Difference between revisions of "Evidence-based health care"

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| style="width:56%; color:#000;" |[[File:EBMpyramid.gif|300px|thumb|right|'''<center>The 'Wedge' of Best Evidence - Start at the top'''</center>]]''Are you interested in contributing to '''HLWIKI Canada''' - [http://hlwiki.ca hlwiki.ca]?'' '''<u>contact</u>''': [http://toby.library.ubc.ca/libstaff/email.cfm?who=120 dean.giustini@ubc.ca]
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| style="width:56%; color:#000;" |<div id="articlecount" style="width:98%; font-size:96%;">[[File:Pyramid2.gif|340px|thumb|right|'''<center>'Wedge' of Best Evidence - Start at the top'''<br>'''Source: http://www.ebmpyramid.org/'''</center>]]''Are you interested in contributing to '''HLWIKI International'''?'' '''<u>contact</u>''': dean.giustini@ubc.ca
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To browse other articles on a range of HSL topics, see the '''[http://hlwiki.slais.ubc.ca/index.php?title=Special:AllPages&from=2007_Sabbatical_-_Dean_Giustini A-Z index]'''.
  
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==Last Update==
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*[[File:Updated.jpg]] 18 July 2017
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==Keywords/metadata==
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* '''best medical evidence, evidence-based, randomized controlled trials, [[realist reviews]], [[systematic reviews]]'''
  
== Introduction==
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==Introduction==
''See also'' '''[[Evidence-based web 2.0]]''', '''[[Point of care decision-making tools - Overview]]''' and '''[[Systematic review searching]]'''
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''See also'' '''[[Blogs]]''' | '''[[Evaluating health information]]''' | '''[[Evidence-based medicine]]''' | '''[[Medical education portal]]''' |  '''[[Point-of-care tools in medicine]]''' | '''[[Systematic review searching]]'''
  
According to the [http://www.cebm.utoronto.ca Centre for Evidence-Based Medicine] (CEBM) and David Sackett: ''"Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients".'' The term ''[[Evidence-based medicine]]'' often includes the synonymous terms evidence-based health care and evidence-based practice and can be extended to nursing, pharmacy, physiotherapy, and allied health. EBHC may also refer to evidence-based management of health services, programs and people (ie. Health Services Research) as well as technologies used to aid health care practice (ie. Health Technology Assessment). Evidence-based practice is known throughout the world but the study of health services research and health technology assessment is relatively unknown. When health professionals refer to ''best evidence'' they are referring to [[major clinical studies & trial types]] that use explicit and reproducible methodologies.
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<center>''"...'''Evidence-based health care''' is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors..."'' ~ '''[http://www.cochrane.org/about-us/evidence-based-health-care#REF1 Cochrane Collaboration]''' </center>
  
In biomedicine, the scholarly communication cycle begins with new ideas about how to treat patients (ie. using new drugs) or clinical problems. Researchers start by writing grant proposals and making formal application to funding agencies. Often, the key to funding stems from gathering the evidence, identifying new areas or 'gaps' in medical knowledge and formulating clear research questions. After these questions are posed, identifiable goals and objectives in research are developed. Once research funding is secured and the research itself conducted, the researcher engages in the formal sharing of findings by publishing articles in peer-reviewed journals or scholarly monographs. Research publications provide the foundation from which future scholarship is carried out and directed, commencing once again in the process described above.
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*According to Sackett, ''"'''...evidence-based medicine''' is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients".'' The terms ''evidence-based health care'' and evidence-based practice are used as synonyms for ''[[evidence-based medicine]]''.  
  
