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BMJ

Principles of evidence based medicine: Summary

Principles of evidence based medicine: Summary

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Health care professionals are increasingly required to base clinical decisions on the best available evidence. Evidence-based medicine (EBM) is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patien...

The concept of evidence-based medicine (EBM), defined as the ‘‘integration of best research evidence with clinical expertise and patient values’’

The practice of it requires life long, self-directed learning where patient ca...

To Improve quality care through the identification and promotion of practices that work, and the elimination of those that are ineffective or harmful.

EBM demands that the effectiveness of clinical interventions, the accuracy of diagnostic tests, and the power of prognostic...

The practice of EBM should start with a well formulated clinical question.

A good question should be clear, directly focused on the problem and answerable by medical literature research.

 A good clinical question has 3-4 components:

  • Patient or problem
  • Intervention, ...

A 4 month old baby is admitted with viral bronchiolitis. The baby's symptoms worsen and you wonder if corticosteroids might help the child improve and reduce the length of hospital stay.

The key components of your clinical question would be:

Patient: 4 month old baby w...

The next step is to seek relevant evidence that will help you answer the question.

Sources are:

  1. Traditional methods (textbooks, journals).
  2. Ask an expert. (answer quality will vary)
  3. Summarised clinical evidence (BestBets).
  4. ...

After obtaining relevant articles on a subject, the next step is to appraise the evidence for its validity and clinical usefulness.

Research evidence may be appraised with regard to three main areas:

  1. Validity
  2. Importance
  3. Applicability to the patient or patients of...

After critically appraising the evidence, we then decide whether that evidence can be applied to our individual patient or population, taking into account the patient’s own personal values and circumstances.

Both efficacy and risks should be fully discussed with the patient or parents, or b...

As we incorporate EBM into routine clinical practice, we need to evaluate our approach at frequent intervals and to decide whether we need to improve on any of the four steps discussed above.

We need to ask whether we are formulating answerable questions, finding good evidence quickl...

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