Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. This article provides simple ways to practice everyday EBM by (1) asking patient-specific clinical questions, (2) finding the most relevant, best evidence, (3) critically appraising evidence to ensure validity, (4) applying evidence to practice, and (5) using available tools to stay abreast of relevant and valid evidence as it becomes available.
SackettDLRosenbergWMGrayJAEvidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71–72.
2.
American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy. 2008;28(6):816–817.
3.
PrasadVGallVCifuA. The frequency of medical reversal. Arch Intern Med. 2011;171(18):1675–1676.
4.
DarenbergJIhendyaneNSjölinJIntravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2003;37(3):333–340.
5.
StevensDL. Dilemmas in the treatment of invasive Streptococcus pyogenes infections. Clin Infect Dis. 2003;37(3):341–343.
6.
EstellatCRavaudP. Lack of head-to-head trials and fair control arms: randomized controlled trials of biologic treatment for rheumatoid arthritis. Arch Intern Med. 2012;172(3):237–244.
7.
LeGrandSBLeskuskiDZamaI. Narrative review: furosemide for hypercalcemia: an unproven yet common practice. Ann Intern Med. 2008;149(4):259–263.
8.
de LorgerilMSalenPAbramsonJCholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal. Arch Intern Med. 2010;170(12):1032–1036.
9.
YudkinJSLipskaKJMontoriVM.The idolatry of the surrogate. BMJ. 2011;343:d7995.
10.
BernardGRVincentJLLaterrePFEfficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344(10):699–709.
11.
RanieriVMThompsonBTBariePSDrotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366(22):2055–2064.
12.
van den BergheGWoutersPWeekersFIntensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–1367.
13.
FinferSChittockDRSuSYIntensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–1297.
14.
Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF). Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287(12):1531–1540.
15.
O'ConnorCMStarlingRCHernandezAFEffect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32–43.
16.
RizzoJDLichtinAEWoolfSHUse of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. Blood. 2002;100(7):2303–2320.
17.
RizzoJDBrouwersMHurleyPAmerican Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer. Blood. 2010;116(20):4045–4059.
18.
NissenSEWolskiK. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457–2471.
19.
NissenSEWolskiK. Rosiglitazone revisited: an updated meta-analysis of risk for myocardial infarction and cardiovascular mortality. Arch Intern Med. 2010;170(14):1191–1201.
20.
HomePDPocockSJBeck-NielsenHRosiglitazone evaluated for cardiovascular outcomes--an interim analysis. N Engl J Med. 2007;357(1):28–38.
21.
HomePDPocockSJBeck-NielsenHRosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet. 2009;373(9681):2125–2135.
22.
JernbergTJohansonPHeldCAssociation between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA. 2011;305(16):1677–1684.
23.
PrasadMChristieJDBellamySLThe availability of clinical protocols in US teaching intensive care units. J Crit Care. 2010;25(4):610–619.
24.
TatsioniABonitsisNGIoannidisJP. Persistence of contradicted claims in the literature. JAMA. 2007;298(21):2517–2526.
25.
DawesMSummerskillWGlasziouPSicily statement on evidence-based practice. BMC Med Educ. 2005;5(1):1.
26.
RosenbergWDonaldA. Evidence based medicine: an approach to clinical problem-solving. BMJ. 1995;310(6987):1122–1126.
27.
RichardsonWSWilsonMCNishikawaJThe well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123(3):A12–A13.
28.
WiltonNKSlimAM. Application of the principles of evidence-based medicine to patient care. South Med J. 2012;105(3):136–143.
29.
Centre for Evidence Based Medicine. EBM tools: Asking focused questions. http://www.cebm.net/index.aspx?o=1036. Updated 07 April 2009, Accessed May 20, 2011.
30.
GuyattGRennieD, EDS. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd ed. Chicago, IL: American Medical Association; 2002.
GuyattGHNorrisSLSchulmanSAmerican College of Chest Physicians. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):53S–70S.
33.
HoogendamAde Vries RobbéPFOverbekeJPM. Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. J Med Lib Assoc. 2012;100(2):121–126.
34.
HuangXLinJDemner-FushmanD.Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006;2006:359–363.
35.
SchardtCAdamsMBOwensTUtilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16.
36.
ElyJWOsheroffJAEbellMHObstacles to answering doctors' questions about patient care with evidence: qualitative study. BMJ. 2002;324(7339):1–7.
37.
NathanJPGimS. Responding to drug information requests. Am J Health Syst Pharm. 2009;66(8):706–711.
38.
HoogendamAStalenhoefAFHde Vries RobbéPFAnswers to questions posed during daily patient care are more likely to be answered by UpToDate than PubMed. J Med Internet Res. 2008;10(4):e29.
39.
BanziRCinquiniMLiberatiASpeed of updating online evidence based point of care summaries: prospective cohort analysis. BMJ. 2011;343:d5856.
40.
BanziRLiberatiAMoschettiIA review of online evidence-based practice point-of-care information summary providers. J Med Internet Res. 2010;12(3):e26.
41.
HowickJChalmersI, Glasziou P, et al. for the OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine.http://www.cebm.net/index.aspx?o=5653. Accessed June 8, 2012.
42.
HaywardRSWilsonMCTunisSRUsers' guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The evidence-based medicine working group. JAMA. 1995;274(7):570–574.
43.
SlawsonDCReedSW. Finding high-quality review articles. Am Fam Physician. 2009;79(10):875–877.
44.
GloverJIzzoDOdatoKThe EBM page generator. Trustees of Dartmouth College and Yale University. http://www.ebmpyramid.org/. Accessed August 5, 2012.
45.
TunisSRStryerDBClancyCM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290(12):1624–1632.
46.
Primer on type I and type II errors. Eff Clin Pract. 2001;4(6):284–285.
47.
Primer on statistical significance and P values. Eff Clin Pract. 2001;4(4):183–184.
48.
Primer on 95% confidence intervals. Eff Clin Pract. 2001;4(5):229–233.
49.
SchulzKAltmanDMoherD. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(1):18.
50.
AltmanDGSchulzKFMoherDThe revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663–694.
51.
BeggCChoMEastwoodSImproving the quality of reporting of randomized controlled trials. JAMA. 1996;276(8):637–639.
52.
VandenbrouckeJPVon ElmEAltmanDGStrengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. PLoS Med. 2007;4(10):e297.
53.
Von ElmEAltmanDGEggerMThe strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007;85(11):867–872.
54.
LiberatiAAltmanDGTetzlaffJThe PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–e34.
55.
MoherDLiberatiATetzlaffJPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
56.
CookDJJaeschkeRGuyattGH. Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group. J Intensive Care Med. 1992;7(6):275–282.
57.
SlawsonDCShaughnessyAFBennettJH. Becoming a medical information master: Feeling good about not knowing everything. J Fam Pract. 1994;38(5):505–513.
58.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The antihypertensive and lipid-lowering treatment to prevent heart attack trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA. 2002;288(23):2981–2997.
59.
KasteleinJJAkdimFStroesESSimvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358(14):1431–1443.
60.
AltmanDG. Confidence intervals for the number needed to treat. BMJ. 1998;317(7168):1309–1312.
61.
BenderR. Calculating confidence intervals for the number needed to treat. Control Clin Trials. 2001;22(2):102–110.
