The University of Queensland

Evidence-based practice (EBP) is "...the integration of best research evidence with clinical expertise and patient values".

EBP ensures the use of current best available evidence to aid in decision making about the care of individual patients to provide better outcomes for patients.

Evidence-based Practice Tools and Tutorials

• Answering Clinical Questions University of Western Australia evidence based practice modules

Steps for Evidence Based Practice

• Step 1: Work out what it is that you want to know
• Step 2: Identify the key concepts you are searching for
• Step 3: Search for the evidence
• Step 4: Appraise the evidence
• Step 5: Putting evidence into practice

Levels of Evidence

Levels of Evidence is a systematic method developed to rank different types of evidence for different question types.

• Levels of Evidence and Grades of Recommendation CEBM - Centre for Evidence Based Medicine, University of Oxford
• Pilot Program - NHMRC Additional levels of evidence and grades for recommendations for developers of guidelines

• Glossary of terms in the Cochrane Collaboration
• Bandolier Glossary
• What is...? Series (Not all content is free)

Step 1: Work out what it is that you want to know.

This is done by defining your question.

A lot of time can be saved by accurately defining your question at the start of the process. Example

• Formulate a Clinical Question
  Module 1 of Answering Clinical Questions, University of Western Australia
• Focusing clinical question Oxford Centre for Evidence-based Medicine
• Evidence-based Answers to Clinical Questions for Busy Clinicians Workbook 2009 Centre for Clinical Effectiveness, Monash University

Step 2: Identify the key concepts you are searching for.

By breaking your question down into its key components you will easily be able to identify the keywords to use when searching the databases.

• Download the PICO form

Find the Best Evidence
Module 2 of Answering Clinical Questions, University of Western Australia

Step 3: Search for the evidence.

• Appraise the Evidence
  Module 3 of Answering Clinical Questions, University of Western Australia
• Best evidence, best practice An introduction to the evidence base - the literature, Lamar Soutter Library, National Network of Library of Medicine(NN/LM) New England Region
• EBP Primers
• Database guide A selection of databases to help you find the best evidence to answer your question.
• EBP Powerpoint tutorial - searching PubMed and the Cochrane Library for EBP

Step 4: Appraise the evidence.

Not all evidence can be trusted and knowing how to critically appraise it for yourself is vitally important.

• Apply the Evidence
  Module 4 of Answering Clinical Questions, University of Western Australia
• Critical appraisal Royal Melbourne Hospital
• Critical appraisal Centre for Evidence-based Medicine
• Critical appraisal Notes and checklists - Scottish Intercollegiate Guidelines Network.
• Critical appraisal tools NHS, Public Health Resource Unit

Readings for 'How to appraise'...

• Greenhalgh, Trisha How to read a paper: Assessing the methodological quality of published papers BMJ 1997;315:305-308.
• Greenhalgh, Trisha How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses) BMJ 1997;315:672-675.
• Greenhalgh, Trisha How to read a paper: Papers that report drug trials BMJ 1997;315:480-483
• Guyatt, Gordon et al How to Use an Article About Therapy or Prevention Based on the Users' Guides to Evidence-based Medicine and reproduced with permission from JAMA. (1993;270(21):2598-2601) and (1994;271(1):59-63). Copyright 1995, American Medical Association.
• Greenhalgh, Trisha How to read a paper: Papers that report diagnostic or screening tests BMJ 1997;315:540-543
• Guyatt, Gordon et al How to Use an Article About a Diagnostic Test Based on the Users' Guides to Evidence-based Medicine and reproduced with permission from JAMA. (1993;270(21):2598-2601) and (1994;271(1):59-63). Copyright 1995, American Medical Association.
• Levine, Mitchell et al How to Use an Article About Harm Based on the Users' Guides to Evidence-based Medicine and reproduced with permission from JAMA. (1993;270(21):2598-2601) and (1994;271(1):59-63). Copyright 1995, American Medical Association.

Step 5: Putting evidence into practice.

The final step, and possibly hardest, is how to use the evidence to produce better outcomes for patients.

• Guyatt, Gordon et al. Integrating Research Evidence with the Care of the Individual Patient Based on the Users' Guides to Evidence-based Medicine and reproduced with permission from JAMA. (1993;270(21):2598-2601) and (1994;271(1):59-63). Copyright 1995, American Medical Association.
• Facing the evidence pt 2 This is a transcript of a Health Report programme which was aired in 2006. Patient advocates are supportive of the move to evidence based health care and explain how to ask your doctor or health professional for evidence about your proposed treatment.
• Osteoarthritis of the knee The knee files - part one highlights the evidence on causes and treatments The knee files - part two focuses on surgery.
• Evidence-based Medicine The interview is with Professor Montori (Mayo Clinic) who is particularly interested in how knowledge is produced, distributed and taken up in medical practice, as well as the patients' role in their medical treatment.
• Evidence risk and the patient Read about two of the pillars of EBM - assessing the evidence and integrating with patient values - see Dr Paul Neeskens' article published in the April 2007 issue of the Australian Prescriber. Dr Neeskens is a General Practitioner in Hervey Bay and teaches for the Rural Clinical Division.
• Practising EBM - Evaluation Centre for Evidence-Based Medicine, University Health Network, University of Toronto