==EBM Explained by Dr. Marc Ebell==
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*EBHC refers also to evidence-based management of health services, programs and people (ie. Health Services Research) as well as technologies used to aid health care practice (ie. Health Technology Assessment). Evidence-based practice is known throughout the world but the study of health services research and health technology assessment is relatively unknown. When health professionals refer to ''best evidence'' they are referring to [[major clinical studies & trial types]] that use explicit and reproducible methodologies.
{{#ev:youtube|XWi7vNv2nos|300}}
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*In biomedicine, the scholarly communication cycle begins with new ideas about how to treat patients (ie. using new drugs) or clinical problems. Researchers start by writing grant proposals and making formal application to funding agencies. Often, the key to funding stems from gathering the evidence, identifying new areas or 'gaps' in medical knowledge and formulating clear research questions. After these questions are posed, identifiable goals and objectives in research are developed.  
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*Once research funding is secured and the research itself conducted, the researcher engages in the formal sharing of findings by publishing articles in peer-reviewed journals or scholarly monographs. Research publications provide the foundation from which future scholarship is carried out and directed, commencing once again in the process described above.
  
 
==Tutorials==
 
==Tutorials==
*'''[http://bit.ly/cJqMXf Introduction to Evidence-Informed Decision Making. National Collaborating Centre for Methods and Tools NCCMT, 2010.]'''
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*'''[http://www.bandolier.org.uk/ Bandolier - Evidence-Based Thinking About Health-Care]'''
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*'''[http://www.nccmt.ca/publications/pub-eidm/1/list-eng.html Evidence-Informed Decision Making. National Collaborating Centre for Methods and Tools NCCMT]'''
 
*'''[http://library.downstate.edu/resources/ebm.htm EBM Primary and Secondary Resources - SUNY Downstate Medical Center]'''
 
*'''[http://library.downstate.edu/resources/ebm.htm EBM Primary and Secondary Resources - SUNY Downstate Medical Center]'''
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*'''[http://nnlm.gov/training/pubmedebm/ NNLM PubMed and the Evidence-Based Universe, 2014]'''
 
*'''[http://www.biomed.lib.umn.edu/learn/ebp/ University of Minnesota - Evidence-based practice]'''
 
*'''[http://www.biomed.lib.umn.edu/learn/ebp/ University of Minnesota - Evidence-based practice]'''
 
*'''[http://us.cochrane.org/understanding-evidence-based-healthcare-foundation-action Understanding Evidence-based Healthcare: A Foundation for Action]'''
 
*'''[http://us.cochrane.org/understanding-evidence-based-healthcare-foundation-action Understanding Evidence-based Healthcare: A Foundation for Action]'''
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*'''[[Key competencies in evidence-based health care]]
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'''
  
 
==Evidence-based practice (EBP)==
 
==Evidence-based practice (EBP)==
 
''See also'' '''[[Evidence-based medicine - history]]'''
 
''See also'' '''[[Evidence-based medicine - history]]'''
  
