EBM

Evidence-based medicine (EBM) is the process of

systematically reviewing, appraising and using clinical research
fndings to aid the delivery of optimum clinical care to patients.
EBM forms part of the multifaceted process of assuring
clinical efectiveness, the main elements of which are:
Production of evidence through research and scientifc
review
Production and dissemination of evidence-ased clinical
guidelines
!mplementation of evidence-ased, cost-efective practice
through education and management of change
Evaluation of compliance with agreed practice guidance
through clinical audit and outcomes-focused incentives.
Patient or problem
"irst, thin# aout the patient and$or setting you are dealing with.
%ry to identify all of their clinical characteristics that in& uence the
prolem, which are relevant to your practice and which would
afect the relevance of research you might f nd. !t will help your
search if you can e as specif c as possile at this stage, ut you
should ear in mind that if you are too narrow in searching you
may miss important articles 'see ne(t section).
Intervention
*e(t, thin# aout what you are considering doing. !n therapy, this
may e a drug or counselling+ in diagnosis it could e a test or
screening programme. !f your ,uestion is aout harm or aetiology,
it may e e(posure to an environmental agent. -gain, it pays to
e specif c when descriing the intervention, as you will want to
re& ect what is possile in your practice. !f considering drug treatment,
for e(ample, dosage and delivery should e included. -gain,
you can always roaden your search later if your ,uestion is too
narrow.
Comparison intervention
.hat would you do if you didn/t perform the intervention0 %his
might e nothing, or standard care, ut you should thin# at this
stage aout the alternatives. %here may e useful evidence which
directly compares the two interventions. Even if there isn/t, this will
remind you that any evidence on the intervention should e interpreted
in the conte(t of what your normal practice would e.
Outcome
%here is an important distinction to e made etween the outcome
that is relevant to your patient or prolem and the outcome measures
deployed in studies. 1ou should spend some time wor#ing out
e(actly what outcome is important to you, your patient, and the
time-frame that is appropriate. !n serious diseases it is often easy
to concentrate on the mortality and miss the important aspects of
-s#ing answerale ,uestions 5
moridity. 2owever, outcome measures, and the relevant time to
their measurement, may e guided y the studies themselves and
not y your original ,uestion. %his is particularly true, for e(ample,
when loo#ing at pain relief, where the patient/s o3ective may e
4relief of pain/ while the studies may def ne and assess this using a
range of diferent measures.
Critical appraisal is the process of carefully and systematically
e(amining research to 3udge its trustworthiness, and its value
and relevance in a particular conte(t.
%he Critical Appraisal Sills Pro!ramme aims to help
people develop the necessary s#ills to ma#e sense of scientifc
evidence, and has produced appraisal chec#lists covering
validit"# results and relevance$