Evidence-based medicine

What is evidence-based medicine?

Definition

"EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology." 

- Sackett, D. Evidence-based Medicine - What it is and what it isn't. BMJ 1996; 312:71-72.

Steps in practicing EBM

• ASK - Convert the need for information into a focused clinical question. Use the PICO framework
• ACQUIRE - Track down the best evidence with which to answer that question.
• APPRAISE - Critically appraise the evidence for its validity, impact, and applicability.
• APPLY - Integrate the evidence with your clinical expertise and your patient's characteristics and values. 
• ASSESS - Assess the results of your intervention. 

Levels of evidence

1. Systematic Reviews
2. Critically Appraised Synopsis/Synthesis
3. Randomized Controlled Trial
4. Cohort/Case-Controlled Studies, Guidelines
5. Case Reports/Series
6. Review Articles
7. Background Information: Textbooks