The phrase ''evidence-based medicine'' dates back to a 1992 article by [http://hlwiki.slais.ubc.ca/index.php?title=Evidence-based_medicine_-_history Gordon Guyatt et al]. EBM is now a worldwide movement that affects all areas of clinical medicine including education and management. Simply put, EBM seeks to locate and apply ''evidence'' from the published medical literature to guide physicians in their decision-making. Some synonyms for EBM include evidence-based practice (EBP) and evidence-based health care (EBHC). There are three distinct but interdependent areas of evidence-based practice; the treatment of individual patients, supported by scientifically valid studies in the literature; practitioners should select treatment options based on the best available scientific research; the second area is a systematic review of literature to evaluate the best studies. This process is human-centered, but also involves computers for information retrieval and statistical analysis. The ability to judge the quality of the medical literature on finding it is central to EBM including what facts can be inferred from it, to appreciate the strength of those inferences, and to apply them to particular patients. As medicine has continued to grow and become more specialized, the number of medical specialties has increased. At the same time, the amount and complexity of the medical literature has also grown. In this sense, evidenced-based medicine can be considered a burgeoning medical specialty, with the medical literature itself - and its efficient retrieval, and appraisal - the object of study. Two of the other scientific issues that have an impact in EBM: 1) the [http://www.google.com/search?hl=en&client=opera&rls=en&hs=Qvu&q=define%3Ageneralizability&btnG=Search generalizability] of research (''extent to which results of a study are applicable to other populations''); and 2) was the research done using [http://en.wikipedia.org/wiki/Scientific_method rigorous methods] and is it [http://en.wikipedia.org/wiki/Reproducibility reproducible]? Finally, EBM may be understood as a "movement" where advocates popularize its methods and usefulness for patient communities, educational institutions and practicing professionals.
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The phrase ''evidence-based medicine'' dates back to 1992 in an article by [http://hlwiki.slais.ubc.ca/index.php?title=Evidence-based_medicine_-_history Gordon Guyatt et al]. Now a worldwide movement, EBM affects all areas of clinical medicine including medical education and management. EBM seeks to apply ''evidence'' from the published literature to guide physicians in their decisions. Synonyms for EBM include evidence-based practice (EBP) and evidence-based health care (EBHC).  
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There are three distinct but interdependent areas of evidence-based practice; the treatment of individual patients, supported by scientifically valid studies in the literature; practitioners should select treatment options based on the best available scientific research; the second area is a systematic review of literature to evaluate the best studies. This process is human-centered, but also involves computers for information retrieval and statistical analysis. The ability to judge the quality of the medical literature on finding it is central to EBM including what facts can be inferred from it, to appreciate the strength of those inferences, and to apply them to particular patients. As medicine has continued to grow and become more specialized, the number of medical specialties has increased. At the same time, the amount and complexity of the medical literature has also grown. In this sense, evidenced-based medicine can be considered a burgeoning medical specialty, with the medical literature itself - and its efficient retrieval, and appraisal - the object of study. Two of the other scientific issues that have an impact in EBM: 1) the [http://www.google.com/search?hl=en&client=opera&rls=en&hs=Qvu&q=define%3Ageneralizability&btnG=Search generalizability] of research (''extent to which results of a study are applicable to other populations''); and 2) was the research done using [http://en.wikipedia.org/wiki/Scientific_method rigorous methods] and is it [http://en.wikipedia.org/wiki/Reproducibility reproducible]? Finally, EBM may be understood as a "movement" where advocates popularize its methods and usefulness for patient communities, educational institutions and practicing professionals.
  
 
==Five (5) steps of EBM - ''see'' [http://hlwiki.slais.ubc.ca/index.php/PICO_framework_-_diagram]==
 
==Five (5) steps of EBM - ''see'' [http://hlwiki.slais.ubc.ca/index.php/PICO_framework_-_diagram]==
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*http://www.cebm.utoronto.ca/practise/formulate/
 
*http://www.cebm.utoronto.ca/practise/formulate/
 
*http://ebn.bmjjournals.com/cgi/content/full/1/2/36
 
*http://ebn.bmjjournals.com/cgi/content/full/1/2/36
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*'''[http://archinte.jamanetwork.com/article.aspx?articleid=1846630 Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care:  a systematic review. ''JAMA Intern Med.'' 2014;174(5):710-718.]'''
  
 
==Randomized controlled trials==
 
==Randomized controlled trials==
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[http://www.mcmaster.ca/ McMaster University] in Ontario, Canada is arguably the birthplace of evidence-based medicine. Several major figures meet there every summer for a series of workshops including [http://en.wikipedia.org/wiki/Gordon_Guyatt Gordon Guyatt], Deborah Cook, Victor Montori, Scott Richardson, Holger Schünemann and others. Many health librarians have attended this annual pilgrimage but there are a number of McMaster health librarians who help to integrate guest health librarians into the [http://clarity.mcmaster.ca/ How to teach EBCP workshop] - they are [[Liz Bayley]], Neera Bhatnagar and others.
 
[http://www.mcmaster.ca/ McMaster University] in Ontario, Canada is arguably the birthplace of evidence-based medicine. Several major figures meet there every summer for a series of workshops including [http://en.wikipedia.org/wiki/Gordon_Guyatt Gordon Guyatt], Deborah Cook, Victor Montori, Scott Richardson, Holger Schünemann and others. Many health librarians have attended this annual pilgrimage but there are a number of McMaster health librarians who help to integrate guest health librarians into the [http://clarity.mcmaster.ca/ How to teach EBCP workshop] - they are [[Liz Bayley]], Neera Bhatnagar and others.
  
