Evidence Based Medicine

Question 1

Why is evidence based medicine important?

Answer 1

• the purpose of the NHS is to provide the greatest possible improvement of health through the resources available
• best treatment with the least amount of waste
• evidence based medicine is important to achieving this goal

Question 2

What is the Sakett et al definition of EBM?

Answer 2

the conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients

Question 3

What is the Carnwell definition of EBM?

Answer 3

the systematic search for, and appraisal of, best evidence in order to make clinical decisions that might require changes in current practice, while taking into account the individual needs of the patient

Question 4

What does EBM provide to help clinicians make decisions?

Answer 4

• production of evidence through scientific research and review
• production and dissemination of evidence based clinical guidelines
• implementation of evidence based, cost effect practice through education and change management
• evaluation of compliance with practice guidance through clinical audit

Question 5

What are the 3 prinicples of EBM?

Answer 5

1. high quality health care rests on objective and clinically relevant information
2. there is a hierarchy of evidence where some types are stronger than others
3. scientific data alone is not sufficient basis for making clinical decisions about individual patients

Question 6

What can EBM answer questions on?

Answer 6

• the effects of therapy
• the utility of diagnostic tests
• the prognosis of diseases
• the aetiology of disorders

Question 7

What are the benefits of EBM?

Answer 7

• filters literature so decisions are made on strong evidence
• forms part of a process of decision making
• produces expert judgement in format clinicians can understand
• you can use it to decide if the information and results are applicable to your patient

Question 8

What are the cons of EBM?

Answer 8

• EBM has been used for a long time
• EBM identifies significant benefits that might be marginal in clinical practice
• EBM generates a massive volume of evidence and guidelines that are impossible to keep up with
• EBM is the mindless application of population studies to the treatment of an individual
• often no RCT or golden standard in literature to address clinical question especially if the patient has a complex problem

Question 9

Describe the steps you would go through to practise EBM

Answer 9

• think of a clinical question
• search medical literature
• find a study that best answers questions
• perform critical appraisal (check validity and bias)
• determine how results will help you care for your patient
• evaluate results in patient/population