ABSTRACT
Evidence-based medicine (EBM) combines the practitioner’s clinical expertise and the patient’s desires and values with the conscientious and judicious use of the current best evidence from the clinical literature1 (Figure 13.1). Clinical expertise is one’s ability to identify
CONTENTS 13.1 Introduction 185
13.1.1 What Is Evidence-Based Medicine? 185 13.1.2 e Five A’s of Evidence-Based Practice 186
13.2 Assessing the Patient 187 13.3 Asking Focused Clinical Questions: e PICO Format 187 13.4 Acquiring Evidence: Dierent Resources for Dierent Information Needs 187
13.4.1 PubMed 188 13.4.2 ACP Journal Club 188 13.4.3 UpToDate 188 13.4.4 National Guideline Clearinghouse 189 13.4.5 Cochrane Reviews 189 13.4.6 Comparison of Resources 190
13.5 Appraisal: Making Sure the Evidence Is Good 190 13.5.1 erapy Article: e Randomized Controlled Trial 191
13.6 Applying Evidence to Patient Care 193 13.7 Causing Negative Outcomes: Number Needed to Harm 194 13.8 Taking Evidence to the Next Level: Integrative Publications 195
13.8.1 Overview, Systematic Review, or Meta-Analysis 195 13.8.2 Clinical Practice Guideline: Adding Recommendations to Evidence 195
13.9 Summary 196 References 198
the patient’s diagnosis, risks and benets, and specic clinical circumstance. Patient values refer to the individual patient’s concerns, expectations, and preferences that must be integrated into clinical decisions. Current best evidence means high-quality, relevant research, usually from clinical trials, that replaces previously accepted treatment standards with those that are more ecacious and safe.