==See also==
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==EBM Explained by Dr. Marc Ebell==
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[[File:Liverpool.png|330px|thumb|right|<center>'''For more information about the systematic review process, see: [http://www.liv.ac.uk/dog-aggression/about.htm University of Liverpool website]'''</center>]]
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<center>{{#widget:YouTube|id=XWi7vNv2nos|height=270|width=360}} {{#widget:YouTube|id=-KPYI_znaTk|height=270|width=360}}</center>
  
* '''[[Top Biomedical Texts 2010, Print & Online]]'''
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==French version==
*[[Medline]] & [[PubMed]]
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* [[Médecine fondée sur les faits]]
*'''[[Evidence-based teaching for academic librarians]]'''
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*[[Filters (ie. hedges)]]
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*[[Hand-searching]]
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*[[Nucleotide searching]]
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*'''[[Point of care decision-making tools - Overview]]'''
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==References==
 
==References==
*Anuradha S, Kruesi L, Eriksson L, Steele M, Harrison T, Lewis M, Royal B, Heslop L, Heim B, Seo JW, Malone J, Del Mar C. Evidence-based practice in action: how can your medical librarian help? Evid Based Med. 2010 Apr;15(2):36.  
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*[http://ebm.bmj.com/content/15/2/36.extract Anuradha S, Kruesi L, Eriksson L, Steele M, Harrison T, Lewis M. Evidence-based practice in action: how can your medical librarian help? ''Evid Based Med''. 2010;15(2):36.]
*[http://www.ncbi.nlm.nih.gov/pubmed/15161896 Chan AW, Hrobjartsson A, Haahr MT, Gotzsche PC, Altman DG. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA. 2004 May 26;291(20):2457-65.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/22529043 Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, et al. Effect of clinical decision-support systems: a systematic review. ''Ann Intern Med''. 2012 Apr 23.]
*[http://www.bmj.com/cgi/reprint/329/7473/1017 Coomarasamy A, Khan KS What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ;2004;329;1017.]
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*[http://www.cadth.ca/en/products/methods-and-guidelines/publication/3458?utm_source=qat-project&utm_medium=vo2-issue-24&utm_campaign=communique-07-26-12 CADTH Quality Assessment Tools (To Evaluate Research Evidence) Project]
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*[http://books.google.ca/books?isbn=0199986703 Cartwright N, Hardie J.  Evidence-based policy: a practical guide to doing it better. Oxford: Oxford University Press, 2012.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/15161896 Chan AW, Hrobjartsson A. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. ''JAMA''. 2004:2457-65.]
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*[http://annals.org/article.aspx?articleid=710356 Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. ''Ann Intern Med''. 1997 Mar 1;126(5):376-80].
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*[http://www.bmj.com/cgi/reprint/329/7473/1017 Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. ''BMJ''. 2004;329;1017.]
 
*[http://www.ebmpyramid.org/home.php EBM Pyramid Generator - Dartmouth Biomedical Libraries, Dartmouth College and the Cushing/Whitney Medical Library]
 
