1. Evidence Based Medicine Searching for Evidence

2. Evidence Based Practice: Steps 1.A sk focused clinical question 2.S earch for the best evidence 3.A ppraise/assess the evidence 4.A pply results in practice 5.E valuate results

3. What Evidence is Best? Meta- Analyses Systematic Reviews Randomized Controlled Trials Cohort Studies Case-Control Studies Case Series, Case Reports

4. Question Types  Study Types Question TypeBest Study Type Diagnosis Prospective, blind comparison to a gold standard Therapy RCT > cohort > case control > case series Prognosis Cohort study > case control > case series Harm/Etiology RCT > cohort > case control > case series Prevention RCT > cohort study > case control > case series

5. Clinical Scenario After routine surgery, a 65 year old male presents with deep vein thrombosis. He has no past history of DVT and no known risk factors for recurrence. After 5 days of heparin, you wonder how long you should treat him with warfarin: 3 months or 6 months?

6. PICOT Our Question P atient / Problem I ntervention C omparison O utcome T ype of question T ype of publication Deep vein thrombosis in 65 y/o male Heparin (5 days)  3 months of warfarin Decreased risk of bleeding and thromboembolic events Therapy RCT (or systematic review, meta-analysis)

7. Clinical Question In a 65 year old male with deep venous thrombosis (DVT), after 5 days of heparin, what is the optimum duration of warfarin therapy: 3 months or 6 months?

8. EBM Website

9. PubMed Clinical Queries

10. Other EBM Resources Summaries Syntheses Synopses Studies RCTs, cohort studies, case-control studies, etc. e.g., PubMed Critical Appraisals of Articles e.g., ACP Journal Club Systematic reviews, meta-analysis e.g., Cochrane Database of Systematic Reviews Critically-appraised evidence-based topics e.g., DynaMed, UpToDate Higher level of evidence Least time-consuming

14. Questions? We’re on call…. Candace Moorer, MLIS Office: 2-5167 moorerc@musc.edu Emily Brennan, MLIS Office: 2-9275 brennane@musc.edu