This document discusses evidence-based guidelines and summarizes different types of medical evidence publications from highest to lowest quality. It then presents a clinical scenario about prostate cancer screening and demonstrates how to formulate a question using PICO (Patient, Intervention, Comparison, Outcome). Resources for finding clinical guidelines like PubMed and the National Guidelines Clearinghouse are described. The presentation raises questions about whether clinical information tools should be considered evidence-based medical resources and how to evaluate them.

1. Evidence-Based Guidelines
Lynn Kysh, MLIS
kysh@usc.edu
Information Services Librarian
Norris Medical Library

2. Evidence Pyramid – Publication Types
Evidence-Based
Guidelines
Systematic
Review & Metaanalysis
Higher Quality of Information
Fewer Articles
Randomized Controlled
Trials
Cohort Studies
Case Control Studies
Lower Quality of Information
More Articles
Case Series, Case Reports

3. Agenda
• A note about guidelines
• Clinical Scenario: Prostate Cancer Screening
• Ask
• PICO
• Acquire
• PubMed
• National Guidelines Clearinghouse
• What about clinical information tools?

5. Evidence
(research)
Clinical
expertise
Patient
values

6. Guide to formulate a question
• Problem/Patient
• Intervention
• Comparison (if any)
• Outcome

7. Clinical Scenario
Your patient is a 50 year old African-American
Chief Executive Officer for a Los Angeles company
presents for his executive physical. His friend was
recently diagnosed with prostate cancer and he
wants to know if he should have a digital rectal
examination and/or PSA. How would you
respond?

8. Using PICO
•P
•I
•C
•O
50 y/o African American man
Digital rectal exam or PSA
No screening
Decrease morbidity and mortality related to
prostate cancer

9. Finding guidelines:
Use “Article Type” filter

10. National Guidelines Clearinghouse
• Guidelines Information
• Organization
• Process
• Evidence used
• Disclosures
• Comparison feature

11. But what about clinical information tools?

12. Are these EBM Resources?
• Opinions vary (and that’s
okay!)
• Appraise the information
• Check evidence ratings
• Follow links to evidence
• Check author information

13. Examined from UpToDate &
Dynamed articles on:
• erectile dysfunction
• fibromyalgia
• hypogonadism
• Psoriasis
• rheumatoid arthritis
• Crohn's disease
All articles from the UpToDate articles demonstrated a
conflict of interest. At times, the editor and author would have
a financial relationship with a company whose drug was
mentioned within the article.

14. Agenda
• A note about guidelines
• Clinical Scenario: Prostate Cancer Screening
• Ask
• PICO
• Acquire
• PubMed
• National Guidelines Clearinghouse
• What about clinical information tools?

15. Questions?
Lynn Kysh, MLIS
Information Services Librarian
kysh@usc.edu
(323) 442-1124

16. Thanks!
Lynn Kysh, MLIS
Information Services Librarian
kysh@usc.edu
(323) 442-1124