How to Practice Evidence-Based Medicine

Anna Donald, MD, MPP

Introduction

This article is the second in a 3-part series. The third and final article will identify practical ways of making your team and organization evidence-based. [Part 1, entitled "Evidence-Based Medicine: Key Concepts," was posted on Medscape General Medicine April 2, 2002, and is available at
http://www.medscape.com/viewarticle/430709.]

Being an evidence-based medicine specialist requires in-depth knowledge of epidemiology and other research methods. It also requires working with a multidisciplinary team that has the appropriate skills and experience. Thankfully, however, it is not necessary to dedicate your life to evidence-based medicine to use it in your work. Just as you might use the materials and concepts of hematology, radiology, and other medical specialties in your daily practice, you can also use materials and concepts of evidence-based medicine.

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Cite this: How to Practice Evidence-Based Medicine - Medscape - Jan 31, 2003.

Table 1. Questions That Evidence-Based Medicine Can Help to Answer
Specific Question	EBM Category
What is the chance that fibrates will reduce coronary mortality in women with isolated low HDL cholesterol?	Treatment question
What is the chance that cell phones cause cerebral tumors?	Risk factor question
What is the chance that raised PSA correctly diagnoses prostate cancer in men over 60 years of age without urinary symptoms?	Diagnostic test question
What is the chance that a child living in an urban area has asthma?	Prevalence question
What is the chance in a given year of dying in an accident if you have untreated epilepsy?	Incidence question

Table 2. Sources of Evidence-Based Information
Bibliographic (Web) Source	URL
BMJ Publishing Group Clinical Evidence	www.clinicalevidence.com
The Cochrane Library (Issue 1, 2003)	www.update-software.com/abstracts/mainindex.htm
ACP Journal Club	www.acpjc.org
Agency for Healthcare Research and Quality	http://www.ahcpr.gov/
The University of York NHS Centre for Reviews and Dissemination	http://agatha.york.ac.uk/welcome.htm
The TRIP database	http://www.tripdatabase.com

Table 3. Guides to Searching, Appraising, and Synthesizing the Literature
Evidence-Based medicine: Finding the best clinical literature. Web site from the University of Chicago. Available at: http://www.uic.edu/depts/lib/lhsp/resources/ebm.shtml
Greenhalgh T. How to Read a Paper: the Basics of Evidence Based Medicine. London, UK: British Medical Journal Publishing Group; 2001.
Guyatt G, Rennie D. User's Guide to the Medical Literature: Essentials of Evidence-Based Clinical Practice. Philadelphia, Pa: American Medical Association; 2001.
Muir Gray JA. Evidence-Based Healthcare: How to Make Health Policy and Management Decisions. Edinburgh, UK: Churchill Livingstone; 2001.
Practising EBM: Five Steps. Web site from Mount Sinai Hospital, Toronto, Canada. Available at: http://www.cebm.utoronto.ca/practise/
Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology. A Basic Science for Clinical Medicine. Boston, Mass: Little Brown & Company; 1991.
Sackett D, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. Edinburgh, UK: Churchill Livingstone; 1997.

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How to Practice Evidence-Based Medicine

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