Download EBM

Locating the Best Evidence
at the
MUSM Libraries
Mercer Medical Library
Macon
[email protected]
Health Sciences Library
Memorial University Medical Center
Savannah
[email protected]
What is EBM?
Evidence-based medicine (EBM) is the integration of 3 components:
Patient
Values
EBM
Best Research
Evidence
Clinical
Expertise
Steps in the EBM Process
Formulate a clinical question.
Use EBM resources to find evidence.
Evaluate evidence for validity.
Apply evidence to your patient.
Formulating a Clinical Question
A well-built clinical question has 4
components.
 The mnemonic PICO is useful for
remembering these.

Formulating a Clinical Question
Patient or Population – Sex, age, race? Primary
complaint? Disease History?
Intervention – What do you want to do for them?
Prescribe a drug? Order a test?
Comparison – What alternatives do
you want to compare the intervention to?
Outcome – What do you hope to accomplish,
improve or affect? Relieve or reduce symptoms?
Improve function or improve test scores?
Sample PICO

In elderly patients, are ACE inhibitors
more effective than beta blockers in
controlling high blood pressure and
minimizing adverse effects?
The “Population” is elderly patients, the
“Intervention” is ACE inhibitors, the
“Comparison” is beta blockers, and the
“Outcome” is controlling high blood pressure
and minimizing adverse effects.
Sample PICO

In children with asthma, are inhaled
steroids more likely to result in growth
delay than standard therapy with betaagonists?
The “Population” is children with asthma, the
“Intervention” is inhaled steroids, the
“Comparison” is beta-agonists and the
“Outcome” is growth delay.
Locating the Best Evidence




Medical literature is immense.
Only a small portion is immediately useful in
answering clinical questions.
Literature reports the whole spectrum of the
scientific research process.
Journey from in-vitro studies to double-blind
randomized control trials is called the “pyramid
of evidence.”
Pyramid of Evidence
Levels of Evidence (LOE)

Rules of evidence have been established to
grade evidence according to its strength.

Several dozen of these hierarchies exist.

Some systems comprise three levels and others
eight or more.
Example of Levels of Evidence
A: There is good research-based evidence to
support the recommendation.
B: There is fair research-based evidence to
support the recommendation.
C: The recommendation is based on expert
opinion and panel consensus.
X: There is evidence of harm from this
intervention.
Agency for Healthcare Research and Quality (AHRQ)
Two Ways to Locate Evidence


Foraging – Keeping up with the new
literature and finding information/research
that is relevant
Hunting – Answering a specific well-formed
question in a timely efficient manner to
include at patient point of care