Post on 23-Dec-2015
Evidence Based Medicine
Searching for Evidence
Evidence Based Practice: Steps
1. Ask focused clinical question
2. Search for the best evidence
3. Appraise/assess the evidence
4. Apply results in practice
5. Evaluate results
What Evidence is Best?
Meta-Analyses
Systematic Reviews
Randomized Controlled Trials
Cohort Studies
Case-Control Studies
Case Series, Case Reports
Question Types Study Types
Question Type Best Study Type
Diagnosis Prospective, blind comparison to a gold standard
Therapy RCT > cohort > case control > case series
Prognosis Cohort study > case control > case series
Harm/Etiology RCT > cohort > case control > case series
Prevention RCT > cohort study > case control > case series
Clinical Scenario
After routine surgery, a 65 year old male presents with deep
vein thrombosis. He has no past history of DVT and no known
risk factors for recurrence. After 5 days of heparin, you
wonder how long you should treat him with warfarin:
3 months or 6 months?
PICOT Our Question
Patient / Problem
Intervention
Comparison
Outcome
Type of question
Type of publication
Deep vein thrombosis in 65 y/o male
Heparin (5 days) 3 months of warfarin
Heparin (5 days) 3 months of warfarin
Decreased risk of bleeding and thromboembolic events
Therapy
RCT (or systematic review, meta-analysis)
Clinical Question
In a 65 year old male with deep venous thrombosis (DVT),
after 5 days of heparin, what is the optimum duration of
warfarin therapy: 3 months or 6 months?
EBM Website
PubMed Clinical Queries
Other EBM Resources
Summaries
Syntheses
Synopses
Studies RCTs, cohort studies, case-control studies, etc. e.g., PubMed
Critical Appraisals of Articles e.g., ACP Journal Club
Systematic reviews, meta-analysise.g., Cochrane Database of Systematic Reviews
Critically-appraised evidence-based topicse.g., DynaMed, UpToDate
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Questions? We’re on call….
Candace Moorer, MLISOffice: 2-5167
moorerc@musc.edu
Emily Brennan, MLISOffice: 2-9275
brennane@musc.edu