Evidence-Based Medicine - Basics

Summary

This video introduces the basics of evidence-based medicine (EBM), emphasizing its role in making informed patient care decisions. The video covers the four steps of EBM: asking focused questions, finding the best evidence, critically appraising it, and applying it in practice. It explains the evidence pyramid and the types of resources used in research, including filtered, unfiltered, and background resources. Using the PECO(T) tool, viewers learn to formulate clinical questions, guiding them through a search strategy for evidence, with a focus on randomized controlled trials. This tutorial sets the foundation for deeper exploration in the following modules.

Takeaways

• 😀 Evidence-based medicine (EBM) involves making healthcare decisions using the best available evidence rather than relying solely on personal experience.
• 😀 The steps of practicing EBM include asking focused questions, searching for evidence, critically appraising the evidence, and applying it in practice.
• 😀 The increasing rate of published clinical trials and systematic reviews makes it difficult for clinicians to stay up-to-date with the latest research.
• 😀 The evidence pyramid highlights different levels of evidence, with systematic reviews and meta-analyses at the top, followed by randomized controlled trials (RCTs).
• 😀 Filtered resources include expert-reviewed and synthesized research, while unfiltered resources require clinicians to assess the quality and applicability of the evidence themselves.
• 😀 Background resources provide foundational knowledge and overviews of diseases or concepts, often through textbooks and similar sources.
• 😀 Systematic reviews and meta-analyses involve thorough literature searches and combine results from multiple studies to provide high-level evidence.
• 😀 Randomized controlled trials (RCTs) are designed experiments that test interventions or treatments and are key for understanding cause-and-effect relationships.
• 😀 The PICO(T) tool is used to formulate focused clinical questions by identifying key components: Patient/Problem, Intervention, Comparison, Outcome, and optionally Type of Question and Study.
• 😀 An example case of Sarah, a pregnant teen with low back pain, demonstrates how the PICO(T) tool can be used to frame a clinical question and guide evidence searches.
• 😀 In the next tutorial, learners will use PubMed to conduct a search based on a clinical question framed using the PICO(T) tool, filtering results for randomized controlled trials.

Q & A

What is evidence-based medicine (EBM)?

Evidence-based medicine is the conscientious use of current best evidence in making decisions about patient care. It moves beyond relying solely on personal experience, aiming to integrate the best available research evidence into clinical decision-making.

Why is evidence-based medicine becoming increasingly important?

The rise in the volume of published clinical research, with 75 clinical trials and 11 systematic reviews published daily, makes it difficult for clinicians to keep up. Therefore, there is a need to be more selective when searching for medical literature.

What are the three types of resources in evidence-based medicine?

The three types of resources are filtered resources, unfiltered resources, and background resources. Filtered resources provide synthesized evidence and conclusions, while unfiltered resources require clinicians to assess their quality. Background resources provide an overview of a condition or concept.

What is the difference between filtered and unfiltered resources?

Filtered resources are those where clinical experts have synthesized and appraised the evidence, making them reliable. Unfiltered resources, however, require clinicians to assess the quality and applicability of the information, which can be more time-consuming.

What are systematic reviews and how do they relate to the evidence pyramid?

Systematic reviews are at the top of the evidence pyramid and involve a comprehensive literature search to identify studies with sound methodology. These reviews synthesize findings from various studies to answer a specific clinical question.

What is the role of randomized controlled trials (RCTs) in evidence-based medicine?

RCTs are carefully planned experiments designed to test the effects of a treatment or intervention on patients. They are considered a high level of evidence for determining cause and effect but require appraisal for quality before use.

What is the purpose of evidence summaries and clinical practice guidelines?

Evidence summaries provide regularly updated, expert-vetted overviews of the latest evidence on clinical topics. Clinical practice guidelines are recommendations that assist clinicians in making healthcare decisions in specific clinical situations.

What are background resources in evidence-based medicine?

Background resources offer foundational information about diseases, conditions, or clinical concepts. Textbooks and integrated clinical tools often serve as examples of background resources, although they may not always be evidence-based.

How do you use the PICO(TT) tool in evidence-based medicine?

The PICO(TT) tool helps frame clinical questions by identifying key components: Patient/Problem, Intervention, Comparison, Outcome, and, when applicable, Type of Question and Type of Study. This helps guide searches for relevant evidence.

How do you construct a clinical question using the PICO(TT) framework?

To construct a clinical question using PICO(TT), identify the key components of the patient's issue: the specific problem (P), the intervention you are considering (I), any comparison (C), the desired outcome (O), and the type of study (T). The example given in the script involves a pregnant teen with back pain, considering physical therapy as the intervention.