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Chinese Medicine Subject Guide: Evidence-based practice

Evidence-based practice

 Evidence-based medicine (EBM)

What is EBM?

One of the most widely accepted definitions of evidence-based medicine is taken from Sackett's 1996 article:

the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research

Reference:
Sackett DL, Rosenberg WMC, Gray MJA, Haynes BR, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;312:71. doi: 10.1136/bmj.312.7023.71.

EBM Hierarchy

It is better to know the categories, or the hierarchy, of EBM resources before you do an in-depth search of the EBM literature because there is an enormous and overwhelming amount of EBM material available in academic and in clinical practice.

 

Reference:
DiCenso
 A
Bayley LHaynes RB. 
Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. 
 

Ask a clinical question with the PICO model

When you have a clinical question that you would like to address by looking for evidence-based practice, you may make use of the PICO model (Patient-Intervention-Comparison-Outcome) to divide a clinical question into the following four dimensions. This strategy helps you to form a more structured question that will return relevant EBM results.

 

 PICO model Example 
Patient or problem  In a patient population over the age of 45, with moderate Alzheimer’s disease, 
Intervention, exposure, prognostic factor are acetylcholinesterase inhibitors the treatment of choice
Comparison over NMDA antagonists
Outcome in effectively increasing the quality-of-life? 

 

Useful resources:

Systematic Review

 Systematic review

What are systematic reviews?

A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made. The key characteristics of a systematic review are:

  • a clearly stated set of objectives with pre-defined eligibility criteria for studies;

  • an explicit, reproducible methodology;

  • a systematic search that attempts to identify all studies that would meet the eligibility criteria;

  • an assessment of the validity of the findings of the included studies, for example through the assessment of risk of bias; and

  • a systematic presentation, and synthesis, of the characteristics and findings of the included studies.

 

Where can I find systematic reviews? 

Systematic reviews can be found via databases and journal platforms directly. Please go the "Books, articles & reviews" section of this guide for links to these access points. 

How to write a systematic review? (Systematic Review Reporting Guidelines)

PRISMA, which stands Preferred Reporting Items for Systematic Reviews and Meta-Analyses, is used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventionsThe PRISMA Statement was published in 2009. It consists of a checklist and a flow diagram, 

 

Adapted from:

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal. 2009 Jun 1;26(2):91-108. Available from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1471-1842.2009.00848.x 

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009 Aug 18;151(4):264-9. Available from http://annals.org/aim/article-abstract/744664