*[http://www.ebmpyramid.org/home.php EBM Pyramid Generator - Dartmouth Biomedical Libraries, Dartmouth College and the Cushing/Whitney Medical Library]
*[http://www.bmj.com/cgi/reprint/334/7589/349 Glasziou P, Chalmers I, Rawlins M, McCulloch P. When are randomised trials unnecessary? Picking signal from noise. BMJ. 2007 Feb 17;334(7589):349-51.]
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*''Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. ''Br Med J (Clin Res Ed)''. 1986 Mar 15;292(6522):746-50.''
*[http://www.jstor.org/stable/25187625 Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes RB. Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills. BMJ. 2000 Apr 8;320(7240):954-5.]
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*[http://www.bmj.com/cgi/reprint/334/7589/349 Glasziou P, Chalmers I, Rawlins M, McCulloch P. When are randomized trials unnecessary? Picking signal from noise. ''BMJ''. 2007;334(7589):349-51.]
*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1404801 Guyatt G, Cairns J, Churchill D, et al. Evidence-Based Medicine Working Group Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-5.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/22675691 Greenhalgh T. Why do we always end up here? Evidence-based medicine's conceptual cul-de-sacs and some off-road alternative routes. ''J Prim Health Care''. 2012 Jun 1;4(2):92-7.]
*[http://www.shef.ac.uk/scharr/ir/userg.html Guyatt G, Rennie D. Users' guides to the medical literature: essentials of evidence-based practice. Chicago,IL. American Medical Association. 2002.]
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*[http://www.jstor.org/stable/25187625 Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes RB. Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills. ''BMJ''. 2000;320(7240):954-5.]
*[http://bmj.bmjjournals.com/cgi/content/full/329/7473/990 Guyatt et al. Evidence-based medicine has come a long way. BMJ 2004 Oct 30;329(7473):990-1]
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*[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1404801 Guyatt G, Cairns J, Churchill D. A new approach to teaching the practice of medicine. ''JAMA''. 1992;268:2420-5.]
*[http://ebm.bmj.com/cgi/content/full/11/4/124 Haynes RB, Sackett DL, Guyatt GH, Tugwell P. Clinical epidemiology: how to do clinical practice research. Philadelphia: Lippincott, Williams, Wilkins; 2006.]
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*[http://medicine.ucsf.edu/education/resed/articles/jama11_introduction.pdf Guyatt G, Rennie D. Users' guides to the medical literature: essentials of evidence-based practice. Chicago,IL. American Medical Association. 2002.]
*[http://ebm.bmj.com/content/11/6/162.2.full Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based healthcare decisions. Evid Based Med. 2006 Dec;11(6):162-4.]  
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*[http://bmj.bmjjournals.com/cgi/content/full/329/7473/990 Guyatt et al. Evidence-based medicine has come a long way. ''BMJ''. 2004;329(7473):990-1]
*Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence for evidence-based discourse in health sciences: truth, power and fascism. Int J Evidence-Based Healthcare 2006;4: 180-186.
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*[http://ebm.bmj.com/cgi/content/full/11/4/124 Haynes RB, Sackett DL, Guyatt GH, Tugwell P. Clinical epidemiology: how to do clinical practice research. Williams & Wilkins; Philadelphia, 2006.]
*[http://www.sciencedirect.com/science/article/B6T5R-47CJF86-2J/2/9c9c9e0e1ce2bfb25fc326727c0a4e12 Lachin JM, Matts JP, Wei LJ. Randomization in clinical trials: conclusions and recommendations. Controlled Clinical Trials 1988;9(4): 365-74.]
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*[http://ebm.bmj.com/content/11/6/162.2.full Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based healthcare decisions. ''Evid Based Med''. 2006;11(6):162-4.]  
*[http://www.biomedcentral.com/content/pdf/1741-7015-2-33.pdf McKibbon KA, Wilczynski NL, Haynes RB. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals? BMC Med. 2004 Sep 6;2:33.]
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*[http://onlinelibrary.wiley.com/doi/10.1111/j.1479-6988.2006.00041.x/abstract Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence for evidence-based discourse in health sciences: truth, power and fascism. ''Int J Evidence-Based Healthcare''. 2006;4:180-186.]
*[http://jama.ama-assn.org/cgi/reprint/273/5/408 Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995 Feb 1;273(5):408-12.]
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*[http://pubs.chla-absc.ca/doi/abs/10.5596/c13-019 Kloda LA, Bartlett JC. Formulating answerable questions: question negotiation in evidence-based practice. ''JCHLA/JABSC''. 2013;34(02):55-60.]
