Locating the Best Evidence

at the

MUSM Libraries

Mercer Medical LibraryMacon

reference.ill@gain.mercer.edu

Health Sciences LibraryMemorial University Medical Center

Savannah

library@memorialhealth.com

What is EBM?

Best Research

EvidenceClinical Expertise

Patient Values

EBM

Evidence-based medicine (EBM) is the integration of 3 components:

Steps in the EBM Process

Formulate a clinical question.

Use EBM resources to find evidence.

Evaluate evidence for validity.

Apply evidence to your patient.

Formulating a Clinical Question

A well-built clinical question has 4

components.

The mnemonic PICO is useful for

remembering these.

Formulating a Clinical Question

Patient or Population – Sex, age, race? Primary

complaint? Disease History?

Intervention – What do you want to do for them?

Prescribe a drug? Order a test?

Comparison – What alternatives do

you want to compare the intervention to?

Outcome – What do you hope to accomplish,

improve or affect? Relieve or reduce symptoms?

Improve function or improve test scores?

Example PICO

In elderly patients, are ACE inhibitors

more effective than beta blockers in

controlling high blood pressure and

minimizing adverse effects?

The “Population” is elderly patients, the

“Intervention” is ACE inhibitors, the

“Comparison” is beta blockers, and the

“Outcome” is controlling high blood pressure

and minimizing adverse effects.

Example PICO

In children with asthma, are inhaled

steroids more likely to result in growth

delay than standard therapy with beta-

agonists?

The “Population” is children with asthma, the

“Intervention” is inhaled steroids, the

“Comparison” is beta-agonists and the

“Outcome” is growth delay.

Locating the Best Evidence

Medical literature is immense.

Only a small portion is immediately useful in

answering clinical questions.

Literature reports the whole spectrum of the

scientific research process.

Journey from in-vitro studies to double-blind

randomized control trials is called the “pyramid

of evidence.”

Pyramid of Evidence

Levels of Evidence (LOE)

Rules of evidence have been established to grade evidence according to its strength.

Several dozen of these hierarchies exist.

Some systems comprise three levels and others eight or more.

Example of Levels of EvidenceA: There is good research-based evidence to

support the recommendation.

B: There is fair research-based evidence to

support the recommendation.

C: The recommendation is based on expert

opinion and panel consensus.

X: There is evidence of harm from this

intervention.

Agency for Healthcare Research and Quality (AHRQ)

Two Ways to Locate Evidence

Foraging – Keeping up with the new

literature and finding information/research

that is relevant

Hunting – Answering a specific well-formed

question in a timely efficient manner to

include at patient point of care

Coming Up…

We’ll see you at your Library sessions. Check with

your tutor for group time.

Macon location – LRC computer lab.

Savannah location – MUSM computer lab

Be prepared to write a PICO and do hands-on

searching for clinical evidence.

If you have questions please contact us at

reference.ill@gain.mercer.edu or

library@memorialhealth.com!