LIS 140

What is “evidencebased medicine?”

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
◦ The integration of individual clinical expertise with the best available external clinical evidence from systematic research.

◦ Initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada.

Sackett, et al. BMJ 1996;312:71-72

Adapted from: Sackett D.L., Rosenberg M.C., Gray J.A., Haynes R.B., Richardson W.S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312, 71-72.

JAMA 1992 “Evidence-based medicine: A new approach to teaching the practice of medicine” “a fundamentally new approach” emphasizing “question formulation, search and retrieval of the best available evidence, and critical appraisal of the study methods to ascertain the validity of results”.

(A) Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992 Nov 4;268(17):2420-5. PMID: 1404801 (http://jama.amaassn.org/cgi/reprint/268/17/2420?ijkey=d3d27e0bf59a836b2ff7923ef06634c6304b1c75&keytype2= tf_ipsecsha)

JAMA 1993 – 2000 series of “Users' Guides to the Medical Literature” presented skills for searching for, appraising, and applying various types of published evidence to medical practice
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systematic reviews knowledge search engines became standard tools for medical literature searching, and knowledge distillation and “push” services developed as a way to compile and disseminate concise reviews of
Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA. 2008 Oct 15;300(15):1814-6. PMID: 18854545 (http://jama.ama-assn.org/cgi/content/full/300/15/1814)

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Asking answerable clinical questions. Searching for the evidence. Critically appraising the evidence for its validity and relevance. Making a decision, by integrating the evidence with your clinicalexpertise and the patient’s values. Evaluating your performance.

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Asking answerable clinical questions.

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Searching for the evidence.

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Critically appraising the evidence for its validity and relevance. Making a decision, by integrating the evidence with your clinical expertise and the patient’s values. Evaluating your performance.


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Patient care Public health Research

 Improving

the quality of patients’ lives…

The four elements of a well-formed clinical question are: 1. Patient or Problem 2. Intervention 3. Comparison intervention (if appropriate) 4. Outcome(s)

Patient / Population / Problem
Hypertension Blood pressure

Intervention / Exposure

Comparison

Outcome

Cocoa Chocolate Flavanoid*

N/A

Reduce Reducing Reduction Lower Lowering

Formulate your PICO question

Try secondary sources

Choose primary database(s)

Combine text words and thesaurus

Filter for the right type of study

“if someone has already searched for and appraised evidence around your question, it makes sense to use that information if possible”

appraisals of the evidence found in response to a clinical question They generally are a one page summary of all the key criteria of a trial evaluation and synthesis of multiple research studies
“law digest”

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

 prompts

you for your clinical question, your search strategy and key information about the study you found;  provides on-line critical appraisal guides for assessing the validity and usefulness of the study;  automates the calculation of clinically useful measures (and their 95% confidence intervals);  helps you formulate clinical "Bottom Lines" from what you've read;

http://www.cebm.net/index.aspx?o=1216

 creates

1-page summaries (CATs) that are easy to store, print, retrieve, and share (as both text and HTML files);  helps you remember when to update each CAT you create;  helps you to teach others how to practice EBM; and  most importantly, looks groovy.
http://www.cebm.net/index.aspx?o=1216

reviews of the evidence around a specific clinical topic findings of studies and systematic reviews are presented as answers to the clinical questions tend to be evidence-driven (telling you what good evidence are for) rather than question driven (telling you what you need to know).

summarize the best quality and most clinically useful recent research from the literature
journals

assessments of the effectiveness and costeffectiveness of health care interventions includes procedures, settings and programmes as well as specific drugs and equipment

A review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from studies that are included in the review (Cochrane Library, Glossary).


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Cayley, Bill, Jr .Introduction to Evidence-Based Medicine. 2011 Clanton, Clista. Evidence-based medicine. 2010 Center for evidence-based medicine: http://www.cebm.net/index.aspx?o=1083