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Steps in the EBM processSteps in the EBM process
Converting information need into a Converting information need into a clinical questionclinical question
Searching the literature for the best Searching the literature for the best evidenceevidence
Critical appraisal of the literatureCritical appraisal of the literature Applying the literatureApplying the literature EvaluationEvaluation
Types of Clinical QuestionsTypes of Clinical Questions
TherapyTherapy DiagnosisDiagnosis EtiologyEtiology PrognosisPrognosis Harm Harm PreventionPrevention Quality ImprovementQuality Improvement
Type of Type of QuestionQuestion
Type of Type of Study/MethodologyStudy/Methodology MEDLINE FiltersMEDLINE Filters
TherapyTherapy -Double-Blind Randomized -Double-Blind Randomized Controlled TrialControlled Trial
-Systematic Review / Meta--Systematic Review / Meta-analysisanalysis
Randomized Controlled Trial [PT],Randomized Controlled Trial [PT],double [TW] and blind [TW]double [TW] and blind [TW]
Meta-analysis Meta-analysis
DiagnosisDiagnosis Controlled TrialControlled Trial Sensitivity and Specificity [MH], Sensitivity and Specificity [MH], Diagnosis [SH]Diagnosis [SH]
PrognosisPrognosis Cohort Studies,Cohort Studies,Case Control,Case Control,Case SeriesCase Series
EXP Cohort Studies [MH],EXP Cohort Studies [MH],Prognosis [MH],Prognosis [MH],Survival Analysis [MH]Survival Analysis [MH]
Morbidity [MH]Morbidity [MH]Mortality [MH]Mortality [MH]
EtiologyEtiology Cohort Studies,Cohort Studies,Case Control,Case Control,Case SeriesCase Series
EXP Cohort Studies [MH],EXP Cohort Studies [MH],Risk [TW]Risk [TW]
PreventionPrevention Randomized Controlled Trial,Randomized Controlled Trial,Cohort Studies Cohort Studies
Randomized Controlled Trial [pt],Randomized Controlled Trial [pt],Cohort Studies [MH], Cohort Studies [MH], Prevention and Control [SH]Prevention and Control [SH]
Quality Quality ImproveImprovementment
Randomized Controlled TrialsRandomized Controlled Trials Randomized Controlled Trial [PT]Randomized Controlled Trial [PT]Practice Guideline [PT] Practice Guideline [PT] Consensus Development Conference Consensus Development Conference [PT] [PT]
From: http://www.uic.edu/depts/lib/lhs/resources/ebm/levels.shtmlMore MEDLINE Filters at http://www.exempla.org/courses/FindBestEBM/pyramid/
PICOPICOPP PPatient, Population, or Problem atient, Population, or Problem
II IIntervention, Prognostic Factor, or ntervention, Prognostic Factor, or Exposure Exposure
CC CComparison or Intervention (if omparison or Intervention (if appropriate) appropriate)
00 OOutcome you would like to measure utcome you would like to measure or achieve or achieve
What type of question are you What type of question are you asking? asking?
Diagnosis, Etiology, Diagnosis, Etiology, Therapy, Prognosis, Therapy, Prognosis, Prevention, HarmPrevention, Harm
Type of study you want to find Type of study you want to find What would be the best What would be the best study study design/methodology?design/methodology?
http://www.uic.edu/depts/lib/lhs/resources/ebm/pico.shtml
PICOPICO
Patient – 54 year old male with a cold Patient – 54 year old male with a cold Intervention – vitamin cIntervention – vitamin c
Comparison – no vitamin cComparison – no vitamin c Outcome – prevent the common coldOutcome – prevent the common cold
Type of Question: Prevention / Type of Question: Prevention / TreatmentTreatment
Type of study design: RTCType of study design: RTC
Clinical Scenario 1Clinical Scenario 1 55-yr old female; history of 55-yr old female; history of
hypertension; sudden onset of chest hypertension; sudden onset of chest pain and shortness of breathpain and shortness of breath
Swelling in R leg for 2 days since return Swelling in R leg for 2 days since return from recent vacationfrom recent vacation
Current meds: estrogens and atenelolCurrent meds: estrogens and atenelol V/Q read as high probability for V/Q read as high probability for
pulmonary embolismpulmonary embolism Patient started on Lovenox; treatment Patient started on Lovenox; treatment
with coumadin initiated in hospitalwith coumadin initiated in hospital Sent home in stable condition; Sent home in stable condition;
coumadin for 6 monthscoumadin for 6 months
PICO ExercisesPICO Exercises Clinical Scenario 2: A 72 y/o male Clinical Scenario 2: A 72 y/o male
with osteoarthritis wants to take with osteoarthritis wants to take glucosamine and chondroitin sulfate glucosamine and chondroitin sulfate instead of other meds. Is there any instead of other meds. Is there any evidence of effectiveness? evidence of effectiveness?
Clinical Scenario 3: A women in her Clinical Scenario 3: A women in her mid 40s with a family history of mid 40s with a family history of breast cancer is scheduling her breast cancer is scheduling her yearly breast exam. Should an MRI yearly breast exam. Should an MRI or a mammogram be scheduled?or a mammogram be scheduled?
PICO ExercisesPICO Exercises
Clinical scenario 4: You have an infant with Clinical scenario 4: You have an infant with suspected congenital heart disease and order suspected congenital heart disease and order an MRI. The parents request an an MRI. The parents request an echocardiogram. Which test should be echocardiogram. Which test should be performed or both?performed or both?
Clinical scenario 5: In children with asthma, Clinical scenario 5: In children with asthma, 2mg/kg of prednisone is commonly used. In 2mg/kg of prednisone is commonly used. In other countries the usual dose is 1mg/kg. other countries the usual dose is 1mg/kg. Which is more effective in reducing length of Which is more effective in reducing length of exacerbations? exacerbations?
Searching PubMedSearching PubMed
PubMedPubMed
Clinical QueriesClinical Queries
Sandy De GrooteSandy De Groote
Steps in the EBM processSteps in the EBM process
Converting information need into a Converting information need into a clinical questionclinical question
Searching the literature for the best Searching the literature for the best evidenceevidence
Critical appraisal of the literatureCritical appraisal of the literature Applying the literatureApplying the literature EvaluationEvaluation
MEDLINEMEDLINE MEDLINE is premiere biomedical database. MEDLINE is premiere biomedical database.
Produced by the National Library of Produced by the National Library of Medicine, MEDLINE is an international Medicine, MEDLINE is an international bibliographic database of over 4500 bibliographic database of over 4500 biomedical journals. It covers the fields biomedical journals. It covers the fields of medicine, nursing, dentistry, veterinary of medicine, nursing, dentistry, veterinary medicine, the health care system and the medicine, the health care system and the preclinical sciences.preclinical sciences.
PubMed www.pubmed.govPubMed www.pubmed.gov-search for primary literature (also -search for primary literature (also
indexes meta-analyses and indexes meta-analyses and systematic reviews)systematic reviews)
- Clinical Queries- Clinical Queries
It dates from 1966 to the currentIt dates from 1966 to the current
ExerciseExercise
Search PubMedSearch PubMed Clinical Scenario 2Clinical Scenario 2 Clinical Scenario 3Clinical Scenario 3
Based on the results – select one or Based on the results – select one or two that you think you might want to two that you think you might want to look at further.look at further. Why did you choose it?Why did you choose it?