What is Evidence-Based Practice?
Evidence-Based Health Care (EBHC) is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources."
Evidence-Based Practice (EBP) is "clinical practice in which patient management decisions are consistent with the principles of evidence-based heath care. This means that decisions will be, first of all, consistent with the best evidence about the benefits and downsides of the alternative management strategies. Second, decisions will be consistent with the values and preferences of the individual patient."
Critical Appraisal
- Critical Appraisal Skills Program ChecklistsThis set of eight critical appraisal tools are designed to be used when reading research. CASP has appraisal checklists designed for use with Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
- Centre for Evidence-Based Medicine Critical Appraisal ChecklistsCritical appraisal worksheets to help you appraise the reliability, importance and applicability of clinical evidence.
- Duke University's Critical Appraisal ChecklistsA wealth of critical appraisal checklists and resources from Duke University.
- Joanna Briggs Institute Critical Appraisal ToolsJBI’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers.
- EBM & Critical Appraisal Calculations: One Guide to Rule Them AllThis is a great handout created by librarians at the Ruth Lilly Library at Indiana University which lists commonly used EBM & Critical Appraisal calculations.
- MedscapeMedscape is an online portal geared toward physicians and health professionals. Its up-to-the-minute reporting on health research makes it a useful source of information for students and professionals hoping to keep up to date. Clinical guidelines and tools like a drug interaction checker extend its usefulness as a point-of-care resource.
- CEBM: Centre for Evidence-Based MedicineThe Centre for Evidence-Based Medicine aims to develop, teach and promote evidence-based health care through a variety of methods so that all healthcare professionals can maintain the highest standards of medicine.
- Duke University's EBP LibGuideDuke has been a leader in EBP instruction. Their LibGuide has many resources for critical appraisal and instructional tips.
- McMaster University's Resources for Evidence-Based PracticeLearn about the core concepts of evidence-based practice and discover resources for developing your skills in EBP.
- EBM TeacherTerry Shaneyfelt, MD, MPH is an Associate Professor in the Department of Medicine at UAB in Birmingham, Alabama. He became interested in EBM while attending the McMaster EBM course in 1999. Since joining the faculty at UAB he has had the privilege of conducting most of the formal EBM educational activities (EBM course, EBM lecture series for residents, journal club). Dr. Shaneyfelt provides OER content and other resources for EBM instruction.
Fast facts for evidence-based practice in nursing : implementing EBP in a nutshell by Call Number: eBookISBN: 9780826194077Publication Date: 2016
Evidence-based management in healthcare : principles, cases, and perspectives by Call Number: eBookISBN: 9781567938722Publication Date: 2017
Beyond evidence-based medicine : clinical pearls from experienced physicians by Call Number: eBookISBN: 9789819944408Publication Date: 2023his textbook assembles the wealth of clinical experiences across multiple medical specialties and offers clinical pearls that will result in better patient care and are highly relevant to daily practice.
Ethics and evidence-based medicine : fallibility and responsibility in clinical science by Call Number: eBookISBN: 9780511061547Publication Date: 2003
Textbook of clinical epidemiology : for medical students by Call Number: eBookISBN: 9789819936229Publication Date: 2023
Problems and pitfalls in medical literature : a practical guide for clinicians by Call Number: eBookISBN: 9783031402951Publication Date: 2023
Principles of research design and drug literature evaluation by Call Number: eBookISBN: 9781260441796Publication Date: 2020
Practical clinical research design and application : a primer for physicians, surgeons, and clinical healthcare professionals by Call Number: eBookISBN: 9783031583803Publication Date: 2024
Pocket Evidence Based Medicine by Call Number: eBookISBN: 9783031194719Publication Date: 2023Discusses every type of study design, from the assessment of diagnostic tests to clinical trials and meta-analysis. The work also introduces readers to novel methods, such as the Bayesian analysis of clinical trials.
Using the Medical Literature in Evidence-Base Practice
How to Use the Medical Literature to Provide Optimal Patient Care
1. Ask: Formulate a structured clinical question using PICO
2. Acquire: Search for and select the best available evidence using the most appropriate resource for the question
3. Appraise: Evaluate the evidence for bias and results
4. Apply: Analyze the results and apply to patient care by considering the risks and outcomes of the evidence
5. Act: Use the evidence by integrating it with clinical expertise and shared decision making with the patient
Clinical Questions & PICO
Before beginning your search of the literature, it's important to understand the difference between background and foreground questions. This will guide you to the correct resource to aid you in answering your question.
Background question: Seek to answer foundational knowledge about a condition, illness, disease, etc.
Foreground question: Seek to answer specific knowledge regarding a clinical decision, usually concerning a specific patient, population, or intervention. According to Guyatt et al. there are 5 types of foreground questions: therapy, harm, differential diagnosis, diagnosis, and prognosis.
