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BMJ

Principles of evidence based medicine

Principles of evidence based medicine

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Principles of Evidence-Based Medicine (EBM)

This article discusses how clinicians can apply EBM to improve the overall outcomes of their patients. This is done by using the 5 step EBM model which will be discussed. 

Evidence-based medicine is defined by A K Akobeng as the 'integration of best research-evidence with clinical expertise and patient values.' The practice of evidence-based medicine looks to bridge the gap between research and clinical practice. Physicians can use this pra...

EBM aims to promote new and innovative practices that are proven to work, and to disregard harmful and ineffective practices. The consequinces of EBM are effective, accurate and precise clinical interventions and diagnostic tests. Important EBM skills include the ability to find, critically appra...

To incorporate EBM into clinical practice, 5 essential steps must be applied:

  1. Formulate an answerable clinical question
  2. Find evidence
  3. Appraise the evidence
  4. Apply the evidence
  5. Evaluate performance

The main idea is to convert all the questions that arise from a difficult case into one structured clinical question.

A good clinical question should have 4 main points:

  • patient or problem in question
  • intervention, test or exposure of interest
  • comparison intervent...

Various sources could help you find evidence. Be wary of textbooks or journals, as they may be out of date. Your colleagues may assist you, but the quality of information obtained from them may vary. The best places to go to find evidence are online electronic bibliographic databases. These datab...

The following principles can be used to improve the quality of your searches when navigating an electronic bibliographic database:

  1. Convert the problem into and answerable question using the PICO format. 
  2. Decide on appropriate key words to make the search more accurate. 

Decide on how useful or valid the articles that you have obtained are. The quality of research articles vary, and it is essential that you avoid using the evidence contained in unreliable articles. Oxford, UK developed tools for appraising research known as the Critical Appraisal Skills Programme...

Once we have critically appraised the evidence and decided on it's relevance, we can apply it in our practice. We now have to decide if this evidence is applicable to our patient or population. All aspects of the evidence should be fully discussed with the patient for them to make an informed dec...

After completing all the previous steps, we should stand back and evaluate our actions throughout this process. We must look especially at our patient outcomes, and decide if patient care and outcome have improved. If not, we should learn from the experience for future reference.

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