This guide aims to collect all the best tips, advice and resources to help to locate evidence to support the practice of Evidence Based Medicine (EBM).
Evidence Based Medicine is an approach to forming medical knowledge, based on systematic and unbiased methods of appraising scientific evidence (Source: BestBETs).
Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values (Source: Ebling Library, University of Wisconsin).
The Key Steps in Evidence Based Practice (EBP) (continues in What is EBM?)
Evidence-based practice (EBP) is the inclusive term which the principles of EBM are founded; primarily EBP is based on five well defined steps.
What is PICO
The PICO framework is an effective tool for constructing a well built clinical question.
PICO stands for:
Patient or Problem
Comparison intervention (if appropriate)
A well built clinical question:
From 'Formulate a Clinical Question', The University of Western Australia
Formulating an answerable question using PICO
P - Patient, Population, or Problem How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age, or ethnicity of a patient might be relevant to the diagnosis or treatment of a disease.
I - Intervention, Prognostic Factor, or Exposure Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factors may influence the prognosis of the patient? Age? Co-existing problems? What was the patient exposed to? Asbestos? Cigarette Smoke?
C - Comparison of Intervention (if appropriate) What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Tour clinical question may not always have a specific comparison.
O - Outcome you would like to measure or achieve What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve functions or test scores? (Source: Ebling Library, University of Wisconsin-Madison)
Example of a PICO question
Patient or Problem
Child with frequent, recurrent acute tonsillitis
Tonsillectomy is warranted in children with frequent, recurrent acute tonsillitis
Type of evidence
TRIP database – evidence based guidelines
Cochrane database of systematic reviews (synthesis of randomised controlled trials)
Something not working - report a problem with access.
Formulating your question
Types of studies
Levels of evidence
Evidence Based Nursing - A way of providing nursing care that is guided by the integration of the best available scientific knowledge with nursing expertise. This approach requires nurses to critically assess relevant scientific data or research evidence, and to implement high-quality interventions for their nursing practice. (NLM PubMed MeSH)
The strongest evidence is in the secondary or pre-appraised research.
The 6S model evidence pyramid
The pyramid is divided into levels with the strongest evidence at the top. Systems is not widely used. Begin with Summaries. If you cannot find the information in Summaries continue down the pyramid remembering that the strength of the evidence decreases as you go further down the pyramid.
DiCenso A, Bayley L, Haynes B. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model, ACP J Club. 2009; Vol 151 Issue 3: p1
Synopses of Syntheses
Syntheses (Systematic Reviews)
Synopses of Single Studies
Appraising the evidence
The purpose of critical appraisal is to determine the relevance of the material collected in relation to the clinical question raised. In other words, does the evidence provide the answer to the question raised and how confidently can the evidence be applied to practice? (Source: Cleary- Holdforth J, Leufer T, 2008 ‘Essential elements in developing evidence-based practice' Nursing Standard. 23, 2, 42-46)
Making a decision
Once the evidence has been appraised, and the best available evidence selected, it must be applied to your local situation. How it is applied will depend on its relevance to local conditions. (Source: The University of Newcastle Australia, viewed online 18 February 2011)
Below is a list of questions you may ask to help determine how evidence applies:
Evaluating your performance
To complete the cycle of practising evidence based medicine clinicians should evaluate their own performance, and this fifth step of self evaluation allows clinicians to focus on earlier steps that may need improvement in the future. Clinicians can evaluate their progress at each stage by asking some or all of the following questions:
Straus, E and Sackett D L 1998, ‘Getting research findings into practice Using research findings in clinical practice' BMJ Vol.317 p.339-342)
Johnson, C 2008, ‘Evidence-based practice in 5 simple steps' Journal of Manipulative and Physiological Therapeutics Vol. 31 p.169-170
Evidence-Based Practice, University of Minnesota Libraries, viewed online 18 February 2011
Evaluating evidence-based practice performance – (Article) By Michael L Green (Source: Evidence Based Medicine 2006; Vol. 11; pages. 99-101)
Covidence, Covidence is a core component of Cochrane’s review production toolkit. (requires separate subscription but can get a free trial)
EBM resources, Centre for Evidence-Based Medicine (UK)
Introduction to Evidence-Based Practice Tutorial from Duke University Medical Centre Library and Health Science Library
DiCenso, A, Bayley, L, Haynes, B 2009, Accessing preappraised evidence: fine-turning the 5S model into a 6S model [editorial], ACP J Club, vol. 151, issue 3, pp 1-2.
Greenhalgh, T 2014, How to read a paper: the basics of evidence-based medicine, 5th edn, Chichester, West Sussex, John Wiley & Sons.
Heneghan, C, Badenoch, D 2006, Evidence-based medicine toolkit, 2nd edn, Malden, Massachusetts, BMJ Books/Blackwell Publishing.
Sackett, DL, Rosenberg WMC, Gray, JAM, Haynes, RB, Richardson, WS 1996, Evidence-based medicine: what it is and what it isn’t, BMJ, vol. 312, pp. 71-72.
How to read a paper bmj http://www.bmj.com/about-bmj/resources-readers/publications/how-read-paper
Cochrane handbook http://handbook.cochrane.org/