EBM Solutions Evidence-Based Guidelines

Abstract

Brahmi reviews EBM Solutions Evidence-Based Guidelines at www.ebmsolutions.com. EBM Solutions provides access to evidence-based studies for both the patient and the health provider.

EBM Solutions Evidence-Based Guidelines. EBM Solutions, 3401 West End Avenue, Suite 510, Nashville, TN 37203-6893; 615.250.1650; [email protected]; www .ebmsolutions.com; Web or application service provider as part of EBMdesktop or EBMpact; pricing based on number of users.

EBM Solutions provides access to evidence-based studies for both the patient and the health provider. Evidence-based guidelines for more than 100 medical illnesses or conditions (each guideline averages 1,700 citations and 70 evidence grades and references) have been developed by an academic consortium of six leading U.S. medical centers: Duke University Medical Center, Emory University's Woodruff Health Sciences Center, Oregon Health & Science University, Mount Sinai New York University Health, Vanderbilt University School of Medicine, and Washington University School of Medicine. Clinical and consumer versions of each guideline are provided. Updates occur every six months or more frequently as the medical evidence requires.

The user may view both patient and provider screens side by side (dual view) or may select one screen. When signing on, the default guideline is congestive heart failure. Each guideline is organized in the same way: Key Points, EBM Highlights, Decision-Tree, Definition, Significance, Causes, Symptoms & Signs, Screening & Diagnosis, Prevention & Treatment, Complementary/Alternative Medicine, Prognosis, Research Frontiers, References, and About the Author. EBM Highlights includes the figures and tables. Algorithms (decision trees) provide graphical presentations of evaluation and decision management and directly link from the decision tree to the corresponding guideline section. In the References section, "Links to Abstract" takes the user to PubMed. Research Frontiers discusses ongoing research. The guidelines are brief and well written. Language used for the patient view is clear and at the appropriate level. Guideline updates are listed and included at the top of each guideline page. A brief (two screen) noninteractive New User Guided Tour is provided.

The Diets & Weight Loss Guideline (updated 7/11/03) is an excellent example of the value of this service. It critically reviews such popular diet supplements as Metabolife356 and Calorad 2000 as well as compares four popular diets, Dr. Atkins's Diet Revolution, The Zone, Sugar Busters, and The Carbohydrate Addict's Diet and several commercial weight loss services including Jenny Craig and Weight Watchers. Excerpts from the Diets & Weight Loss guideline follow:

Fad diets also lack the physical activity and behavioral therapy components recommended in the Evidence Report for long-term weight control (see Criteria for Healthy WeightLoss Diets and Characteristics of Popular (Fad) Diets) ...

The Atkins' diet, a low-carbohydrate, high-protein, high-fat, ketogenic diet, induces ketosis, a metabolic adaptation to starvation. However, because ketosis can produce mild-to-moderate side effects, ketogenic diets are not recommended for healthy weight loss E (A2). In addition, while the Atkins's diet may promote weight loss and reduce total cholesterol in the short-term, it may promote coronary artery disease over the long-term E (A1).

Most importantly, links to the evidence are indicated by a red capital E, followed by an alphanumeric modifier that indicates the level of evidence. EBM Solutions has adapted the evidence grading of the American College of Chest Physicians. Each treatment or prevention recommendation is followed by a letter grade and a number grade. The letter grade refers to the scientific strength of the study. A letter grage of A indicates the strongest evidence, followed by B and C. The number grade reflects the trade-off between benefits and risks for the recommendation. A grade of 1 suggests that for most patients the benefits clearly outweigh the risks, while a 2 suggests that the trade-off between benefit and harm is not clear for the average patient.

Overall, EBM Solutions is an excellent product that is supported by an academic medical community and strives to provide the best evidence to both patients and health providers.