An Introduction to Evidence-Based Practice (EBP) Nader Shaikh MD MPH Russ Kolarik MD MPH Updated 1-10-11

Goals Describe the process of EBP Construct answerable questions Describe strategies to search efficiency Identify resources for critical appraisal Become familiar with the CAT presentation

Session Format Background Clinical case Formulating a question Searching the literature Appraising the literature Guidelines & expectations for presentations

EBP - Process Frohna JG, Park SM, Pituch KJ. Integrating Evidence- Based Medicine into The Curriculum. May 2003. Dept. of Pediatrics, University of Michigan.

What is Evidence- Based Practice? Decision based on all three components Patient preferences Clinical expertise Research evidence Frohna JG, Park SM, Pituch KJ. Integrating Evidence- Based Medicine into The Curriculum. May 2003. Dept. of Pediatrics, University of Michigan.

Why is EBP important? Traditional sources can be inaccurate or out-dated Blindly following ‘expert’ opinion not ideal Allows us to recognize the strength of evidence behind recommendations Sackett et al. Evidence –Based Medicine How to Practice and Teach EBM 2ndEd. 2000

EBP Not a fad Not blind application of evidence to all patients Not “Cookbook Medicine” Not blind application of evidence to all patients Conscientious use of evidence- integrated with clinical expertise and patient values Not a fad Frohna JG, Park SM, Pituch KJ. Integrating Evidence- Based Medicine into The Curriculum. May 2003. Dept. of Pediatrics, University of Michigan.

Clinical Case You are seeing a 2 year old male for croup. You are thinking of giving him steroids, but are unsure if there is proven benefit.

Formulating a Question Patient or problem Intervention or exposure Comparison intervention or exposure (if relevant) Outcome http://cebm.jr2.ox.ac.uk Each resident to write question in PICO format for the croup case

Searching for Evidence Find your HSLS password Decide where to start your search Decide on your search terms and limits Each resident to write down search strategy. The we can try a few online

Where to start your search Examples Computerized decision support systems Clinical Evidence, Evidence based journals, Up to Date Systems Synopses Syntheses Cochrane review Original articles Studies Haynes RB, Levels of Evidence

How to Find Summarized Evidence Cochrane Database of Systematic Reviews Cochrane Register of Controlled trials Database of abstracts of Reviews Clinical queries Clinical evidence Limit to meta-analysis Secondary journals Guidelines

Appraising the literature User’s Guides Critical appraisal essentials (table) Assess quality of the evidence (table) Get help from faculty Show sample user’s guide, Appraisal table, and quality of evidence table Walk residents through appraisal of a bad article on croup using the 2 tables

Presentation of evidence CAT = Critically Appraised Topic CAT components Question Search strategy Evidence found (summarized) Quality of the evidence Bottom line CAT evaluation sheet Cat Bank Show CAT example and template and CAT evaluation sheet

Conclusion EBP will allow you to… Integrate current evidence into patient care Stay up to date with the literature Deliver better care to your patients