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Internal Medicine Portal: EBM

Week to week archive of journal club articles, the learning points discussed, and links to additional resources. For McMaster critical appraisal forms and help, please see the Critical Appraisal tab under EBM or reach out to the librarians.

What is Evidence-Based Medicine?

“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient's unique values and circumstances.”
-Centre for Evidence Based Medicine (CEBM), Toronto, CA

 

THE EBM PROCESS

Assess Assess the patient or problem to determine the pertinent issues.
Ask Ask a clear, answerable question to be pursued.
Acquire Acquire the evidence from an appropriate source.
Appraise Appraise the evidence to further examine its worth and reliability.
Apply Apply the evidence to the particular patient and their unique values and circumstances.
 

Tutorials & Outside Links

Formulating Clinical Questions

General questions or background questions ask for basic knowledge about an illness, disease, condition, test, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

For example

  • What is hairy cell leukemia?
  • What are the adverse effects of Black Cohosh?
  • What is the mechanism of action for dopamine agonists?
  • What causes seizures?
  • What are the diagnostic criteria for Deep Vein Thrombosis?

These types of questions are best answered by medical textbooks, point-of-care tools (e.g. DynaMed Plus, Essential Evidence Plus, Lexicomp, OvidMD), and narrative review articles.

A well-built clinical foreground question should have at least 4 components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query.

P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)

I = Intervention, Prognostic Factor, Test, Exposure (What main intervention are you considering? What do you want to do with this patient? What is the main alternative being considered?)

C = Comparison (What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication,  placebo, or standard of care, or two diagnostic tests?)

O= Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

 Use this chart to help determine the best study to search for during your literature search.


Type of Question


Description


Study Design


  Diagnosis


An evaluation of a test, screening or other assessment such as history or physical exam

 
Prospective, blind comparison to a gold standard. RCT > controlled clinical trial (CCT) > cohort > case control > case series


  Therapy


An evaluation of a therapeutic or preventive intervention


RCT > CCT > cohort >case control > case series


  Prognosis


An evaluation of clinical outcomes over time


cohort > case control > case series

 
  Etiology/Harm


An evaluation of a therapeutic, preventive, screening or diagnostic intervention, or a non-therapeutic exposure or behavior

 
cohort > case control > case series


  Prevention


An evaluation of the effectiveness of an intervention or exposure in preventing morbidity and mortality


RCT > CCT > cohort > case control > case series


  Cost
 


An evaluation of cost versus benefit of a treatment or procedures


Economic analysis, cost-benefit analysis

Another element of the well-built clinical question to consider is the type of study (methodology). This information can be helpful in focusing the question and determining the most appropriate type of evidence.

                   Based on a design by Dahlgren Memorial Library, Georgetown University

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Click on the button below to access the Patient Health Education Portal!

Evidence-Based Medicine

IM Weekly Journal Club Blog

Click the link above to be taken to the Internal Medicine journal club blog with the breakdown of key articles discussed this year

Critical Appraisal Sheets

Click the link above to be taken to the critical appraisal sheets used in methodically evaluating articles for personal use or in journal club

JAMA User's Guide to the Evidence

Click the link above to be taken to the JAMA User's Guide to the Evidence e-book, broken into chapters for ease of access. 

Resources

Click the link above to be taken to evidence-based resources that will help answer your clinical questions.

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After-hours access to the library is available to WRNMMC Staff via the CDO at 301-295-4611.