*[http://ebm.bmj.com/content/11/2/35.full Jackson R, Ameratunga S, Broad J, Connor J, Lethaby A, Robb G, Wells S, Glasziou P, Heneghan C. The GATE frame: critical appraisal with pictures. Evid Based Med. 2006 Apr;11(2):35-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/23702528 Maggio LA, Tannery NH, Chen HC, Cate OT, O'Brien B. Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006-2011. ''Acad Med.'' 2013 Jul;88(7):1022-1028.]
*MeSH: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=mesh&list_uids=68016454&dopt=Full Review [Publication Type]] - limit search results to systematic reviews
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*[http://www.sciencedirect.com/science/article/B6T5R-47CJF86-2J/2/9c9c9e0e1ce2bfb25fc326727c0a4e12 Lachin JM, Matts JP, Wei LJ. Randomization in clinical trials: conclusions and recommendations. ''Controlled Clinical Trials''. 1988;9(4):365-74.]
*[http://www.bmj.com/cgi/content/full/312/7023/71 Sackett DL. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-2.]
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*[http://www.biomedcentral.com/content/pdf/1741-7015-2-33.pdf McKibbon KA, Wilczynski NL, Haynes RB. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals? BMC Med. 2004;2:33.]
*[http://jama.ama-assn.org/cgi/reprint/280/15/1336 Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the "evidence cart". JAMA. 1998 Oct 21;280(15):1336-8.]
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*[http://heapol.oxfordjournals.org/content/early/2012/06/20/heapol.czs050.full.pdf?keytype=ref&ijkey=LSzssgcB9V8dvUx Moat KA, Lavis JN. 10 best resources for ... evidence-informed health policymaking. ''Health Policy Plan''. 2012 Jun 20.]
*[http://www.cmaj.ca/cgi/reprint/163/7/837 Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. CMAJ. 2000 Oct 3;163(7):837-41.]
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*[http://www.nesta.org.uk/library/documents/A4UEprovocationpaper2.pdf Nutley S, Powell A, Davies H. What counts as good evidence? Research Unit for Research Utilisation (RURU). School of Management, University of St Andrews. UK, 2012.]
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490095/pdf/jgi_04045.pdf Straus SE, Ball C, Balcombe N, Sheldon J, McAlister FA. Teaching evidence-based medicine skills can change practice in a community hospital. J Gen Intern Med. 2005 Apr;20(4):340-3.]
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*[http://www.sciencedirect.com/science/article/pii/S0895435612001394 Prorok JC, Iserman EC, Wilczynski NL, Haynes RB. The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey. ''J Clin Epidemiol''. 2012 Sep 10.]
*[http://www.mclibrary.duke.edu/training/pdaformat/articlepda.html Richardson WS, Wilson MC, Nishikawa J, Hayward R. The Well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;123:A-12.]
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*[http://www.biomedcentral.com/1472-6920/13/77/abstract Rohwer A, Young T, van Schalkwyk S. Effective or just practical? An evaluation of an online postgraduate module on evidence-based medicine (EBM). ''BMC Med Educ''. 2013 May 27;13(1):77.]  
**http://www.authorstream.com/Presentation/hushamelsafi-71580-evidence-based-medicine-intro-medical-practice-introduction-dr-bassil-education-ppt-powerpoint/
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*[http://jama.ama-assn.org/cgi/reprint/280/15/1336 Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the "evidence cart". ''JAMA''. 1998;280(15):1336-8.]
**http://freepdfhosting.com/ebaef05bfe.pdf
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*[http://www.cmaj.ca/cgi/reprint/163/7/837 Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. ''CMAJ.'' 2000;163(7):837-41.]
**University of Nottingham. School of Nursing Educational Technology Group. http://www.nottingham.ac.uk/nmp/sonet/subjects/ebp/
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*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490095/pdf/jgi_04045.pdf Straus SE, Ball C, Balcombe N, Sheldon J, McAlister FA. Teaching evidence-based medicine skills can change practice in a community hospital. ''J Gen Intern Med.'' 2005;20(4):340-3.]
 +
*[http://www.mclibrary.duke.edu/training/pdaformat/articlepda.html Richardson WS, Wilson MC, Nishikawa J, Hayward R. The well-built clinical question: a key to evidence-based decisions. ''ACP Journal Club''. 1995;123:A-12.]
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*[http://www.worldcat.org/oclc/3517053 Vygotsky LS. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard Press; 1978.]
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*[http://www.worldcat.org/oclc/39666619 Wenger E. Communities of practice: learning, meaning and identity. Cambridge: Cambridge University Press; 1998.]

