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MD 812 Searching for Evidence: Intro to EBP

Step 3: Introduction to Evidence Based Medicine

Evidence Based Practice (EBP) 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 evidence from systematic research."

Clinical information is often divided into two types of information: background information and foreground information

Background questions are needed when searching for general information on symptoms, disease progression, pathophysiology, or epidemiology. These questions generally require answering who, what, where, why and how. Background information is well accepted and consistent. Example: What are the symptoms of gastroparesis?

Foreground questions are needed when answering question regarding clinical care of a specific patient. Answering foreground questions require specific knowledge and often change with the addition of new research. With foreground questions, it helps to develop a focused question using PICO. Example: In adult patients with Allergic Rhinitis, are Intranasal steroids more effective than oral antihistamines in the management of symptoms?

Literature's Nuances

Thousands of articles are published everyday, which means there is an every growing amount of information you as a health care professional will have to navigate and appraise. All research is based on around primary, secondary, and tertiary information sources. The distinction between these source types depends on the originality of the information being communicated and the proximity to the original source of information. As you progress through your clinical career, you will use all of these resources types. You will learn what questions are best answered by primary, secondary, and tertiary sources.

  • Primary literature reports original research. Basic science and biomedical primary sources are documents or records that synthesize a study, experiment, trial, or other research project. These sources are often written by the researcher(s) who conducted the study or ran the experiment, and are often testing a hypothesis. This type of information is not pre-appraised, therefore you will be required to appraise the information for validity. One article describing causation is not always enough to effect decision making. If you are looking at individual articles consider appraising the Methods, Results, and Discussion. When reviewing primary literature, you should be able to find a description of the patients included and excluded, total number of patients studied, basic data so calculations can be completed, limitations, and interpretation of results.
  • Secondary literature analyzes, synopsizes, and synthesizes primary literature. The advantage of secondary literature is that the information has already been appraised by other professionals, though you always must appraise the methods used for appraisal. Basic science and biomedical primary sources are documents or records that synthesize a study, experiment, trial, or other research project. These sources are often written by the researcher(s) who conducted the study, ran the experiment, and are often testing a hypothesis. Methodologies and results should be comprehensive and descriptive.
  • Tertiary resources synthesizes and compilations and will include the decisions made through primary and secondary research. This resources include textbooks, reference books, fact books, encyclopedias, and almanacs. 
Granular Pyramid Single Studies vs. Summaries

Appraisal of Sources

So you have found an article in PubMed that describes a treatment that could be beneficial to your case? Since it is a single study, and therefore not pre-appraised information, you will have to appraise the validity of the literature yourself. You will need to analyze the methods, results, discussion sections of the article. Consider possible flaws in the research design in the methods and results. To learn more about breaking down the appraisal process check out this resource: Breaking Down Appraisal: Considerations for Appraising Primary Literature

Appraisal Tools

Applying evidence to your case requires factoring in patient preferences, abilities, and resources as well as clinician experience and resources.

After applying the chosen therapy, it is important to perform assessment. Assessment involves evaluating your patient after the application of your evidence based decision. It also includes self-evaluation of your decision, process, and abilities. You must be a lifelong learner when applying evidence based practice principles.

EBM Venndiagram

Clinical Evidence Made Easy

A concise and accessible introduction to understanding clinical data sources

How to Read a Paper: the Basics of Evidence Based Medicine and Healthcare

A clear and wide-ranging introduction to evidence-based medicine and healthcare