Evidence-Based Medicine

in the Library

Rebecca Burbank Nov. 22nd, 2013

Learning Objectives

• What is Evidence-Based Medicine

(EBM)?

• How can the Library support EBM

practitioners?

• What are a few helpful tools and

resources?

Evidence-Based Medicine

• Founded in statistics and systematic

review

• Focused on individual patients

Duke MCLA &UNC Health Sci Library

(2013). Introduction to evidence-

based practice. Retrieved from

http://guides.mclibrary.duke.edu/eb

mtutorial

EBM is “the conscientious, explicit and

judicious use of current best evidence

in making decisions about the care of

the individual patient. It means

integrating individual clinical expertise

with the best available external clinical

evidence from systematic research.”

(Sackett, 1996)

Why do practitioners need EBM?

• Improved healthcare

• The need for proven practices in

medicine

• Standardization of practices

• Reduction of unnecessary care and

costs

Practicing EBM

• Craft a clinical question

• Search the medical literature

• Identify the best study for the query

• Critically appraise the study

• Determine the clinical application

• Evaluate your individual results

Mayer, D. (2004). Essential evidence-

based medicine. Cambridge, UK:

Cambridge University Press.

Evidence Cycle

Assess

Ask

Acquire Appraise

Apply

Patient

Duke MCLA &UNC Health Sci Library

How can we help you?

Librarians support EBM by teaching users…

– To decode their clinical scenarios • Define search query, identify alternate terms,

what is MeSH?

– Identification of appropriate sources • Do I need a cohort study or an RCT?

– Appraisal of literature • Look for bias in studies, determine validity

Problem Area

Formulating a

research question

PICO

CEBM

Patient or

Problem

Intervention or

Indicator

Comparison

or Control

Outcomes

Tips for

Building

How would I

describe a

group of

patients like

mine?

Balance

precision

with brevity.

Which main

intervention am I

considering?

Be specific.

What is the main

alternative to

compare?

Be Specific.

What do I

hope to

accomplish?

Patient specific

outcomes.

Be specific.

Clinical Scenario

Mathew is a 16 year old who suffers with

major depressive disorder. He is currently

receiving cognitive-behavioral therapy

and wants to know if adding psychiatric

medication (like selective serotonin re-

uptake inhibitors or SSRIs) to his treatment,

will improve his treatment outcome.

Patient or

Problem Intervention

Comparison

or Control Outcomes

Adolescent

AND MDD

SSRIs AND

CBT

CBT

Improve

treatment

Clinical Query

Patient or

Problem Intervention

Comparison

or Control Outcomes

Example Adolescent

Depression

OR

Adolescent

“major

depressive

disorder”

SSRIs AND (CBT

OR

psychotherapy)

CBT OR

psychotherapy

Reduced

depression

OR improved

treatment

Would combining SSRIs and CBT improve

treatment in an adolescent with major

depressive disorder, when compared to CBT

alone?

Questions : Foreground vs.

Background

Amount of expertise

Background

questions

asked

Adolescent depression SSRIs

Psychotherapy OR CBT Improved treatment

Clinical Scenario

Ms. Baxter is a 60 year old woman with

osteoarthritis of the hip. Her daughter

has given her a magnetic bracelet to

relive the hip pain. Ms. Baxter is

skeptical and asks you, her physical

therapist, if there is any evidence to

support this.

Duke MCLA &UNC Health Sci Library

Patient or

Problem Intervention

or Indicator

Comparison

or Control Outcomes

Adult

woman

Magnets OR Magnetic

bracelets

N/A

Reduced

pain

Which is the Best Question?

A. Do magnets relive pain?

B. In women, do magnets reduce pain

from osteoarthritis of the hip?

C. In women, do magnetic bracelets

reduce pain from arthritis?

Clinical Scenario

Edith is a 85 year old woman who has

periods where she cannot remember

words or how to speak (aphasia). Her

husband asks her doctor if they should

be worried about Alzheimer's disease.

Patient or

Problem Intervention

or Indicator

Comparison

or Control Outcomes Woman

elderly Aphasia

No aphasia

Alzheimer's

OR

dementia

Clinical Query

Patient or

Problem

Intervention

or Indicator

Comparison

or Control

Outcomes

Example Elderly

women

Aphasia OR

“memory lapse”

No aphasia Alzheimer's

OR dementia

What is the frequency of Alzheimer’s disease

amongst elderly women who are experiencing

aphasia?

Recap

• EBM is the balance of patient’s interests, clinical expertise, and best available evidence

• The library can teach PICO to guide the research process and create clinical queries

• The Trip search engine can be used to satisfy both background and foreground questions

Thank You

Be sure to stop in for the next installment

EBM in the Library: Analyzing Statistical

Strength

This presentation can be found on slideshare!

@beckyburbank

References

• CEBM (2009). Asking focused questions. Retrieved November 19, 2013 from http://www.cebm.net/?o=1036

• Duke MCLA &UNC Health Sci Library (2013). Introduction to evidence-based practice. Retrieved November 19, 2013 from http://guides.mclibrary.duke.edu/ebmtutorial

• Mayer, D. (2004). Essential evidence-based medicine. Cambridge, UK: Cambridge University Press.

• Sackett, D. L., Rosenberg, W. M. C., Muir, G. J. A., & Brian, H. R. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71.

• Welty, E., Hofstetter, S., & Schulte, S. J. (2012). Time to re-evaluate how we teach information literacy: Applying PICO in library instruction. CRL News, 73(8), 476-477.