FINDING THE EVIDENCE

1. FINDING THE EVIDENCE

17. •A good answerable question will
help us focus on evidence that is
relevant to a patient’s clinical needs,
(or your own knowledge needs).
•They can suggest high yield search
strategies
•They can suggest the forms that
useful answers might take (i.e. what is
best research design to answer our
question)
THE QUESTION - WHY IS IT SO
IMPORTANT?

18. FRAMEWORK TO
Patient/Problem
Intervention
Comparison
Outcome
In a man with depressive
symptoms…
…Is cognitive behavioural therapy…
…compared with fluoxetine…
…better at improving depressive
symptoms?

19. CLINICAL QUESTIONS
• Background - “What is it?”
• General information on a condition or
disease
• Foreground – “What do I do for this
patient?”
• Patient
• Intervention/Investigation
• Comparison Intervention/Investigation
• Outcome (Patient-Oriented)

26. Framework to
Patient/Problem
Intervention
Comparison
Outcome
In a man with depressive
symptoms…
…Is cognitive behavioural therapy…
…compared with fluoxetine…
…better at improving depressive
symptoms?

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38. Langkah2 dalam memproses EBM

39. Steps in the Evidence-Based Process are:
(Citrome, & Ketter, 2009)

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Constructing A Clinical Question
P
patient
I
intervention
C
comparison
O
outcome
Who? What?
Alternative
Intervention?
Outcomes
“How would I
describe a group
of patients
similar to this
particular
patient?”
”Which
treatment, test
or other
intervention?”
“Compared to what
other treatment, test,
or perhaps compared
to doing nothing”
What is the
patient oriented
outcome – better
prognosis?
Higher rate of
cure? Etc.?”

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Examples
P I C O
Kids with acute otitis
media -2-4 y/o
Antibiotics
No treatment except
acetaminophen
for pain/fever
No pain after two
days?
Adult with
microhematuria
IVP CT scan
Diagnostic accuracy
(Predictive value or
likelihood ratio)
Adult patients <70 TIA No TIA
Rates of CVA within
90 days
Healthy adolescents
Routine
scoliosis
screen
No screening –
evaluate only if
problems
Pain, disability, need
for intervention

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Types of Questions
Best Answered by EBM Resource
• Therapy Question
– In patients with migraine headaches without auras, is Depakote more
effective than Inderal for prophylaxis of headaches?
• Prognosis Question
– In diabetic patients with foot ulcers, is the diagnosis of osteomyelitis
with MRI as predictive of healing as an audible pulse on Doppler
examination?
• Diagnosis Question
– In geriatric patients with suspected carotid stenosis, is duplex
ultrasound as good as magnetic resonance angiography in detecting
significant carotid stenosis?
• Harm Question
– For pregnant patients, does the consumption of large amounts of
coffee, (compared to non-coffee drinkers) increase the rate of
spontaneous abortion?

43. Hunting Tools

44. 44
Drilling Down for Information
Grandage KK, Slawson DC, Shaughnessy AF. When less is more: a practical approach
to searching for evidence-based answers. J Med Libr Assoc. 2002 Jul;90(3):298-304.

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EBM Hunting Tools
A high-quality Hunting tool employs a transparent
process that
• Searches multiple EBM databases (several
foraging tools)
• Organizes results to make them easy to find
• Provides levels of evidence
(Slawson, et al)

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EBM Pyramid
5, C
MEDLINE
InfoRetriever
DynaMed

47. • Biomedical journal literature
PubMed Database
• Published by:
The National Library of
Medicine
• International scope

48. Accessing PubMed
• Freely available over the Internet
• Also through library’s home page
@ www.pubmed.gov

49. tool that searches for evidence-based literature
PubMed’s Clinical Queries

50. Diagnosis Therapy
Etiology (cause)
Prognosis (prediction of probable outcome)
Clinical Queries Searchable by:

51. Click Clinical Queries

52. Enter asthma
Search
Click

53. Results for Therapy and
Broad Scope
Change to Narrow Scope

54. Click See all (7542)

55. Click Limits

56. Click on the article title
you wish to read