Latest revision as of 12:13, 18 July 2017

'Wedge' of Best Evidence - Start at the top
Source: http://www.ebmpyramid.org/
Are you interested in contributing to HLWIKI International? contact: dean.giustini@ubc.ca

To browse other articles on a range of HSL topics, see the A-Z index.

Contents

[edit] Last Update

  • Updated.jpg 18 July 2017

[edit] Keywords/metadata

[edit] Introduction

See also Blogs | Evaluating health information | Evidence-based medicine | Medical education portal | Point-of-care tools in medicine | Systematic review searching

"...Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors..." ~ Cochrane Collaboration
  • According to Sackett, "...evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The terms evidence-based health care and evidence-based practice are used as synonyms for evidence-based medicine.
  • EBHC refers also to evidence-based management of health services, programs and people (ie. Health Services Research) as well as technologies used to aid health care practice (ie. Health Technology Assessment). Evidence-based practice is known throughout the world but the study of health services research and health technology assessment is relatively unknown. When health professionals refer to best evidence they are referring to major clinical studies & trial types that use explicit and reproducible methodologies.
  • In biomedicine, the scholarly communication cycle begins with new ideas about how to treat patients (ie. using new drugs) or clinical problems. Researchers start by writing grant proposals and making formal application to funding agencies. Often, the key to funding stems from gathering the evidence, identifying new areas or 'gaps' in medical knowledge and formulating clear research questions. After these questions are posed, identifiable goals and objectives in research are developed.
  • Once research funding is secured and the research itself conducted, the researcher engages in the formal sharing of findings by publishing articles in peer-reviewed journals or scholarly monographs. Research publications provide the foundation from which future scholarship is carried out and directed, commencing once again in the process described above.

[edit] Tutorials

[edit] Evidence-based practice (EBP)

See also Evidence-based medicine - history

The phrase evidence-based medicine dates back to 1992 in an article by Gordon Guyatt et al. Now a worldwide movement, EBM affects all areas of clinical medicine including medical education and management. EBM seeks to apply evidence from the published literature to guide physicians in their decisions. Synonyms for EBM include evidence-based practice (EBP) and evidence-based health care (EBHC).

There are three distinct but interdependent areas of evidence-based practice; the treatment of individual patients, supported by scientifically valid studies in the literature; practitioners should select treatment options based on the best available scientific research; the second area is a systematic review of literature to evaluate the best studies. This process is human-centered, but also involves computers for information retrieval and statistical analysis. The ability to judge the quality of the medical literature on finding it is central to EBM including what facts can be inferred from it, to appreciate the strength of those inferences, and to apply them to particular patients. As medicine has continued to grow and become more specialized, the number of medical specialties has increased. At the same time, the amount and complexity of the medical literature has also grown. In this sense, evidenced-based medicine can be considered a burgeoning medical specialty, with the medical literature itself - and its efficient retrieval, and appraisal - the object of study. Two of the other scientific issues that have an impact in EBM: 1) the generalizability of research (extent to which results of a study are applicable to other populations); and 2) was the research done using rigorous methods and is it reproducible? Finally, EBM may be understood as a "movement" where advocates popularize its methods and usefulness for patient communities, educational institutions and practicing professionals.

[edit] Five (5) steps of EBM - see [1]

  1. Formulate a sensible, focused clinical question.
  2. Search the medical literature for evidence related to the focused, clinical question.
  3. Rate the quality of the available studies.
  4. Apply the evidence to a particular patient or clinical situation.
  5. Assess outcomes of decisions.

