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EBM: Research Guide

What is Evidence-Based Medicine (EBM)?


Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values.
Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000

 

Evidence-Based Practice (EBP)

What is Evidence-Based Practice (EBP)?

EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
Sackett D, 1996


EBP differs slightly from EBM, in that it is an umbrella term of sorts; it encompasses evidence-based medicine, evidence-based nursing, evidence-based physical therapy, evidence-based dentistry, etc.

Evidence-Based Nursing (EBN)

What is Evidence-Based Nursing (EBN)?
EBN is 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.

MESH definition

Why Evidence Based Nursing?


Evidence-based nursing is one approach that may enable nurses to manage the explosion of new literature and technology and ultimately may result in improved patient outcomes. Sole reliance on textbooks and expert faculty knowledge does not promote the critical thinking skills needed tosurvive in the current fast paced clinical settings. Evidence based practice allows nurses to enrich their clinical training and experience with up to date research. Learning the skills of evidence based practice allows nurses to search for, assess, and apply the literature to their clinical situations.

The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders. Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature.

 

 
The Evolution of Evidence Based

The lecture provides history, definitions, and general background information that is helpful when first learning about evidence based medicine.


EBM: The Process
What is the Five- step process  More>>>

 

  • Asking Focused Questions
    The translation of uncertainty into an answerable question
  • Finding the Evidence
    Systematic retrieval of the best evidence available
  • Critical Appraisal
    Critical appraisal of evidence for validity, clinical relevance and applicability
  • Making a Decision
    The application of results in practice
  • Evaluating Performance
    Audit and feedback of clinical practice to improve performance
  • Designing Research
  • Designing trials or assessing research design

    Well Built Clinical Question
    Richardson WS, Wilson MC, Nishikawa J, Hayward RSA. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club. Nov-Dec 1995;123;A12

Forming Questions:

Qualitative questions
Aim to discover meaning or gain an understanding of a phenomena. They ask about an individual's or population's experience of certain situations or circumstances

Quantitative Questions: The PICO(T) Model
Aim to discover cause and effect relationships. Grounded in the scientific method, answers to such questions will compare two or more individuals or groups based on differing outcomes associated with exposures or interventions.

A quantitative approach can answer many different types of questions, but all can be formatted by following the PICO(T) Model outlined below:
McMaster University



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

It is a novel approach of allowing users to conduct a focused search based on a structured clinical question. It is the anatomy of a good clinical question. It is a mnemonic that helps one remember the key components of a well-focused question. The question needs to identify the key problem of the patient, what treatment or tests you are considering for the patient, what alternative treatment or tests are being considered (if any) and what is the desired outcome to promote or avoid.

  • P= Patient 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 gender, age or race 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? Or what factor may influence the prognosis of the patient - age, co-existing problems, or previous exposure?
  • C= Comparison:
    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? Your clinical question may not always have a specific comparison.
  • O= Outcome:
    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 function or test scores?
CATmaker More>>>

It is a software tool which helps you create Critically Appraised Topics, or CATs, for the key articles you encounter about Therapy, Diagnosis, Prognosis, Aetiology/Harm and Systematic Reviews of Therapy.

EBM Pyramid: Levels of Evidence More>>>>

Levels of evidence (sometimes called hierarchy of evidence) are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. These decisions gives the "grade (or strength) of recommendation". The systematic review or meta-analysis of randomized controlled trials (RCTs) and evidence-based practice guidelines are considered to be the strongest level of evidence on which to guide practice decisions. (Melnyk, 2004) The weakest level of evidence is the opinion from authorities and/or reports of expert committees.

The following organizations describe levels of evidence:

Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence

Guide to Research Methods: The Evidence Pyramid  

Oxford Centre for Evidence-Based Medicine - Levels of Evidence (March 2009) 

Essential Evidence Plus: Levels of Evidence

 

Glossary


CEBM Glossary
Centre for Evidence-based Medicine


EBP in Summary
  • EBP is a process for making informed clinical decisions
  • EBP is about USING research - not doing it
  • EBP involves clinical reasoning to integrate:
    Clinical experience
    Clients’ preferences
    Highest quality evidence available (both quantitative and qualitative)
Case Studies

 

Databases


 

 

 

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