Introduction to Evidence Based Medicine

why does EBM matter

• medical literature rapidly changing

• conflicting medical information from different sources

• skills needed for every practice setting

EBM definition

applying scientific literature to the patient care setting

• incorporates current clinical evidence with professional expertise and patient specific factors to make a decision

• AKA Evidence Based Practice

EBM inclusions

includes

• drug literature evaluation

• incorporation of patient-specific information

• clinical experience to make a clinical decision 

cornerstones of EBM

• best evidence

• patient factors

• clinical expertise

• patient preferences

5 A’s of EBM

1. Ask 

2. Acquire

3. Appraise

4. Apply

5. Assess

5 A’s of EBM — ask

developing a clearly defined answerable question from available information

5 A’s of EBM — acquire

performing a search for the best evidence available

5 A’s of EBM — appraise

appraising the available evidence

5 A’s of EBM — apply

evaluating the available evidence with patient-specific factors

5 A’s of EBM — assess

follow up and evaluating the effectiveness of the first four steps

application of EBM

• therapeutic guideline development

  • America Diabetes Association

• managed care organizations

  • CVS Caremark

  • review scientific evidence to determine what medication

• answering questions regarding complex patients

types of literature

• primary

• secondary 

• tertiary

primary literature

clinical research studies

• RCT

• cohort

• case-control

secondary literature

searchable database allowing for identification of primary or tertiary resources

examples:

• PubMed

• EBSCO

tertiary literature

provide information that has been summarized by an author or editor into a summary of the topic 

examples: 

• textbooks

• review articles

• guidelines

• online application

  • LexiComp

  • Micromedex

anatomy of an article

1. title 

2. abstract

3. introduction

4. methods

5. results

6. discussion

7. conclusion

anatomy of an article — abstract

brief description of the overall study and findings

anatomy of an article — introduction

describes the clinical question and previous evidence leading to this research question

anatomy of an article — methods

• describes the study design

• statistical analysis

anatomy of an article — results

presents the study findings

anatomy of an article — discussion

• describes the findings

• compares to previous studies

• illustrates the clinical importance of the study results

anatomy of an article — conclusion

• brief summary of the impact of the study

anatomy of an article — discussion/conclusion

articles may not have an individual discussion or conclusion section; it can be combined into either a discussion or conclusions section

peer review definition

• process where reviewers provide comments and insight on a submitted article for publication in the journal 

• a reviewer needs qualifications or credentials to review within a journal/topic area

• most scientific journals utilize this process

• newsletters and magazines typically do not utilize this process

why is peer review done

• ensures the article is written clearly

• helps prevent weak or repetitive information from being published

• provides expert opinion and feedback