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Evidence Based Medicine (EBM)

Resources and Information related to the field and practice of Evidence Based Medicine (EBM)

 

The first step of EBM is to assess the patient, situation, and clinical need.  In this stage you still assess the patient to determine all the pertinent issues - this may include a differential diagnosis, treatment decisions, or prognosis. 

A common fallacy is that EBP devalues the fundamental tenets of the practice of medicine, specifically clinical expertise.  A comprehensive understanding of pathophysiology and clinical examination skills still remain integral to the EBM process. 

The Assess stage allows you, the clinician, to determine if you need to proceed to the Ask stage. You must determine through expertise, history taking, and patient interaction what type of clinical question is under investigation. 

 

CLINICAL QUESTIONS

During the assess phase, you should evaluate the clinical situation to determine whether your question/investigation is asking a background or foreground question. Knowing the type of clinical question you are investigating helps you to determine the best research strategy and resources to answer the question.

 

BACKGROUND QUESTIONS

  • Concern well-documented or well-known knowledge in the field 
  • Generally, have two parts
    • A question root (who, what, where, when, why)
    • a disorder, test, treatment, or other healthcare aspects
  • These questions are often best answered with handbooks, textbooks, point-of-care tools, charts, or standard procedure

Examples

  •  What are the clinical manifestations of menopause?
  • What causes migraines?

FOREGROUND QUESTIONS

  • Highly specific knowledge questions that affect clinical decision making
  • They include a broad range of biologic, psychological, and sociological issues
  • Generally answered by searching the primary medical literature (databases)
  • These questions usually involve specific patients, populations, or healthcare related problems
  • They usually investigate comparisons (two treatments, two preventative measures, two drugs)
  • These are the questions involved in the EBM process and need to go through the PICO process

Examples

  • Does hand washing among health care workers reduce the rates of hospital-acquired infection?
  • In pediatric patients with Allergic Rhinitis, are intranasal steroids more effective than antihistamines in the management of Allergic Rhinitis symptoms?