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

2. 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

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

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

5. 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 Dept. of Pediatrics, University of Michigan.

6. 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

7. 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 Dept. of Pediatrics, University of Michigan.

8. 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.

9. Formulating a Question
Patient or problem
Intervention or exposure
Comparison intervention or exposure (if relevant)
Outcome
Each resident to write question in PICO format for the croup case

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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