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Evidence-Based Medicine: Examples of EBM in Action

A basic introduction to the history and steps of evidence-based medicine, with a focus on the EBM resources held by the Whittemore Library.

EBM in Action: EAST's Practice Management Guidelines

The Eastern Association for the Surgery of Trauma (EAST) has created 'Practice Management Guidelines' to provide its members with evidence-based information meant to promote best practices.

Below is a link to one EAST Guideline focusing on the prevention of falls in the elderly.  Reading this document will give you a feel for how EBM can be used to find and assess the available evidence. At the same time it highlights the limits of EBM; there is not always a plethora of evidence. 

Pay particular attention to the list of PICO questions (and the conclusions for each one) that were generated during the writing of this Guideline.

 

Prevention of Fall-Related Injuries in the Elderly

EBM in Action: An Open-Access Cochrane Systematic Review

The Cochrane Collaboration, named after EBM pioneer Archie Cochrane, creates systematic reviews of the highest quality.

Cochrane Review Groups located around the world carry out EBM by formulating clinical questions, collecting and appraising the available evidence in the form of Randomized Controlled Trials, then conducting rigorous systematic reviews.  At such time as new evidence becomes available, the review authors will update the document.

While the collected systematic reviews (as well as other databases Cochrane produces) are available as a subscription product, some reviews have been made freely-available. Below, you will see a link to one such review.

If you want to see a really well-done systematic review (the type of study considered the highest level of evidence in the EBM process) is done, read through the review below - you will be impressed by the rigorous methodology behind Cochrane reviews.

 

Probiotics for prevention of necrotizing enterocolitis in preterm infants

EBM in Action: Royal Manchester Hospital's BestBETs

BETs (Best Evidence Topic) were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. As the site itself says:  "Evidence Based Medicine (EBM) is an approach to medical decision making that acknowledges our need to be informed by a comprehensive summary of the best scientific evidence, appraised systematically and expertly, without bias."

Keep in mind, though, that these documents, while helpful, are not complete systematic reviews.

It is also noted that the BET method allows the use of lower quality research (which is sometimes the only research available),in which case the shortcomings of the evidence used are acknowledged.

As with other forms of EBM topic review, each BET has a clinical "bottom line" for the busy physician.

 

BestBETs