EBM Online. Evidence-Based Medicine (http://ebm.bmjjournals.com/)

Evidence-Based Medicine Online comprises the cumulative contents (from January 2000 onwards) of the bimonthly print edition of Evidence-Based Medicine (EBM). Brian Haynes and Paul Glasziou edit the journal, and the British Medical Journal Publishing Group with the assistance of Stanford University’s Highwire Press publishes it online.

The general purpose of Evidence-Based Medicine is to select from the biomedical literature those articles reporting original studies and systematic reviews that warrant immediate attention by physicians attempting to keep up to date with important advances in general and family practice, internal medicine, surgery, psychiatry, paediatrics, and obstetrics and gynaecology. Members of the editorial staff scan more than 100 general medical and specialist journals on a regular basis to identify the most clinically important and valid research for clinicians. For example, to be selected, therapy studies should be randomised trials with >80% follow up, and diagnostic studies should make an independent, blind comparison of a test with a gold diagnostic standard. EBM also selects primary articles and systematic reviews relating to clinical prediction, aetiology, prognosis, cost effectiveness, and quality improvement. Structured abstracts summarise each article, and experts comment on the study to place its findings in a clinical context. These abstracts often have more methodological details (about allocation concealment, blinding, and funding) than the original articles. Other content includes important editorials that are relevant to the philosophy and practice of evidence-based medicine and Resource Reviews that highlight tools for evidence-based practice.

The same editorial team produces both EBM and ACP Journal Club using the same procedures, but the intended audience of each journal is different. The first is intended for use in Europe by generalists while the second one is intended for use in North America by internists. This difference in target audience explains the differences in content and the overlap: approximately one half of the abstracts in ACP Journal Club are published in EBM. Almost always the editorial and resource corner sections are the same for both publications.

On the EBM website, we can review the table of contents and some featured abstracts and commentaries from each issue of EBM, but the fulltext journal is available online for a subscription fee. For users in countries of low and lower middle income economies, the contents are available for free, a generous feature I applaud.

This website is very user friendly. PDF versions of each article are available allowing storage, printing, and transfer to a personal digital assistant. One can use the “cite-track” feature, which alerts users when content matching certain user-defined criteria becomes available. The search engine is user friendly and is a major strength of the website. The user can enter a word or phrase (if you use a phrase, I’d suggest using quotation marks when typing) or a simple Boolean expression into a query box. Features to narrow the search strategy allow the user to search by citation, authors, and year. Articles are also grouped into intuitive collections for fast access. Users can receive the electronic table of contents for each issue of the journal via email.

This website is a great first step in searching (it yields results more quickly than when searching Medline). Its limited breadth of coverage means it must often be followed by searching on other databases, including PubMed, because of low yield in certain areas (like tropical diseases). EBM does not scan or feature content from journals not published in English, a major area in need of improvement. Except for logistical limitations, there are no reasons why studies of high methodological quality and clinical relevance not published in English should not be featured in the journal. Users will find that limited dialogue in the form of letters exists between readers and the journal. During the evaluation of the page (May 2003) we found only one letter in the past 180 days.

In conclusion, the EBM website is an excellent source of pre-appraised evidence for the practising clinician, providing quick access to high yield material that has a high likelihood of being valid and valuable. The website is user friendly and the added features useful. Evidence-Based Medicine Online is, in 2003, the premier tool to keep up to date.