Evidence-Based Medicine Guidelines collects, summarizes, and updates the core clinical knowledge essential in general practice and ambulatory care. The guidelines also describe the scientific evidence underlying the given recommendations.
EBM Guidelines is the most extensive collection of guidelines for primary care with more than 900 headings. The guidelines have two approaches: problem-based guidelines include a variety of symptoms encountered in primary care, while disease-specific guidelines include even quite rare diseases. Non-invasive primary care techniques and minor surgery as well as inpatient care at non-specialist hospitals are all covered. The guidelines also include procedures that are not commonly carried out in general practice but can be performed there after adequate training. The video library of EBM Guidelines aims at teaching procedure skills.
Despite the extensiveness of the contents, the individual guidelines are concise and easy to read as they have been specifically structured for reading from a computer screen. The hypertext properties of the database make it easy to obtain more detailed information by links to other articles and to scientific evidence supporting the recommendations. The objective of EBM Guidelines is to give the right information by one search term in one minute.
The idea of EBM Guidelines emerged in 1987 from the obvious need for a handbook discussing the diagnosis and treatment of the wide range of diseases and conditions encountered by the general practitioner. The members of the editorial team are experienced, practicing primary care physicians, most of whom also have a Ph.D. degree. They have been trained in the critical appraisal of medical literature. The team works in close cooperation with about 20 specialist coordinators and more than 300 authors. Although the editors draw from the expertise of specialists the guidelines are clearly intended for use in general practice and outpatient departments for unselected patients. According to published studies general practitioners who searched information for a clinical problem from EBM Guidelines found what they were looking for in over 80% of the cases 1.
Since the first electronic version was published in 1989 the contents of the database have been continuously updated. Over the years the guidelines have been extensively reviewed and even rewritten several times to include mounting evidence from clinical studies, comments by external referees, and feedback that has been collected systematically from clinicians who use the database in their daily practice.
There are four updating processes that complement each other: (1) All guidelines are sent to authors and external reviewers every 2 years for systematic updates; (2) The editorial board meets once a month, and at every meeting, one speciality or a group of topics are discussed with 1 - 3 top experts on the field invited to attend; (3) The editorial team produces and updates evidence summaries continuously (see next paragraph), and whenever the evidence summaries give rise to updates to the guidelines, the guidelines are updated; (4) The editorial teams of the translated versions of EBM Guidelines systematically check for updating needs.
Updated parts of the text appear in red colour for a minimum of 6 months after the update was made.
Concise summaries of scientific evidence attached to the individual guidelines are the unique feature of EBM Guidelines. These summaries are based on Cochrane reviews and DARE abstracts from the Cochrane Library as well as on other recent systematic reviews. Furthermore, the Cochrane Library and medical journals are searched specifically for original publications. For a more detailed description on how the evidence is obtained and updated see the article EBM Guidelines evidence summaries EBM Guidelines Evidence Summaries.
Whenever material relevant to topics of primary care appears, a brief summary of this scientific evidence is written. The summary is then graded with a scale from A to D (evidence code, see table below) and a short statement on the level of evidence is added to the summary. Each evidence summary consists of a heading, evidence code, evidence statement, and the actual summary. A comment at the end of the evidence summary indicates the reasons for downgrading or upgrading the quality of evidence, as suggested by the GRADE group http://www.gradeworkinggroup.org/. The evidence summaries are frequently updated. Links to full-text Cochrane reviews from the evidence summaries provide an easy access to the best available evidence in the context of clinical guidelines.
The contents of individual guidelines are reviewed and edited to comply with the relevant evidence, and evidence codes, which also serve as hypertext links to the summaries, are inserted to relevant sites in the guideline text.
| Code | Quality of evidence | Definition |
|---|---|---|
| A | High | Further research is very unlikely to change our confidence in the estimate of effect.
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| B | Moderate | Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
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| C | Low | Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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| D | Very low | Any estimate of effect is very uncertain.
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1) According to GRADE http://www.gradeworkinggroup.org
The evidence summaries allow the clinician to judge how well founded the recommendations are. The summaries are concise and easy to read; however, only few details of the systematic reviews and original publications can be cited. Therefore it is strongly recommended that the users study the full-text Cochrane review or consult original references for more information whenever an evidence summary appears insufficient.
Unfortunately, there is no high-quality evidence for many of the recommendations given in the guidelines, particularly for those concerning diagnosis and non-pharmacological treatment. These recommendations are based on textbooks, review articles, and expert opinion agreed upon by independent referees. Although every effort has been made to ensure that these non-graded recommendations are also practicable and safe, the clinician should be alert and use his own knowledge and judgment in decisions concerning these clinical questions. The evidence code D is mainly used for recommendations concerning important clinical questions with insufficient evidence.
The collection contains high-quality images of all common and many rare dermatological conditions. Images can be retrieved either by searching with a search term, or through links from the guidelines.
The short video clips of EBM Guidelines include procedures that can be performed in primary and ambulatory care, clinical findings, and ultrasonographic examinations.
Audio samples are linked to articles describing some pulmonary diseases and heart murmurs in children Cardiac Murmur in a Child. A sound card and earphones or high-quality loudspeakers are required.
EBM Guidelines also includes calculators and interactive forms, e.g. for peak expiratory flow rate variation Pef Calculator, glomerular filtration rate Gfr Calculator body mass index Bmi and LDL cholesterol Ldl, and AUDIT questionnaire Audit.
In most cases, only one search term will give you all the information you need. The extremely quick retrieval software has been specifically developed for searching from medical databases and presenting the search results logically. The search programme uses a thesaurus based on MeSH and the UMLS (Unified Medical Language System) of the National Library of Medicine.
The programme has been tested and the documentation reviewed by Duodecim Publishing Company Ltd. The company, however, makes no warranty or representation, either express or implied with respect to the programme or the documentation, its quality, performance or fitness for a particular purpose. Duodecim Publishing Company Ltd. does not warrant that the functions contained in the programme will meet your requirements or that the operation of the programme will be uninterrupted or error free. Possible programme defects will be corrected when a new version of the programme is released. As a result the programme and the documentation are licensed "as is", and the licensee is assuming the risk as to its quality and performance.
The licensee acknowledges that the product is intended as a reference source for medical professionals. The information contained in the software includes a significant number of common diseases as well as some rare diseases; however, it should not be considered complete. The variation in the spectrum of diseases between different countries and a number of alternative treatment protocols cannot be covered by the guidelines.
It is therefore crucial that the software be used only as reference material, similar to a textbook or a journal article, and that the software not be given undue weight in diagnostic decision-making. The software should never replace informed medical judgement and diagnosis by a competent licensed physician. The responsibility for all decisions rests solely with the licensee. Furthermore, Duodecim Publishing Company Ltd. has no control over the conditions under which the licensee uses the software, and Duodecim Medical Publications Ltd. therefore does not and cannot warrant any performance or results.