Pharmacy (PharmD)

"Evidence based medicine is 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 means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ : British Medical Journal. 1996;312(7023):71-72.

1. Assess the patient.

2. Ask a searchable clinical question (see "How to Ask" box below).

3. Acquire the evidence by searching resources.

4. Appraise the evidence for validity (is it accurate information from a reputable source?), applicability (usefulness in answering your clinical question), and timeliness (current). 

5. Apply information drawn from your evidence, combined with clinical expertise and patient values to make a clinical decision in practice. 

6. Self-evaluate your performance with the patient and your ability to answer your clinical question. 

Clinical scenarios often contain many factors making it difficult to search in a database. We can organize these factors by using the PICO model to identify key concepts, words or phrases. 

P: patient, problem, or population
I: intervention
C: comparison
O: outcome

An evidence pyramid is a way to organize different types of evidence in EBP research. The  evidence pyramid helps us visualize both the quality of evidence and the amount of evidence available. Systematic reviews are at the top of the pyramid because it is summary evidence (when experts critically evaluate all literature on a topic) and it is the least common. 

When facilitating EBP (asking a clinical question), you want to look at summary evidence such as Systematic Reviews, Practice Guidelines, and any resources on critically-appraised topics. 

You can find systematic review articles in almost all of the health science databases.  Cochrane Database of Systematic Reviews contains full text articles, as well as protocols focusing on the effects of healthcare.  Systematic reviews are at the top of the Evidence Pyramid, meaning they have a high level of evidence, but also there aren't as many of them. Be aware that you may need to broaden your topic in order to find relevant systematic reviews.

You can also search for Systematic Reviews by using the "Advanced Search" feature in our EBSCO databases.  Under "Publication Type" scroll down and select "Systematic Review".  

You can search for case studies in our databases as well.  When conducting your search, specify the Publication/Document Type ("Case Study") in the Advanced Search feature on CINAHL Ultimate, Medline Ultimate, and ProQuest Health & Medical Complete.

In clinical research, randomized controlled trials (RCTs) are the preferred method to study the safety and efficacy of current treatments. RCTs are used to answer patient-related inquiries and are required by governmental regulatory bodies as the basis for approval decisions.  You can find randomized controlled trials within several of our databases:

• Cochrane Central Register of Controlled Trials is a bibliography of controlled trials identified by contributors to the Cochrane Collaboration and others, as part of an international effort to hand search the world's journals and create an unbiased source of data for systematic reviews.
• In the Advanced Search feature on MEDLINE Ultimate, you can modify your search options by selecting "Randomized Controlled Trial" under the "Publication Type" section.

• CINAHL Ultimate offers this same tool in its Advanced Search option, in addition to a "Randomized Controlled Trials" button located on the left-hand side of the page under the "Limit your results" section.