Best evidence: The tip of the information iceberg

Incorporating high-quality evidence into clinical decision making re­quires systematic searching, appraising, and synthesizing of the literature.

Performing these complex and time-consuming tasks on a regular basis is beyond reasonable expectations for busy physicians, so using existing sources of evidence-based information, particularly systematic reviews, is helpful. 

Unlike traditional narrative reviews that are generally written by a few authors who subjectively select literature to comment on a broad topic, systematic reviews tend to be produced by a team that endeavors to search the literature on a narrow clinical question in an unbiased and reproducible manner and analyze the search results according to explicit criteria. 

Two initiatives of note that produce carefully synthesized and appraised systematic reviews are Clinical Evidence from BMJ Publishing Group and the Cochrane Collaboration. Both tend to focus on the benefits and harms of clinical interventions.

Clinical Evidence, created in 1999, summarizes systematic reviews, RCTs, and observational studies, and states the current view on what is known and unknown about specific aspects of disease management. 

Conveniently, patient leaflets on general topics supplement the more precisely focused systematic reviews. Clinical Evidence is both a stand-alone publication as well as a component of BMJ Point of Care. The Cochrane Collaboration, a distinct and independent organization, has been producing the Cochrane Database of Systematic Reviews since 1993. 

The Collaboration is not-for-profit, funded by agencies such as universities, charities, and personal donations. Like Clinical Evidence, Cochrane reviews tend to focus on the risks and benefits of therapeutic interventions. Both of these resources are available for free to all College members at

In addition the College Library offers workshops on identifying and effectively searching high-quality medi­cal evidence, and we are also happy to arrange one-on-one learning sessions with College members. 
—Karen MacDonell, Judy Neill
Librarians/Co-Managers, College of Physicians and Surgeons of BC Library

Karen MacDonell, PhD, MLIS, Judy Neill. Best evidence: The tip of the information iceberg. BCMJ, Vol. 52, No. 9, November, 2010, Page(s) 437 - College Library.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

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