Evidence-based medicine for the new millennium: Critical appraisal and pragmatic approach.

It is not news that medicine and other health care areas are changing. In recent years, physicians have been confronted with the challenge of the exponential increase in medical knowledge, as approximately two million articles are published annually in close to 23,000 biomedical journals. It is estimated that a general physician has to read 19 articles a day for 365 days each year to keep abreast with his field. 1 The challenge is compounded further by the fact that much of the published knowledge is of controversial value. That paradox set the way for the foundation of the recent concepts of evidence-based medicine (EBM). This has been defined by David L. Sackett, a founder of the EBM movement, as " the judicious use of current best evidence in making decisions about the care of individual patients. " 2 In a recently published article in the Annals of Saudi Medicine, Stewart elegantly introduced the readers to the new approach. 3 This editorial is intended to provide practical guidance for practicing physicians, physicians primarily involved in academic medicine, and also for health care policymakers in how to apply EBM. Searching for evidence traditionally takes the following steps: 1) precisely formulating the question; 2) designing a search strategy; 3) identifying search resources; 4) critically appraising search results; 5) refining the search if dictated; and 6) applying the findings and making a decision about an individual patient or a medical controversy. Computerized databases are the main search resources. MEDLINE, perhaps the most frequently used medical database, contains approximately seven million citations and abstracts from only 4000 journals. 4 This multipurpose database is produced by the US National Library of Medicine. There are also several databases that are MEDLINE-dependent, e.g., Cancerlit, PDQ (oncology-related databases), and EMBASE, which host, in addition to MEDLINE database, many of the pharmaceutical trials. Recently, MEDLINE access became available free of charge for anyone who has access to the Internet through Internet Grateful MED PubMed, though a MEDLINE-dependent database, has unique and indispensable features. PubMed allows searchers to find articles by specifying publication type and also determining the sensitivity and specificity of the search. PubMed also has an advanced search option operated by a powerful search engine developed by McMaster University to permit filtering the literature to optimize retrieval of clinically applicable studies. Other databases are particularly designed to serve EBM. Through a joint effort between the American College of Physicians …