Ascension - TX

                                                                                       Evidence Based Medicine

What is Evidence Based Medicine

The most commonly used definition for EBM is that "Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." provided by David Sackett et al in the 1996 article, " Evidence-Based Medicine: What it is and what it isn't" for BMJ. (Full text here)

However, there are some specific points to consider when defining Evidence-Based Practice. 

"Evidence-based practice (EBP) refers to the systematic process where-by decisions are made and actions or activities are undertaken using the best evidence available. The aim of evidence-based practice is to remove as far as possible, subjective opinion, unfounded beliefs, or bias from decisions and actions in organisations. Evidence for decisions comes from various sources:

  1. Peer-reviewed research
  2. Work-based trial and error testing
  3. Practitioner experience & expertise
  4. Feedback from practice, practitioners, customers, clients, patients or systems

Evidence based practice also involves the ability to be able to evaluate and judge the validity, reliability and veracity of the evidence and it’s applicability to the situation in question. This means that there are a series of methods and approaches for developing practice, and that evidence-based practitioners undergo continual development and training as practice develops." (Oxford Review.com)

 

The Center for Evidence Based Managment (CEBMa) recommends that researchers consider the following questions in regard to published research and evidence. The process of evaluating evidence is known as critical appraisal.

1. Is the evidence from a known, reputable source?

2. Has the evidence been evaluated in any way? If so, how and by whom?

3. How up-to-date is the evidence?

CEBMa offers tools to help appraise research studies in the form of Critical Appraisal Checklists; you can set up a free account to access these resources.

Assessment Tools

Search Tips & Training

                                          The IOWA Model

Center of Evidence Based Medicine: Study Designs

According to the Center of Evidence Based Medicine, study designs include:

A defined population (P) from which groups of subjects are studied

Outcomes (O) that are measured

Experimental and analytic observational studies also include:

Interventions (I) or exposures (E) that are applied to different groups of subjects

Click here to go to a description of each research study type, including strengths and weaknesses

https://s3.amazonaws.com/libapps/accounts/1934/images/IJSTD-33-49-g002_Fig2_flowchart.jpg; 2019.6.18

Levels of Evidence

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Understanding 'Levels of Evidence'

Developed by the Physiotherapy Association of British Columbia this tutorial explains the levels of evidence, based on research study design, so that you can find the best evidence for your practice using a database

 

                                            The Funnel

"Evidence-based practice needs an update. To that end, this is the  fifth article in our Journal of PeriAnesthesia Nursing series revolutionizing processes for evidence-based practice (EBP). The objective of this series is to identify EBP-related traditions that have been in existence for decades, some of which are outdated, while others are not grounded in evidence, and may just add confusion, poor scholarship, and a workload burden. Since the October 2022 issue of the Evidence into Practice column, we have addressed implementation 
failure,1 problems with Patients/Problem/Population, Intervention, Comparison, and Outcome (PICO),2,3 and a need for team science in 
EBP work.4 The next step in the EBP process involves assembling, appraising, and synthesizing the best evidence.5 In this column, we examine the common practice of grading evidence according to levels in an evidence hierarchy, also referred to as the evidence pyramid"

Read the full article Here.

What is PICO?

PICO is a mnemonic used to aide the clinician or researcher in identifying the important parts of a well-defined clinical question. This question then provides the basis for a search of medical literature on the question topic.

Elements of a Clinical Question

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Types of Possible Questions in Relation to PICO

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The 5 A's

From Ascension WI:

The 5 "A's" will help you to remember the EBP process:

  1. ASK:  Information needs from practice are converted into focused, structured questions.
  2. ACCESS / ACQUIRE:  The focused questions are used as a basis for literature searching in order to identify relevant external  evidence from research.
  3. APPRAISE:  The research evidence is critically appraised for validity.
  4. APPLY: The best available evidence is used alongside clinical expertise and the patient's perspective to plan care.
  5. ASSESS / AUDIT:  Performance is evaluated through a process of self reflection, audit, or peer assessment.

Please note, there are several models for EBP with various named and numbered steps.  This guide will detail the first three steps ASK, ACCESS/ACQUIRE, APPRAISE.  Some models include a 6th step for DISSEMINATE.

* This box and graphic was created by Diane Giebink-Skoglind of ThedaCare. Used by permission.  The graphic is adapted from Melnyk, BM & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best pracatice. (2nd ed.)  Philadephia: Wolters-Kluwer/Lippincott Williams & Wilkins.

 

 

Levels of Evidence

Level I

Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or 3 or more RCTs of good quality that have similar results.
Level II

Evidence obtained from at least one well designed RCT (eg large multi-site RCT).
Level III

Evidence obtained from well-designed controlled trials without randomization (ie quasi-experimental).
Level IV

Evidence from well-designed case-control or cohort studies.
Level V

Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).
Level VI

Evidence from a single descriptive or qualitative study.
Level VII

Evidence from the opinion of authorities and/or reports of expert co

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