Evidence Based Medicine Principles

Principles of Evidence Based Medicine

• Health care professionals need to base clinical decisions on available evidence
• Evidence-based medicine (EBM) is a method utilizing research evidence, clinical expertise and patient values to solve problems.
• EBM involves formulation of answerable questions, searching for evidence, critical evaluation, determining applicability, and evaluating performance.

Value of EBM

• Improves care quality by identifying effective practices and eliminating ineffective or harmful ones
• It promotes critical thinking, requiring clinicians to assess the clinical interventions
• Demands accuracy and precision of diagnostic tests, and powers of prognostic markers

What is Evidence Based Medicine

• EBM integrates research, expertise, and patient values to make decisions
• It includes lifelong learning to address clinical and healthcare questions.
• EBM acknowledges evolving research, requiring continuous updating of practices

Practicing EBM

• Strive for optimal care through current evidence and patient values
• Personal experience, judgment, skills, and patient preferences matter
• Professionals should develop crucial EBM skills to find, appraise, and incorporate sound scientific evidence

Five-Step EBM Model

• Step 1: Formulate answerable questions to address information needs.
• Step 2: Find best evidence with which to answer the questions.
• Step 3: Critically appraise the evidence for validity and usefulness.
• Step 4: Apply appraisal results in clinical practice.
• Step 5: Evaluate performance of applied evidence.

Formulating a Clinical Question

• Translation of clinical problem into an answerable question can be difficult
• Good clinical questions should be clear, focused, and researchable
• Effective clinical question contain four components (PICO):
  • Patient or problem being addressed
  • Intervention, test, or exposure being considered
  • Comparison intervention, if applicable
  • Outcome(s) of interest

Finding Evidence

• Seeking relevant evidence helps answer questions that may arise
• Overcome traditional obstacles by using secondary sources of reliable summarized evidence like Archimedes, Clinical Evidence, and BestBets
• Utilize online databases for efficient searching, and learn to maximize database searches

Basic Search Principles

• Convert clinical problems into clear answerable questions, ideally in PICO/PIO format
• Generate a relevant keyword list from the clinical question
• Select a reliable bibliographic databases such as the Cochrane Library databases and MEDLINE

Conducting Searches

• Efficient searches combine terms using Boolean operators such as "AND" and "OR"
• PUBMED limits search results by publication type, date, language, or population
• "Clinical queries" in PUBMED filters evidence-based searches within Medline

Appraising Evidence

• Validity, importance, and applicability should be considered
• Critical assessment asks key questions about evidence and relevance to patients
• CASP tools are available for evaluating research of randomized trials, systematic reviews, case-control, and cohort studies

Applying Evidence

• Deciding if evidence applies to a patient requires considering the patient's values and circumstances
• Communicate efficacy and risks to patients or parents
• Decisions to apply evidence depend on costs and treatment availability

Evaluating Performance

• As Strauss and Sackett suggested, one should formulate questions and find good evidence quickly while effectively appraising evidence
• Clinical expertise and patient values need to be integrated with evidence in a way that has a rational effect
• Formal audits can measure the impact on improving patient care

Conclusion

• Aim to improve care integrating research, expertise, and patience preferences
• Five steps include formulating question, searching, critical appraisal , assessing applicability, and evaluating performance