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Review On Evidence-Based Cancer Medicine
Review On Evidence-Based Cancer Medicine
1
1998 Kluwer Academic Publishers. Primed in the Netherlands.
Key words: continuing education, evidence-based medicine, information retrieval, information technology, Internet, keeping
up-to-date
strategy or moving on to a different database if neces- Knight-Ridder Information, Inc., and HealthGate pro-
sary. Finally, the findings must be applied in a way that vide both online access and access over the Internet.
fits the clinical circumstances of the patient and respects Ovid also provides access to a growing number of full
their wishes. text journal articles. A more complete listing of infor-
mation about CANCERLIT distributors is available at
http://www.graylab.ac.uk/cancernet/400006.html.
Defining the question The majority of these vendors also provide MED-
LINE access. Recently, however, MEDLINE access
The first step for any evidence search is to formulate became available free of charge, for anyone who has
a 'well-built clinical question' [1]. This entails identifying access to the Internet, through PubMed (http://
a question that is important to the patient's well-being, www.ncbi.nlm.nih.gov/PubMed) and Internet Grateful
is interesting to you, and that you are likely to encounter Med (http://igm.nlm.nih.gov). Both services provide
on a regular basis in your practice. (For practical pur- access to all MEDLINE citations as well as the Pre-
poses, it is more efficient and usually better for your MEDLINE database, which includes citations and their
patient if you seek consultants for questions that you abstracts before they have been indexed by the US Na-
seldom address in your practice.) tional Library of Medicine. PubMed also provides links
To be answerable, the question must be specified to a small but growing number of fulltext articles via the
internet home pages of journals. Internet Grateful Med
terns place an asterisk (*) in front of the medical subject all occurrences of a certain series of letters, regardless of
heading. what letters come afterwards. For example, a textword
It is important to note that when the appropriate search using the term 'neoplas:' (the symbols'for " " a r e
subject heading for an article is being chosen, the most used by many, but not all, CANCERLITand MEDLINE
specific index terms available are used. For example, if systems to denote this concept) would retrieve citations
an article is about apples and oranges (and assuming with a variety of terms including 'neoplasm','neoplasms'
that the MeSH vocabulary actually included such edible and 'neoplastic'. Searching using the textwords 'mortality
products), it would be indexed using these terms. Doing or survival' and then combining the results with the
a search using the MeSH term 'fruits' would not retrieve previous search using 'AND' produces a list of about 27
the article because only articles that deal with fruits in citations in the 1994-1997 MEDLINE database. You now
general would be indexed using the term 'fruits'. To find have a manageable list of citations to review.
the article on apples and oranges, the MeSH term 'apple' As an alternative to the textword search, you could
or 'orange' would need to be used, or a special feature of limit the search to meta-analyses, that is, review studies
MEDLINE called 'exploding' could be used. Asking that summarize the evidence across relevant trials. IGM
MEDLINE to 'explode' a term indicates that you want provides a point-and-click feature for 'publication types',
all articles that include that term to be retrieved, along including reports that use meta-analysis. Combining
with all articles that have been indexed using more this term with the first two search terms above retrieves
specific topics. To continue with the food theme, a search eight articles. Three of these reports include meta-anal-
Table I. Guidelines for critical screening of journal articles on clinical research topics."
Random allocation of Clearly identified com- Inception cohort, early in Clearly identified com- Comprehensive search for
patients to comparison parison groups, one being the course of the disorder parison group for those relevant articles
groups free of the disorder and initially free of the at risk of, or having, the
outcome of interest outcome of interest
Outcome measure of Objective or reproducible Objective or reproducible Blinding of observers of Explicit criteria for rating
known or probable clinical diagnostic standard, assessment of clinically outcome to exposure; relevance and merit
importance applied to all participants important outcomes blinding of observers of
exposure to outcome
Hollow-up of at least 80% Blinded assessment of test Follow-up of at least 80% Follow-up of at least 80% Inclusion of all relevant
and diagnostic standard studies
high quality studies. The Cochrane Library is one such one citation is in the 'Abstracts of quality assessed sys-
resource, produced by the Cochrane Collaboration, an tematic reviews', one citation is in the 'Other assessed
international organization that prepares, maintains, and reviews' section, while two citations appear under 'Other
disseminates systematic reviews of randomized trials of reviews'. The first of these is the El-Sayed paper [2].
many health care interventions. The Cochrane Library, Moreover, this version includes an independently pre-
available on CD-ROM from UpDate Software in Ox- pared structured abstract that summarises the method-
ford, is updated quarterly and contains four biblio- ology and results of the review and indicates that the
graphic sections: the Cochrane Database of Systematic meta-analysis has some weaknesses. Nevertheless, the
Reviews (CDSR), the Database of Reviews of Effective- commentary accepts the authors' conclusions that che-
ness (DARE), the Cochrane Controlled Trials Registry motherapy has significantly increased treatment toxicity
(CCTR), and the Cochrane Review Methodology Data- and only improved survival when used concurrently
base (CRMD). CDSR consists of complete reports of with local definitive therapy, but not when used as induc-
Cochrane Collaboration systematic reviews. This section tion treatment.
also lists the protocols for Cochrane systematic reviews
under development. DARE comprises systematic reviews Best evidence
that have been published outside of the Collaboration.
Certain methodological quality criteria have to be met for Another valuable resource for locating high quality
a systematic review to be included in DARE. Unfortu-
A. Are the results of the study valid? Evidence-Based Medicine 12. Haynes RB. The origins and aspirations of ACP Journal Club
Working Group. JAMA 1994; 271: 389-91. (Editorial). ACP J Club 1991; 114: A18.
Jaeschke R, Guyatt GH, Sackett DL. Users'guides to the medical 13. Warren RM, Duffy SW, Bashir S. The value of the second view in
literature. III. How to use an article about a diagnostic test. screening mammography. Br J Radiol 1996; 69: 105-8.
B. What are the results and will they help me in caring for my 14. Wald NJ. Murphy P. Major P et al. UK.CCCR multicentre
patients? Evidence-Based Medicine Working Group. JAMA 1994; controlled trial of one and two view mammograohy in breast
271:703-7. cancer screening. BMJ 1995; 311: 1189-93.
Laupacis A, Wells G, Richardson WS, Tugwell P. Users'guides to 15. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB. Evidence-
the medical literature: V. How to use an article about prognosis. based medicine: What it is and what it isn't. BMJ 1996: 312: 71 2.
Evidence-Based Medicine Working Group. JAMA 1994; 272:
234-7. Received 6 February 1998: accepted 18 February 1998.
Oxman AD, Cook DJ, Guyatt GH. Users' guides to the medical
literature: VI. How to use an overview. Evidence-Based Medicine Correspondence to:
Working Group. JAMA 1994; 272: 1367-71. Dr. R. B. Haynes
10. Haynes RB, Wilczynski N, McKibbon KA et al. Developing Room 3H7. McMaster University Medical Center
optimal search strategies for detecting clinically sound studies in 1200 Main St W
MEDLINE. J Am Med Informatics Assoc 1994; 1. 447-58. Hamilton
n. Wilczynski NL, Walker CJ, McKibbon K.A, Haynes RB. Assess- Ontario L8N 3Z5
ment of methodological search filters in MEDLINE. Proc Canada
ANNU Symp Comp Appl Med Care 1994; 17: 601-5. E-mail: bhaynes(nsfhs.mcmaster.ca