The Evidence Based Process
- Translate clinical case into a question
- Formulate methodology
- Evaluate and use the information
The Clinical Question
Consider significant aspects of the clinical situation and build a relevant question that is carefully phrased in order to facilitate the best answer as follows:
PICO: The EBM process begins with formulating an answerable question using the following standard structure:
PATIENT/PROBLEM
INTERVENTION
COMPARISON
OUTCOME
Searching PubMed for Best Evidence
Search by specific clinical study category or for systematic reviews in PubMed:
After running one of these searches, you may further refine your results using PubMed's Limits feature.
Results of searches on these pages are limited to specific clinical research areas. For comprehensive searches, use PubMed directly. offers several filters that retrieve specific types of studies as follows:
A Hierarchy of Strength of Evidence for Treatment Decisions
- Systematic Reviews of Randomized Trials
- Single Randomized Trial
- Systematic Review of Observationaal Studies Addressing Patient-Important Outcomes
- Single Observational Studies Addressing Patient-Important Outcomes
- Physiologic Studies (e.G. studies of blood pressure, cardiac output, exercise capacity, bone density etc.)
- Unsystematic Clinical Observations
What is Evidence Based Practice?
"Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decidion-making."
- Sackett, D.L. Strauss. S. E. Richardson, W.S. et. al. Evidence-Based Medicine: How to Practice and Teach EBM. London: Churchill-Livingstone, 2000.
Evidence-based clinical practice is based upon the traditional process of evidence-based medicine (EBM), for which Dr. David Sackett offers one of the best definitions as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual expertise with he best available external clinical evidence from systematic research."
Evidence-based practice is thus based on formal examination of evidence from clinical research and requires that the professional develop new skills such as effective searching of the literature and application of formal rules of evidence in evaluating the literature itself.
A. Kaji in The Annals of Emergency Medicine defined EBM as an information gathering skill based on knowledge of information resources, generating a clinical question, and application of best evidence to a patient situation. (Evidence-based medicine. A primer for the emergency medicine resident. Ann Emerg Med. 2002 Jan;39(1):77-80).
EBM Web Sites
- BestBETsanswers to very specific clinical problems, using the best available evidence. Each Topic answers a carefully worded 3-part question, using a structured approach to finding and reviewing the literature. BETs are designed specifically for Emergency Medicin
- Centre for Evidence-Based MedicineThe goal is to help develop, disseminate, and evaluate resources taht can abe used to practise and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of disciplines.
- Centre for Health EvidenceThe Centre for Health Evidence (CHE) is a multi-disciplinary initiative that brings universities, health organizations, and professional associations together. CHE supports the learning, teaching, and practice of evidence-based health care.
- Centre for Reviews and DisseminationThe Centre for Reviews and Dissemination (CRD) is part of the National Institute for Health Research (NIHR) and is a department of the University of York. CRD, which was established in 1994, is one of the largest groups in the world engaged exclusively in
- Database of Abstracts of Reviews of Effects (DARE)Over 15,000 abstract summaries of systematic reviews from around thd world on topics absent from Cochrane's. Quality evidence based tool for health care professionals produced by National Health Services Centre (UK)
- eMedicine World Medical LibraryFree and current evidence-based information. Searches can be restricted to a consumer option for information from online textbooks and a growing collection of consumer treatment guidelines. Similar to the subscription evidence-based provider database.
- National Guideline Clearinghousea public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the Amer
- SUMSearchSUMSearch combines meta-searching and contingency searching in order to automate searching for medical evidence. Meta-searching, which is used by from general Internet search engines such as from Go2Net, Dogpile, and SavvySearch.
- Trip Database: Turning Research into PracticeStarted in 1997 as a small search engine with a focus on medial articles consieerd evidence-based. Grown since then to allow health professionals to find the highest quality evidence based resources on the Web.
- Understanding Evidence-based Healthcare: A Foundation for ActionA web course from the United States Cochrane Center and Consumers United for Evidence-based Healthcare (CUE), to help consumer advocates understand the fundamentals of evidence-based health care. Monthly course registration for a three-month long course.
- PEDro - Physiotherapy Evidence DatabaseProduced by Centre for Evidence Based Physiotherapy, provides access to bibliographic information and abstracts of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy and rates the evidence and quality of clinical trials. Offers "Advanced" search mode, pre-selected subject category terms and search limits i.e. type of study.
Electronic Books on Evidence Based Practice
Pyramid of Evidence
Jan Glover, Dave Izzo, Karen Odato, and Lei Wang. Trustees of Dartmouth college and Yale university. 2006. EBM Page Generator. 26 March 2010. http://www.ebmpyramid.org/help.php
