PRINCIPLES OF

EVIDENCE BASED
MEDICINE

INTRODUCTION
Complex health problems
Development
of
science
and
technology
Increasing demand for high quality
health care

Health care professionals are required

to base clinical decisions on the best
available evidence (epidemiological,
clinical and laboratory)

WHAT IS
EVIDENCE BASED MEDICINE?
Evidence Based Medicine (EBM) defined
as the integration
between the best
research evidence and clinical expertise
and patient values.
Information overload lost of translation
EBM allows the integration of good
quality published evidence with clinical
and laboratory expertise and the opinions
and values of the patients and their
families.

Patients
Values and
preference

Knowledge
Experience
Skills

Best available evidence

CLINICAL
DECISION

WHY
EVIDENCE BASED
MEDICINE?
To improve quality of health care through
the identification and promotion of the
best
information, and to eliminate of
those ineffective or harmful ones.
EBM promotes effectiveness of:
clinical interventions
the accuracy and precision of diagnostic tests
the power of prognostic markers

Health care professionals should develop

the key EBM skills; find, critically
appraise, and use scientific evidence into
their own practice.

THE FIVE STEP OF EBM

Formulating answerable
questions
Finding the evidence
Appraising the evidence
Applying the evidence
Evaluating performance

clinical

Formulating Answerable Clinical

Questions
Good clinical questions should have 4
essential components:
the Patients or problem in questions;
the Intervention, test, or exposure of
interest;
Comparison interventions (if relevant);
the Outcome, or outcomes of interest.

Finding the Evidence

Traditional sources of information
asking colleagues or expert
textbooks or journals

Online electronic database

Medline
Pubmed
Embase
Cochrane library

Hierarchy of evidence

Systematic
review with
or without metaanalysis
RCTs
Cohort studies
Case-control studies
Case series
Case reports
Opinion

Appraising the Evidence

Appraise the evidence for its validity,
importance and clinical usefulness.
Remember!!! the quality of information is
variable.
How to develop critical appraisal?
skill for asking a few key questions about validity
and its relevance
basic knowledge on the topics

Using
CASP
programs)

(critical

appraisal

Systematic reviews and meta-analysis

RCT, cohort or case-control

skills

Applying the Evidence

Its important to take into account the

patients own personal values.
Therapeutic alliance should be
formed with the patients and families.
The cost and the availability of the
services

Evaluating the Performance

Evaluate our practice at frequent intervals.

Change or improve your practice according
to the newest and best evidence.

CASE
4 month old baby admitted to the hospital with viral
bronchiolitis. The childs.symptoms get progressively worse
and you wonder whether giving corticosteroids might help
the child improve and reduce the length of stay in hospital.
You decide to use clinical score as a measure of
improvement. The clinical question would be:
Patient problem: 4 month old baby with viral
bronchiolitis.
Intervention: corticosteroids.
Comparison: no corticosteroids.
Outcomes: clinical score, length of hospital stay.
Formulation of clinical question:
In a 4 month old baby with viral bronchiolitis, does the
administration of corticosteroids compared with not
giving corticosteroids improve clinical score and reduce
length of hospital stay.

Several groups have been

leaders in Evidence
Based
Medicinein promoting the
Their initiatives
practice of EBM are numerous and are
detailed in various sections of this
guide.
1.
Agency for Healthcare Research and Quality
(AHRQ)
http://www.ahrq.gov/
2. Centre for Evidence Based Medicine
http://www.cebm.net/
3. Cochrane Collaboration--dedicated to the
creation, review,
maintenance and dissemination of
systematic overviews of
the effects of health care