Evidence-Based Medicine

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John Reazer

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What is EBM?

The "Classic Definition"

"EBM is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research ... thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care".

Sackett DL. Rosenberg WM. Gray JA. Haynes RB. Richardson WS. Evidence based medicine: what it is and what it isn't.BMJ. 312(7023):71-2, 1996

Overview/Tutorials

Introduction to Evidence-Based Practice (Duke University)

This self-paced tutorial will take you through the complete EBM process, emphasizing the elements of a well-built clinical question and the key issues that help determine the validity of evidence.

Centre for Evidence-Based Medicine (Toronto)

The goal of this Website is to help develop, disseminate, and evaluate resources to use in practice and in teaching EBM to undergraduate, postgraduate and continuing education health care professionals.This site, which is produced by Mount Sinai Hospital, University Health Network (Toronto, Canada), also serves as support for the book entitled, Evidence-based Medicine: How to Practice and Teach EBM by David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes. The 3rd edition is available in the Library.

Evidence Based Medicine - Finding the Best Clinical Literature (University of Illinois)

This guide is designed to assist health care professionals and students become effective and efficient users of the medical literature.

The Evolution of Evidence-Based Medicine

This 10 minute video will introduce to the development and key concepts of Evidence-Based Medicine

Suny Downstate Medical Centre Evidence-Based Medicine Tutorial

Work at your own pace through this tutorial.

University of Western Australia Answering Clinical Questions Tutorial

Four modules will help you to answer clinical questions using an EBP approach.

Types of Clinical Questions

Etiology: how to identify causes for disease (including its iatrogenic forms).

Diagnosis: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.

Prognosis: how to estimate our patientâs likely clinical course over time and anticipate likely complications of the disorder.

Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.

Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.

 

FROM: User's Guides to the Medical Literature: essentials of evidence-based clinical practice G. Guyatt et al (eds) New York, 2008.

Ask a Searchable Clinical Question

PICO is a useful tool for asking focused clinical questions.

PICO1.jpg

PICO clarifies the question, determines search concepts and type of study that is most appropriate to answer the question type.

PICO

P.I.C.O. Model for Clinical Questions

 

P

Patient, Population, or Problem

How would I describe a group of patients?

I

Intervention, Prognostic Factor, or Exposure

Which main intervention, prognostic factor,
or exposure am I considering?

C

Comparison or Intervention (if appropriate)

What is the main alternative to compare
with the intervention?

O

Outcome you would like to measure or achieve

What can I hope to accomplish, measure,
improve, or affect?

 

What type of question are you asking?

Diagnosis, Etiology/Harm, Therapy, Prognosis,
Prevention

 

Type of study you want to find

What would be the best study design?


 

Evidence Pyramid

evidence_pyramidsm.jpg

Study Design
Levels of Evidence
Selecting the Resources

Evidence-based practice requires that clinicians search the literature to find answers to their clinical questions. There are literally millions of published reports, journal articles, conference proceedings, and research studies available to clinicians. Choosing the best resource to search is an important decision.

Electronic Textbooks and Libraries
Pre-Appraised Resources
Databases
Video Tutorials of Library Resources
Meta-Search Engines