- Therapy: determining the effect of interventions on patient-important outcomes (symptoms, function, morbidity, mortality, and costs)
- Harm: ascertaining the effects of potentially harmful agents (including therapies from the first type of question) on patient-important outcomes
- Differential diagnosis: in patients with a particular clinical presentation, establishing the frequency of the underlying disorders
- Diagnosis: establishing the power of a test to differentiate between those with and without a target condition or disease
- Prognosis: estimating a patient's future course
Guyatt, G, Rennie, D, Meade, MO, Cook, DJ. Users' Guide to the Medical Literature: Essentials of Evidence-based Clinical Practice. 3rd ed. New York, NY: McGraw Hill Education, 2015.
Before you can search the literature, it's important that you carefully break down your question into key search terms. Using PICO will guide you in thinking about your question.
Framing the Clinical Question Using PICO
Guyatt, G, Rennie, D, Meade, MO, Cook, DJ. Users" Guide to the Medical Literature: Essentials of Evidence-based Clinical Practice. 3rd ed. New York, NY: McGraw Hill Education, 2015.
Example scenario: A 37-year-old female with Bipolar I Disorder is currently taking olanzapine with a mood stabilizer to manage manic or mixed episodes. The patient is experiencing suboptimal effects from the olanzapine including weight gain and poor satisfaction with the medication. Is it safe and effective to switch from olanzapine to ziprasidone in this patient?
Evidence, Study Designs, & Clinical Tools
In order to make an evidence-based decision in the clinical setting, an awareness of the levels of evidence is essential. Here you'll find the Haynes pyramid which guides you through the reliability of evidence found in the medical literature.
Townsend W; Donovan K; Ginier E; MacEachern M; Mani N. "Integrated "5S" Levels of Organization of Evidence Pyramid". September 2015. (http://hdl.handle.net/2027.42/138965). CC BY 4.0 https://creativecommons.org/licenses/by/4.0/. Adapted from: Haynes RB. Of studies, syntheses, synopses, summaries and systems: the “5S" evolution of services for evidence-based health care decisions. ACP J Club. 2006 Nov-Dec;145(3):A8-9.
Meta-analysis: A systematic review that uses quantitative methods to synthesize and summarize the results.
Systematic Review: The application of strategies that limit bias in the assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. SRs focus on peer-reviewed publications about a specific health problem and use rigorous, standardized methods for selecting and assessing articles.
Randomized Controlled Trial (RCT): An experiment in which subjects in a population are randomly sorted into two or more groups to receive or not receive an experimental preventative or therapeutic procedure or treatment. The two groups' results are then assessed to determine the effectiveness of the treatment.
Controlled Clinical Trial: These experiments are similar to RCTs except that the methods of selecting the groups are non-randomized. These types of studies are more likely to suffer from bias than RCTs.
Observational Study: A type of study in which the researchers compare people who receive an intervention to those who do not. The researchers are not involved in the selection of the population nor the original intervention, but instead compare the records of the patients who had been treated with the intervention to those who had not been treated. Examples of observational studies are cohort and case-control studies.
Case Series: A group or series of case reports involving patients who were given similar treatment. There is no comparison group for case series studies.
(Adapted from CEBM and Dahlgren Memorial Library)
Swanberg SM, Mi M, Engwall K. An integrated, case-based approach to teaching medical students how to locate the best available evidence for
clinical care. MedEdPORTAL. 2017;13:10531. https://doi.org/10.15766/mep_2374-8265.10531
Background Resources
- Access Medicine This link opens in a new windowProvides access to videos, self-assessment, and leading medical textbooks; connects researchers to more than 1,000 diagnoses through Diagnosaurus, which allows students to browse by symptom, disease, or organ system at the point of care.
- Access Pharmacy This link opens in a new windowProvides access to videos, self-assessment, and over 50 leading medical textbooks; enables faculty to create, track, and report their students' progress through a curriculum tool that eases workflow; and allows practicing pharmacists to brush up on their medical knowledge to ensure the best patient outcome.
- UpToDate and UpToDate Anywhere This link opens in a new windowUpToDate is a continuously updated medical resource for clinicians. UpToDate presents a comprehensive synthesis of the evidence on diagnosis, followed by recommendations that can be acted on at the point of care. For off-campus and mobile use you need to create a login. Users must be on campus to create a login, and will be required to use a '.highpoint.edu' email account to complete the registration.
Studies
- PubMed (HPU-specific link) This link opens in a new windowComprises more than 19 million citations for biomedical articles from MEDLINE and life science journals. Citations may include links to full text articles from PubMed Central or publisher websites. Use the Journal Finder icon next to article entries to check for access in HPU Libraries' collection.
- MedlinePlus via NC LIVE This link opens in a new windowBrings together authoritative information from the National Library of Medicine, the National Institutes of Health, and other government agencies and health related organizations. This database also has extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news.
- Clinical Trials This link opens in a new windowClinicalTrials.gov is a web-based resource that provides patients, their family members, health care professionals, researchers, and the public with easy access to information on publicly and privately supported clinical studies on a wide range of diseases and conditions.
- WHO International Clinical Trials Registry PlatformThe Clinical Trials Search Portal provides access to a central database containing the trial registration data sets provided by the registries.