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Evidence-Based Medicine

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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.

Evidence-Based Medicine Toolbox

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.

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?


 

Formulating the Clinical Question
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.

Practice Guidelines
Electronic Textbooks and Libraries
  • AccessMedicine
    Trusted Content. Instant Answers. Innovative online resource that provides students, residents, clinicians, researchers, and all health professionals with access to more than 50 medical titles from the best minds in medicine, updated content, thousands of images and illustrations, interactive self-assessment, case files, diagnostic tools, a comprehensive search platform, and the ability to download content to a mobile device.
  • ClinicalKey
    Clinical search engine that adapts to any screen size, helping you find fast answers and deep evidence from more than 1,000 full-text reference books, 600 full-text journals, videos, images and more.
Pre-Appraised Resources
  • ACP Journal Club
    The content is carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, flowed by assessment of relevance to medical practice.
  • BMJ Clinical Evidence
    Clinical Evidence describes the best available evidence from systematic review, RCTs, and observational studies when appropriate for assessing the benefits and harms of treatment.
  • DynaMed Plus
    DynaMed Plus is the next-generation clinical reference tool physicians can rely on for fast, easy access to point-of-care decision support. Written by a team of specialized physicians and researchers, content is updated several times daily to include information on the latest evidence-based research, providing practice-changing answers to clinical questions with optimized speed.
  • UpToDate
    Clinical decision support tool designed to answer clinical questions that arise in daily practice. Subscription database with access for UM/JMH authorized users.
Databases
  • Center for Review and Dissemination (DARE)
    Assists decision-makers by identifying and describing systematic reviews and economic evaluations, appraising their quality, and highlighting their relative strengths and weaknesses.
  • Cochrane Library
    A collection of databases that contain different types of high-quality, independently-assessed evidence to inform healthcare decision-making. Includes: Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, Health Technology Assessment Database and NHS Economic Evaluation Database.
  • PubMed Clinical Queries
    Allows you to quickly focus your PubMed search on clinical studies and systematic reviews. Find out more in our online tutorial.
Video Tutorials of Library Resources
Please note:  Micromedex and Isabel are for educational use only.
Meta-Search Engines
  • Trip Database
    The TRIP Database searches across multiple Internet sites for evidence-based content. It covers key medical journals, Cochrane Systematic reviews, clinical guidelines, and other highly relevant sources.
  • SUMSearch
    SUMSearch is a metasearch engine that provides references to answer clinical questions. Simultaneously searches multiple sources of high quality with emphasis on Evidence-Based Medicine