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EBM in the Library - PICO


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Learn about Evidence Based Medicine and the PICO search model

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EBM in the Library - PICO

  1. 1. Evidence-Based Medicine in the Library Rebecca Burbank Nov. 22nd, 2013
  2. 2. Learning Objectives • What is Evidence-Based Medicine (EBM)? • How can the Library support EBM practitioners? • What are a few helpful tools and resources?
  3. 3. Evidence-Based Medicine • Founded in statistics and systematic review • Focused on individual patients Duke MCLA &UNC Health Sci Library (2013). Introduction to evidencebased practice. Retrieved from
  4. 4. EBM is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett, 1996)
  5. 5. Why do practitioners need EBM? • Improved healthcare • The need for proven practices in medicine • Standardization of practices • Reduction of unnecessary care and costs
  6. 6. Practicing EBM • • • • • • Craft a clinical question Search the medical literature Identify the best study for the query Critically appraise the study Determine the clinical application Evaluate your individual results Mayer, D. (2004). Essential evidencebased medicine. Cambridge, UK: Cambridge University Press.
  7. 7. Evidence Cycle Assess Ask Apply Patient Acquire Appraise Duke MCLA &UNC Health Sci Library
  8. 8. How can we help you? Librarians support EBM by teaching users… – To decode their clinical scenarios • Define search query, identify alternate terms, what is MeSH? – Identification of appropriate sources • Do I need a cohort study or an RCT? – Appraisal of literature • Look for bias in studies, determine validity
  9. 9. Problem Area Formulating a research question
  10. 10. PICO Patient or Intervention or Comparison Outcomes Problem Indicator or Control Tips for Building How would I describe a group of patients like mine? Which main intervention am I considering? What is the main What do I alternative to hope to compare? accomplish? Patient specific outcomes. Balance precision with brevity. Be specific. Be Specific. CEBM Be specific.
  11. 11. Clinical Scenario Mathew is a 16 year old who suffers with major depressive disorder. He is currently receiving cognitive-behavioral therapy and wants to know if adding psychiatric medication (like selective serotonin reuptake inhibitors or SSRIs) to his treatment, will improve his treatment outcome. Patient or Adolescent SSRIs AND Intervention Problem AND MDD CBT Comparison CBT or Control Improve Outcomes treatment
  12. 12. Clinical Query Would combining SSRIs and CBT improve treatment in an adolescent with major depressive disorder, when compared to CBT alone? Comparison Patient or Outcomes Intervention or Control Problem Example Adolescent Depression OR Adolescent “major depressive disorder” SSRIs AND (CBT CBT OR OR psychotherapy psychotherapy) Reduced depression OR improved treatment
  13. 13. Questions : Foreground vs. Background Background questions asked Amount of expertise
  14. 14. Adolescent depression SSRIs Psychotherapy OR CBT Improved treatment
  15. 15. Clinical Scenario Ms. Baxter is a 60 year old woman with osteoarthritis of the hip. Her daughter has given her a magnetic bracelet to relive the hip pain. Ms. Baxter is skeptical and asks you, her physical therapist, if there is any evidence to support this. Patient or Adult Problem woman Magnets OR Intervention Magnetic or Indicator bracelets Comparison Reduced N/A Outcomes or Control pain Duke MCLA &UNC Health Sci Library
  16. 16. Which is the Best Question? A. Do magnets relive pain? B. In women, do magnets reduce pain from osteoarthritis of the hip? C. In women, do magnetic bracelets reduce pain from arthritis?
  17. 17. Clinical Scenario Edith is a 85 year old woman who has periods where she cannot remember words or how to speak (aphasia). Her husband asks her doctor if they should be worried about Alzheimer's disease. Patient Woman or Problem elderly Intervention Aphasia or Indicator Comparison Alzheimer's No aphasia Outcomes or Control OR dementia
  18. 18. Clinical Query What is the frequency of Alzheimer’s disease amongst elderly women who are experiencing aphasia? Patient or Intervention Problem or Indicator Example Comparison or Control Outcomes Elderly women No aphasia Alzheimer's OR dementia Aphasia OR “memory lapse”
  19. 19. Recap • EBM is the balance of patient’s interests, clinical expertise, and best available evidence • The library can teach PICO to guide the research process and create clinical queries • The Trip search engine can be used to satisfy both background and foreground questions
  20. 20. Thank You Be sure to stop in for the next installment EBM in the Library: Analyzing Statistical Strength This presentation can be found on slideshare! @beckyburbank
  21. 21. References • CEBM (2009). Asking focused questions. Retrieved November 19, 2013 from • Duke MCLA &UNC Health Sci Library (2013). Introduction to evidencebased practice. Retrieved November 19, 2013 from • Mayer, D. (2004). Essential evidence-based medicine. Cambridge, UK: Cambridge University Press. • Sackett, D. L., Rosenberg, W. M. C., Muir, G. J. A., & Brian, H. R. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71. • Welty, E., Hofstetter, S., & Schulte, S. J. (2012). Time to re-evaluate how we teach information literacy: Applying PICO in library instruction. CRL News, 73(8), 476-477.