Evidence Based Medicine

Question 1

What is evidence based medicine?

Answer 1

The conscientious, explicit, judicious and reasonable use of modern, best proof in making decisions about the care of individual patients
- means integrating individual clinical expertise with the best available external clinical evidence from systematic research

Question 2

Key concepts in EBM?

Answer 2

1. Make use of all available information
2. Critically appraise the evidence
3. Apply the evidence to the individual patient and context

Question 3

Uses of EBM?

Answer 3

1. to support clinical decision-making
2. to develop protocols and guidelines
3. to improve healthcare in general
4. to incorporate new evidence in clinical practice

Question 4

The 5 steps of EBM?

Answer 4

1. Formulate the clinical question
2. Systematically search for relevant evidence
3. Critically appraise the evidence
4. Apply the evidence
5. Evaluate performance

Question 5

How to formulate the question?

Answer 5

PICO method
1. Patient - think about age group/ gender/ country or area
2. Intervention - intervention of interest
3. Comparison - golden standard
4. Outcome - outcome that will be changed by the intervention

Question 6

How to search for evidence?

Answer 6

1. Talk to experts / experienced clinicians (expert’s opinion)
2. Read guidelines / textbooks
3. Search online:
   - Search credible websites (and look at their sources)
   - Search online databases (pubmed.gov, EMBASE, MEDLINE)
   - Search (peer-reviewed) scientific journals

Question 7

Rating Levels of evidence?

Answer 7

Level I: Evidence obtained from at least one properly designed randomized controlled trial.
Level II-1: Evidence obtained from well-designed controlled trials without randomization.
Level II-2: Evidence obtained from well-designed cohort studies or case-control studies, preferably from more than one center or research group.
Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Question 8

Evaluation of performance?

Answer 8

Do you ask answerable well formulatedquestionsusing PICO?
Do you search for evidence in the right sources and do you search them the right way?
Do you critically appraise the literature?
Do you integrate research based evidence with your own clinical experience and expertise and the patients’ preferences and implement it into your practice?
If your answer is “yes” to these questions, you’re using EBM!