Evidence Based Medicine

Question 1

Define EBM

Answer 1

Application of the best available research to clinical care

Question 2

When is EBM used?

Answer 2

Patients = to make choices

Clinicians = tailor treatment to clinical circumstances, understand individual patient risk-benefit profile

CCGs and hospital trusts = in guidelines and care pathways

NICE and commissioners = to advise which treatments to fund, and understand value for money

Question 3

What are the steps in EBM?

Answer 3

Ask - form answerable clinical questions

Acquire - systematic retrieval of best evidence

Appraise - to determine validity and applicability

Apply - incorporate evidence (in patient-care, development of guidelines, protocol)

Assess - evaluate performance

Question 4

What does PICO stand for?

Answer 4

P patient
I intervention
C comparison
O outcome

Question 5

How do you retrieve the best evidence?

Answer 5

Pre-appraised sources, and national guidelines

If cannot find answer there, then systematic reviews, primary research e.g. Embase, Medline

Refine your search by limits e.g. study deign, time period

Consider hierarchy of evidence

Question 6

What is the hierarchy of evidence?

Answer 6

Question 7

How do you critically appraise evidence?

Answer 7

1) are the results valid?

2) what are the results?

3) is the evidence useful for patient care?