PREVENTIVE MEDICINE

EBM 1: ACQUIRING EVIDENCE

Dr. Sta. Maria
EBM Moodle Course Book (2020), Activity 1 Discussion PPT (2020)

Acquiring Evidence entails 3 important steps: STEPS IN PERFORMING A LITERATURE SEARCH

Asking a Focused Clinical Question → Searching the Medical Literature →
Step 1: Identify the concepts in the focused clinical question (P, E, O, M)
Retrieving the Medical Literature
• M – Methodology
o Search engines have methodology filters to remove unwanted
ASKING A FOCUSED CLINICAL QUESTION
study designs
(WHAT’S THE CLINICAL PROBLEM?)
o Best to look for the best study design to answer the clinical
CLINICAL QUESTIONS
question (review hierarchy of evidence)
• Need to be framed such that they are:
• The P, E, O, M of the clinical question will serve as the keywords to be
o Answerable by available studies
used in the literature search
o Searchable in available electronic databases
o Will expand or limit the search
Example: Question on Therapy
Continuing the example of diarrhea…
A 7-year-old child was brought by her mother to your clinic due to loose, watery
Population/Patient Pediatric patient with diarrhea (diarrhea)
stools for 2 days. Upon history taking and physical examination the child is having
Exposure Probiotics vs. standard therapy (probiotics)
acute gastroenteritis with mild dehydration. You decided to give the child oral
Outcome Duration of symptoms (duration of symptoms)
rehydration salts and zinc syrup. The mother asked if you can also prescribe
Methodology Systematic review, randomized control trial
probiotics to her child because she heard from her friend that probiotics is good for
patients with diarrhea. Hence you looked for evidence on the effectiveness of
Step 2: Prioritize the concepts from most to least important
probiotics in decreasing the duration of watery diarrhea.
• Need to plan which key concept will be searched first and last
• PEO of the Clinical Scenario • The first key concept may be the most important concept
P (Population/Patient) Pediatric patient with diarrhea o Usually the exposure
E (Exposure) Probiotics vs. standard therapy • There is no hard and fast rule about the ranking
O (Outcome) Duration of symptoms
Continuing the example of diarrhea…
• Writing the focused clinical question: Key Concepts/Words Rank
o Among patients with acute diarrhea (P), how effective is probiotics (E) P Pediatric patient with diarrhea (diarrhea) 3
compared to standard therapy (C) in decreasing the duration of E Probiotics vs. standard therapy (probiotics) 1
symptoms (O)? O Duration of symptoms (duration of symptoms) 4
M Systematic review, randomized control trial 2

SEARCHING THE MEDICAL LITERATURE Step 3: Expand/Limit the search sequentially until you obtain a manageable
(WHAT’S THE LATEST ARTICLE?) number of articles
AVAILABLE SEARCH ENGINES • Combine or exclude each concept using operators (AND, OR, and NOT)
• PubMed, EBSCO, Google Scholar o AND: retrieves results that include all the search terms
o Liked to different electronic medical literature databases: o OR: retrieves results that include at least one of the search terms
▪ Medline o NOT: excludes the retrieval of terms from the search
▪ EMBASE • Combine and exclude terms, or even add new concepts until you find a
▪ Cumulative Index of Nursing and Allied Health Literature manageable number of articles that you can review and choose from
(CINAHL) • Revise the search if necessary or add more keywords to your search
▪ Cochrane Central Register of Controlled Trials (CENTRAL)
Continuing the example of diarrhea…
ARTICLE SEARCH*
• For PubMed:
https://pubmed.ncbi.nlm.nih.gov/help/#how-do-i-search-pubmed

• For Cochrane Library

https://www.wiley.com/network/cochranelibrarytraining

• For EBSCO Host

https://connect.ebsco.com/s/article/Where-can-I-find-tutorials-on-EBSCO-
interfaces?language=en_US
https://www.youtube.com/watch?v=LwdvCs9aFKQ&feature=youtu.be
https://www.youtube.com/watch?v=Cs-t62k4Kss&feature=youtu.be
https://www.youtube.com/watch?v=DjKNxqiuwpY&feature=youtu.be
https://www.youtube.com/watch?v=K56OPY3sbJ8&feature=youtu.be

*These are links to the tutorials for each website

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 RETRIEVING THE MEDICAL LITERATURE
• Choose an article to appraise and apply to the patient
• Remember the hierarchy of evidence
o Choose the best available study to appraise
• Get the full text article
o If the article is not free, contact FEU-NRMF’s librarian to get a copy
within a few days

ADDITIONAL NOTES FROM ACTIVITY 1 DISCUSSION

DIFFERENCES BETWEEN RISK AND PROGNOSITC FACTORS
• Patients, outcomes, and rates are different
Studies about Studies about
Risk Factors Prognostic Factors
Patients Healthy people Sick people
Consequences of disease
Outcomes Onset of disease (death, complications,
disability, suffering)
Relatively frequent events
Low probability events

(ex: several percent of

(ex: yearly rates for the
Rates patients with acute
onset of various diseases
myocardial infarction die
are 1/1,000 to 1/100,000
before leaving the
or less)
hospital)

• Factors may be different

o Variables associated with increased risk are not necessarily the
same as those marking worse prognoses
▪ Ex: the number of well-established risk factors for CVD
(hypertension, smoking, dyslipidemia, diabetes, and family
history of coronary artery disease) is inversely related to the
risk of dying in the hospital after a first myocardial infarction
o Clinicians can often form good estimates of short-term prognosis
from their own personal experience.
o They may be less able to sort out, without the assistance of
research, the various factors that are related to long-term prognosis
or the complex ways in which prognostic factors are related to one
another.

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