Locating the Best Evidence at the MUSM Libraries

Mercer Medical LibraryMacon

reference.ill@gain.mercer.edu

Health Sciences LibraryMemorial University Medical Center

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What is EBM?Evidence-based medicine (EBM) is the integration of 3 components:

Best Research Evidence

Clinical Expertise

Patient Values

EBM

Steps in the EBM Process

Formulate a clinical question.

Use EBM resources to find evidence.

Evaluate evidence for validity.

Apply evidence to your patient.

Formulating a Clinical Question

A well-built clinical question has 4 components.

The mnemonic PICO is useful for remembering these.

Formulating a Clinical Question

Patient or Population – Sex, age, race? Primary complaint? Disease History?

Intervention – What do you want to do for them? Prescribe a drug? Order a test?

Comparison – What alternatives do you want to compare the intervention to?

Outcome – What do you hope to accomplish, improve or affect? Relieve or reduce symptoms? Improve function or improve test scores?

Sample PICO In elderly patients, are ACE inhibitors more effective than beta

blockers in controlling high blood pressure and minimizing adverse effects?

The “Population” is elderly patients, the “Intervention” is ACE inhibitors, the “Comparison” is beta blockers, and the “Outcome” is controlling high blood pressure and minimizing adverse effects.

Sample PICO In children with asthma, are inhaled steroids

more likely to result in growth delay than standard therapy with beta-agonists?

The “Population” is children with asthma, the “Intervention” is inhaled steroids, the “Comparison” is beta-agonists and the “Outcome” is growth delay.

Locating the Best Evidence Medical literature is immense. Only a small portion is immediately useful in

answering clinical questions. Literature reports the whole spectrum of the

scientific research process. Journey from in-vitro studies to double-blind

randomized control trials is called the “pyramid of evidence.”

Pyramid of Evidence

Levels of Evidence (LOE) Rules of evidence have been established to

grade evidence according to its strength.

Several dozen of these hierarchies exist.

Some systems comprise three levels and others eight or more.

Example of Levels of EvidenceA: There is good research-based evidence to

support the recommendation.

B: There is fair research-based evidence to support the recommendation.

C: The recommendation is based on expert opinion and panel consensus.

X: There is evidence of harm from this intervention.

Agency for Healthcare Research and Quality (AHRQ)

Two Ways to Locate Evidence Foraging – Keeping up with the new

literature and finding information/research that is relevant

Hunting – Answering a specific well-formed question in a timely efficient manner to include at patient point of care