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"A way of providing health care that is guided by a thoughtful integration of the best available scientific knowledge with clinical expertise. This approach allows the practitioner to critically assess research data, clinical guidelines, and other information resources in order to correctly identify the clinical problem, apply the most high-quality intervention, and re-evaluate the outcome for future improvement." (PubMed MeSH)
Or to put this simpler: " Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision making by emphasizing the use of evidence from well-designed and well-conducted research."
At the top of the pyramid is filtered evidence including systematic reviews, meta-analyses, and critical appraisals. These studies evaluate and synthesize lower level studies together. The top of the pyramid represents the strongest evidence.
At the bottom of the pyramid is unfiltered evidence including randomized controlled trials, cohort studies and case reports. These are individual reports and studies, also known as the primary literature.
While you should seek the highest level of evidence available, remember that evidence at the top of the pyramid might not exist for your particular clinical question. If that is the case, you'll need to move down the pyramid to find the strongest evidence that addresses your clinical question. Another consideration to bear in mind is the human factor. Not all systematic reviews are created equally! Always apply a critical eye to everything you read.
"The formulation of a focused clinical question containing well-articulated PICO elements is widely believed to be the key to efficiently finding high-quality evidence and also the key to evidence-based decisions...Empirical studies have shown that the use of PICO frames improves the specificity and conceptual clarity of clinical problems, elicits more information during pre-search reference interviews, leads to more complex search strategies, and yields more precise search results." (Xiaoli Huang, et al)
How effectively you find your evidence in literature depends upon how well you ask the research question. Use the PICO mnemonic to build that question.
P I C O
P -- patient, population, participant
I -- intervention, therapy
C -- comparison (not always required)
O -- outcome
4 Types of PICO Questions
In children with respiratory infection, is the respiratory rate as effective as chest x-ray in detecting pneumonia?
In premature infants (compared to full-term infants), what is the lifetime prevalence of hearing deficit?
In patients with recurrent infection, do antibiotics, compared to no treatment, reduce recurrence rate?
In post-menopausal women, does hormone replacement therapy increase the risk of breast cancer?
A way of providing health care that is guided by a thoughtful integration of the best available scientific knowledge with clinical expertise. This approach allows the practitioner to critically assess research data, clinical guidelines, and other information resources in order to correctly identify the clinical problem, apply the most high-quality intervention, and re-evaluate the outcome for future improvement (PubMed MeSH).
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Randomized Controlled Trials