Pediatric Informatics: Computer Applications in Child Health (Health ...

10 Evidence-Based Medicine and Pediatrics 139
time. 41 Another metric that has been used is bibliometric analysis of the Internet
search engine results, using page rank and number of connections (hyperlinks)
to other online documents as indicators of authority (higher rankings in the
search engine results indicate higher authority and quality of information). These
methodologies are being studied more and appear to have value in assessing
quality of information. 42–45
10.6 Bringing Evidence to the Point-of-Care
10.6.1 Incorporation of Evidence
Pediatricians have traditionally been trained that answers to clinical queries often
lie in original research studies. With the Internet, improved searching strategies and
knowledge of EBM, searching is easier, faster, and produces better results. A “5-S”
(5 layer) model 4 of the evolution of evidence incorporation into care systems has
been proposed. In it, evidence can be found in:
Studies:
Evidence begins as research published in the form of original journal
articles. These may be found through MEDLINE (PubMed, http://www.
pubmed.gov) or through commercial indexing services (Ex: EMBASE http://
www.embase.com, Highwire Press http://www.highwire.org). Google Scholar (http://scholar.google.com/) is a World Wide Web search engine that searches
journal articles as well as “peer-reviewed papers, theses, books, abstracts, and
articles, from academic publishers, professional societies, preprint repositories,
universities, and other scholarly organizations.”
Syntheses:
Summaries of research studies and other evidence are published as
systematic reviews. These may be found through MEDLINE (systematic review
subsets and PubMed Clinical Queries: http://www.ncbi.nlm.nih.gov/entrez/query/
static/clinical.shtml) or through the Cochrane Database of Systematic Reviews.
Synopses:
Brief descriptions of original articles and reviews using defined
(and transparent) methods, which may provide enough information to base clinical
actions. These are found in collections of focused articles that look at clinical
problems and questions in a structured manner (Ex: a PICO question answered in
a PICO format). Collections may be found at: the ACP Journal Club (http://www.
acpjc.org/), Evidence-Based Medicine (http://ebm.bmjjournals.com/) and Essential
Evidence Plus (formerly InfoPOEMs, http://www.essentialevidenceplus.com).
Summaries:
Published integration of best available evidence from previous
layers (particularly syntheses) to provide evidence on management options for
a given health problem. These may be found in evidence-based textbooks
(Ex: Moyer VA, Elliott E, Davis RL, Gilbert R, Klassen T, Logan S, Mellis C,
Williams L, eds. Evidence Based Pediatrics and Child Health, 2nd Edition,
London, BMJ Books, 2004; Feldman W. Evidence-Based Pediatrics. Hamilton,