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Principles of evidence based medicine

Principles of evidence based medicine

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Principles of Evidence-Based Medicine (EBM)

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. 


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2) What is EBM?

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 practice to stay current, and constantly refresh their knowledge. The aim of EBM is to deliver optimal patient care.  


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3) Why EBM?

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 appraise and incorporate sound scientific evidence. 


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4) Five step EBM model.

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


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5) Step 1: Formulate an answerable clinical question

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 interventions
  • outcome of interest

These 4 points are also known as the abbreviation PICO


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6) Step 2: Find evidence

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 Be wary of textbooks or journals, as they may be out of date.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 databases contain a vast variety of articles, and thus require advances searching skills to be navigated effectively. These basic principles can be summarized in 4 essential steps. 


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7) Basic search principles

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. 
  3. Choose a bibliographic database within which to conduct your search, such as the Cochrane Library. 
  4. Conduct the search


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8) Appraise the evidence

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, or CASP. These tools are freely available on the internet. 


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9) Step 4: Apply the evidence

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 decision. All costs and the availability of the treatment should be considered before applying the evidence. 


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10)Step 5: Evaluate performance

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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These ideas are important to medical students and docters who look to become better and more up to date in their practice, and to better the outcomes of their patients.

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