Introduction to EBM

Definition: Evidence based medicine is the conscientious and judicious use of current best evidence in the health care of individuals and populations.

Components:
Identifying a problem or area of uncertainty
Formulating a relevant, focused, clinically important question that is likely to be answered
Finding and appraising the evidence
Assessing the clinical importance of the evidence
Assessing the clinical applicability of any recommendations or conclusions
Deciding whether or not to act on the evidence
Assessing the outcomes of your actions
Summarizing and storing records for future reference

Questioning
Break the question down into its "anatomy"
Subjects or groups involved
Proposed intervention
Comparison intervention
Outcome of interest

A time saving initial question is, "How likely is it that there are high quality studies that have produced valid and clinically important evidence specifically addressing this issue?"

Classify the question into a domain:
Therapy (clinical trial)
Diagnosis (comparison to a standard)
Prognosis (follow-up study)
Harm

Searching
Effective evidence must be:
Accessible and timely
Valid (credible and current)
Clinically important
Applicable to your patient or population
Where to start searching depends on:
Available time
Available databases
Subject matter and domain of the question
Currency and level of evidence desired
How well the issue lends itself to study

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Potential sources:
colleagues
textbooks
journal articles
guidelines
caremaps or disease guidance systems

Where should you look?
If the issue is common:
Guidelines
Current textbook with evidence links
Systematic reviews
Evidence based abstraction services
Primary literature
If the issue is rare, or circumstances idiosyncratic:
Current textbook with evidence links
Evidence based abstraction service
Primary literature
If the currency of information is paramount:
Primary literature