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Evidence-based Practice in Healthcare

This guide is designed to assist health care professionals and students become effective and efficient users of the medical literature.

Introduction to Study Design

Once you have your question, the next step is to think about about kind of study would work best with your question.

  1. Is your question trying to describe a population OR analyze factor relationships?
    • I'm describing a population = descriptive study or qualitative research; you may even look into an observational study
    • I'm analyzing factors = analytic study and will match into a PICO format (See second chart)

flow chart for study types: descriptive vs. analytics. Qualitative vs. quantitative

Centre for Evidence-Based Medicine. Retrieved on August 24, 2016 from http://www.cebm.net/study-designs/. 

This chart further explains the Analytic Research possibilities.

flow chart that further explains study types, specifically analytical studies. experimental vs. observational.

Primary & Secondary Research & Study Designs

Type of Question

Type of Study/Methodology

MEDLINE Filters

Therapy: information needed about treatments (effectiveness, cost, etc.) 

Double-Blind
Randomized Controlled Trial 

Randomized Controlled Trial [PT]
double [TW] and blind [TW] 

Diagnosis: information needed about a diagnostic test (sensitivity, accuracy, etc.)

Controlled Trial

Sensitivity and Specificity [MH]
Diagnosis [SH] 

Prognosis: information needed about the course of the disease over time, expected complications, etc. 

Cohort Studies
Case Control
Case Series 

Cohort Studies [MH]
Prognosis [MH]
Survival Analysis [MH] 

Etiology/Harm: information needed about causes of disease or contributing factors of disease

Cohort Studies

Cohort Studies [MH]
Risk [TW] 

Prevention: information needed about the prevention of disease (immunization, social factors, etc.)

Randomized Controlled Trial
Cohort Studies  

Randomized Controlled Trial [PT]
Cohort Studies [MH]
Prevention and Control [SH]

Quality Improvement: information needed about clients' and health professionals' experiences and concerns

Randomized Controlled Trial

Randomized Controlled Trial [PT]
Practice Guideline [PT]
Consensus Development Conference [PT]  

(Abbreviations: MH=Medical Subject Heading; PT=Publication Type; SH=Subheading; TW=Text Word)

The practice and teaching of Evidence-Based Medicine has outcome products which help the health care provider and consumer keep up with the medical literature and assess the evidence. This secondary literature synthesizes, filters, and evaluates the primary research literature. Dissemination and incorporation of valid clinical research findings into medical practice is the ultimate goal.

  • Systematic Reviews                                               
  • Meta-Analyses                                                           
  • Critically Appraised Topics                                                                      
  • Decision Analyses/Decision Tools
  • Evaluated Bibliographic Databases
  • Practice Guidelines
  • Consensus Development Reports

Filtered or Synthesized Information

Description/Definition

How To Find This Type of Information

 

 

Systematic Reviews

-differ from traditional review articles in that conclusions are evidence-based rather than commentary

-start with a clearly articulated question

-use explicit, rigorous methods to identify, critically appraise, and synthesize relevant studies

-appraise relevant published and unpublished evidence before combining and analyzing data

-include description of how primary data sources are identified

-assess individual studies for validity

*Cochrane Collaboration
-Cochrane Database of Systematic Reviews
-York Database of Abstracts of
Reviews of Effectiveness
-Cochrane Controlled Trials Register
-Cochrane Review Methodology Database

*In MEDLINE:
-Review [PT] AND medline [TW]
-(Quantitative OR Systematic OR Methodologic)
AND (Review OR Overview)

*In PubMed Clinical Queries "Systematic Review" is available as a limit option.

 

Meta-Analyses

-specific methodologic and statistical technique for combining quantitative data

-type of systematic overview

*Cochrane Collaboration

*In MEDLINE:
-Meta-analysis [PT]
-meta-anal* [TW] OR
-metaanal* [TW]

 

 

Evidenced-based Practice Guidelines

-gather, appraise, combine evidence systematically

-include statements designed to assist practitioner and patient decisions

-developed by professional groups, government agencies, local practices

-include a structured abstract: objective, option, outcomes, evidence, values, benefits/harms/costs, recommendation, validation, sponsors

 

*National Guideline Clearinghouse

*Agency for Healthcare Research and Quality

*US Preventive Services Task Force Recommendations

 

 

Critically Appraised Topics (CATs)

-scan literature for clinically relevant studies

-critically appraise the studies

-provide commentary on strength of study and clinical significance

-provided in a one-page format

*EBM Reviews -- ACP Journal Club (UIC access via Journals)

*Essential EvidencePLUS - InfoPOEMS -- (UIC access via Databases A-Z)

 

Decision Analyses

-studies that analyze decisions faced by clinicians for an individual patient, about clinical policy, or a global health care policy

-application of explicit, quantitative methods to analyze decisions under conditions of uncertainty

-risks and benefits of a decision are made fully explicit

-decision tree is included

*In MEDLINE:

-Decision Support Techniques [MH]

-Cost-Benefit Analysis [MH]

-decision analysis [TI]