[edit] EBM and librarians

  • In the first step, clinicians decide explicitly what patient population they are studying, what tests, treatments, and alternatives are under consideration, and what outcomes are to be measured. The acronym PICO - Patient, Intervention, Comparison and Outcome is often used to remember these steps, and questions.
  • The second step of EBM is searching the medical literature. Health librarians must therefore have an understanding of the methods, strengths, and weaknesses of search strategies/ tools as they strive to find the highest levels of evidence. In general, systematic reviews (not to be confused with general reviews) are considered the highest level of evidence, followed by randomized controlled trials (RCTs), then case-control studies, followed by expert opinions, and anecdotal evidence.
  • The third step - rating the quality of the available studies - involves a knowledge of research methodologies in order to make valid conclusions. For example (with RCTs): was a control group used? Was assignment to an experimental vs. control group truly random? Were patients, treatment providers, and outcome assessors blinded to assignments? What is the risk of a Type I or Type II error? What is the effect size? In systematic reviews (involving health librarians), was the literature review truly comprehensive? Was the assessment of study quality done with rigour, and was it subjectively graded? Can numerical assessments be statistically combined (a "meta-analysis") to increase statistical power? Answers to these questions often depends on the particular parameters decided in step one.
  • The fourth and fifth steps involve translating findings of controlled studies to the less-ideal and less-controlled situation of particular patients. What are the risks and benefits for this patient? What are his or her preferences? What are the costs, alternatives and availability of treatments? Even for a statistically significant finding is the effect size practically significant? Do practitioners have the skills or resources to deliver treatments or to monitor outcomes? The final step involves reassessment of the clinical question and outcomes where the whole process may begin again by returning to the patient.

[edit] PICO - sensible, focused questions

The PICO acronym (patient/population; intervention; comparison; outcome) is used by health professionals and librarians in providing direction for step one of EBM. The PICO framework - diagram guides EBM as it combines elements of the clinical scenario in an orderly fashion. The goal, of course, is to build a focused, answerable clinical question:

  • P - patient, population of patients, problem
  • I - intervention (a therapy or test)
  • C - comparison (another therapy or placebo)
  • O - outcome

Generally speaking, health librarians use the most relevant terms, keywords and concepts from PICO to find the best evidence. Several resources are available to introduce EBM concepts and to guide you through the process of shaping your information need into a clinical question.

For other examples, see:

[edit] Randomized controlled trials

See Major clinical studies & trial types

A randomized controlled trial (RCT) is a clinical trial or scientific study used in the testing of the efficacy of medicines or medical procedures. The RCT is widely considered the most reliable form of scientific evidence because it is the best known study design for eliminating a variety of biases that regularly compromise the validity of medical research.

[edit] Systematic reviews (SRs)

Systematic reviews are generally viewed as the highest level of medical evidence for they bring together major randomized controlled trials in a given area, pool results (which may include a meta-analysis) and review their efficacy. An understanding of SRs and how to implement them in practice is mandatory for all health professionals. SRs are summaries of the literature based on expert searching. A literature review is followed by an in-depth critical appraisal of individual studies to identify the most valid and applicable evidence. Finally, appropriate techniques are applied to combine these valid studies in the SR. Many SRs are based on an explicit quantitative meta-analysis of data, but there are qualitative reviews which adhere to the standards for gathering, analyzing and reporting evidence. Many healthcare journals now publish SRs, but the best-known source is the Cochrane Collaboration, a group of over 6,000 specialists who systematically review biomedical trials and the results of other research. Cochrane reviews, based on explicit meta-analyses, are published in the Cochrane Database of Systematic Reviews section of the Cochrane Library, which has over 3000 complete reviews. The Cochrane Group provides a handbook for systematic reviewers where guidelines indicate appropriate content. The Alberta Research Centre for Child Health Evidence provides an overview of EBM terms taken from the Cochrane Reviewer's Handbook.

[edit] Canadian context

McMaster University in Ontario, Canada is arguably the birthplace of evidence-based medicine. Several major figures meet there every summer for a series of workshops including Gordon Guyatt, Deborah Cook, Victor Montori, Scott Richardson, Holger Schünemann and others. Many health librarians have attended this annual pilgrimage but there are a number of McMaster health librarians who help to integrate guest health librarians into the How to teach EBCP workshop - they are Liz Bayley, Neera Bhatnagar and others.

[edit] EBM Explained by Dr. Marc Ebell

For more information about the systematic review process, see: University of Liverpool website

[edit] French version

[edit] References

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