyze the clinical effectiveness of health care interventions. The groups focus on particular conditions, such as stroke, or a family of related conditions, such as infectious diseases.

What is the primary content of this resource?

The highly structured reviews in the CDSR database summarize and synthesize results from the highest quality research studies, usually randomized, controlled trials. The data is compiled and evaluated using well-defined criteria. The results are combined statistically, often using meta-analysis, decreasing the likelihood of bias. Extensive literature searches are conducted to identify relevant studies from the international medical literature. Electronic searches are often supplemented by hand-searching to insure comprehensive retrieval of relevant studies

What is the unique value of this resource?

The Cochrane systematic reviews are a result of clearly defined and rigorous methodologies for identifying, evaluating and summarizing the highest quality research studies. The work of the Cochrane groups is considered the gold standard in the search for the best medical evidence.

What are the limitations of this resource?

There are two significant limitations to the CDSR. The first is that the reviews focus on treatment and prevention only, excluding other areas such as diagnosis, prognosis and etiology. The second issue is the relatively small size of the database and the limited number of topics that are included.

Cochrane Database Sample Search

ACP Journal Club

Who produces this information?

The American College of Physicians (ACP) publishes ACP Journal Club under the editorship of EBM expert Dr. R. Brian Haynes at McMaster University. In addition, an international editorial board that oversees and reviews policy issues.

What is the primary content of this resource?

ACP Journal Club offers enhanced abstracts and expert commentary on selected original studies and systematic reviews “that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine.” Over 100 top journals are reviewed regularly for “the best original and review articles on the cause, course, diagnosis, clinical prediction, prevention, treatment, or economics of medical disorders managed by internists and related subspecialists, and on quality improvement and continuing medical education intervention trials in internal medicine.”

What is the unique value of this resource?

Two features distinguish this resource: pre-selection of key articles of interest to internal medicine practitioners and expert commentary on the clinical usefulness of these selected studies. Another value-added feature of ACP Journal Club is the inclusion of enhanced abstracts that summarize the objectives, methods and results of the studies in a consistent format.

What are the limitations of this resource?

The ACP Journal Club content is heavily focused on adult internal medicine issues, with some limited references to topics in family medicine, pediatrics, psychiatry, obstetrics/gynecology and surgery. Other medical specialty areas are not covered.

ACP Journal Club Sample Search

PubMed Clinical Queries

Who produces this information?

The National Library of Medicine (NLM) compiles the MEDLINE database, which is freely accessible using the PubMed search system. All of the articles included in MEDLINE are not evidence-based. Special search strategies and techniques are needed to filter through the millions of MEDLINE references to find the articles that can be considered the best evidence. The PubMed Clinical Query filters are supplied by NLM but based largely on the work of RB Haynes and his colleagues at McMaster University.

What is the primary content of this resource?

This specialized PubMed feature provides a quick way to use pre-defined filters for selecting the highest quality MEDLINE studies in four areas: therapy, diagnosis, etiology and prognosis. For each of these topic areas, two emphasis categories are available:

	Sensitivity - also known as "recall;" retrieves larger number of articles but probably includes some less relevant hits
	Specificity - also known as "precision;" will retrieve fewer, more relevant articles (search default)

To view the strategies used for processing these clinical query searches, see this table.

Another filter on the Clinical Queries page will quickly search for systematic reviews on your topic. According to NLM, “this strategy is intended to retrieve citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, guidelines, and citations to articles from journals specializing in review studies of value to clinicians.”

What is the unique value of this resource?

The Clinical Query filters provide a quick and easy way to retrieve clinically relevant, methodologically sound and systematically researched articles from the enormous MEDLINE database

What are the limitations of this resource?

The search strategies used for these filters are fairly broad. Depending on your search topic, you may still retrieve large numbers of articles, especially if you select “sensitivity” as your emphasis category.

PubMed Clinical Queries Sample Search