LIBRARYSKILLSUCL Evidence based resources 1 Evidence Based Medicine

LIBRARYSKILLS@UCL Evidence based resources 1 Evidence Based Medicine and the Cycle of Evidence Library. Skills@UCL www. ucl. ac. uk/library/skills libraryskills@ucl. ac. uk

Learning outcomes By the end of this video, you will: § Understand the concept of Evidence Based Medicine. § Be aware of the importance of finding the appropriate evidence to support your clinical decision making in evidence based practice. § Understand the 5 steps that are required to complete the process of evidence based clinical practice. § Appreciate the usefulness of pre-appraised resources in finding high quality evidence to support patient care.

What is Evidence Based Medicine? “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. ” -- Sackett et al BMJ 1996; 312: 71 -72 (13 January).

EBM Triad Sackett, et al. defined Evidence-Based Medicine as “the integration of best research evidence with clinical expertise and patient values”. -- Sackett DL, Straus SE, Richardson WS, Rosenberg W Haynes RB. "Evidence-based Medicine: How to Practice and Teach EBM". Edinburgh: Churchill Livingstone. Clinical judgement /expertise Best external evidence EBM Patient values & expectations Sackett DL, Rosenberg WMC, Gray JAM, Hayens RB. Evidence based medicine: what it is and what it isn’t. BMJ. 1996; 312: 71– 72. doi: 10. 1136/bmj. 312. 7023. 71

Evidence Based Practice “EBM is nothing more than a process of life-long, selfdirected learning in which caring for patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues. ” -- The EBM Working Group.

Evidence Based Practice Cycle R T Erasmus, A E Zemlin (2009). Clinical audit in the laboratory. J Clin Pathol 62: 593 -597

Levels of Evidence Pre-appraised resources Evidencebased Guidelines (including evidence-based clinical summaries, patient pathways) Systematic reviews “Pre-appraised literature is that which uses an explicit review process to find appraise evidence. ” Best research design as determined by question type (Chapa, Hartung & Mayberry, 2013). Treatment RCTs Diagnosis Etiology/Harm Crosssectional studies Cohort/case control Prognosis Cohort studies Expert opinion, review articles, lab studies, comments, letters etc Academy of Nutrition & Dietetics. Academy Evidence Analysis Manual. Available at: https: //www. andeal. org/vault/2440/web/files/2016_April_EA_Manual. pdf. Accessed 15/10/18

We have covered: • Some definitions of Evidence Based Medicine / Practice • The evidence audit / cycle. • The pyramid / hierarchy of research evidence. • The relevance of pre-appraised resources in the context of clinical practice.

libraryskills@UCL www. ucl. ac. uk/library/skills