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What is Evidence-based Practice?
Evidence-based practice helps ground professional decisions in the literature of the discipline and in the context of the patient(s), subjects or other situations. The practice started in medicine and related disciplines, but has spread into other areas, including veterinary medicine, conservation, education and dietetics. Appropriate sources may vary by discipline; IF in doubt, consult your advisor/professor.
A feature of reviews for evidence-based practice is the structure of the review, and its protocols. What rules did the authors follow when doing the the review, the meta-analysis or systematic review? There should be a summary of findings, details on where they searched, how, when, how the studies were selected, how many, what quality, and whether they limited the search to English language sources, or other languages, among other possibilities. Did they cover the relevant, important literature in the field? Is the number sufficient? How did they define useful studies? Does their definition make sense? Did they exclude studies, and if so, do they detail why? Did they include randomized controlled studies as at least part of their selection, if those studies exist in the discipline? Did they suggest implications of the results of the study for practice and research? Are recommendations or protocols included, or are you directed to them in another document?
Some Databases with Systematic Reviews
- CINAHL Complete This link opens in a new windowThe Cumulative Index of Nursing and Allied Health Literature (CINAHL) indexes nearly 800 nursing, biomedical, and consumer health journals. Scroll down to find ways to limit your search, including publication types, patient age groups, nurses as authors, and so on.
- ERIC (Ebsco) This link opens in a new windowCovers: 1966-. Complete database on educational materials from the Education Resources Information Center (ERIC). ERIC indexes two different kinds of publication: journal articles and ERIC Documents or reports.
- The Guide to Community Preventive Services (from the Centers for Disease Control)."The Guide to Community Preventive Services is a free resource to help you choose programs and policies to improve health and prevent disease in your community. Systematic reviews are used to answer these questions:
•Which program and policy interventions have been proven effective? •Are there effective interventions that are right for my community? •What might effective interventions cost; what is the likely return on investment?"
- MEDLINE Complete (Ebsco) This link opens in a new windowProvides comprehensive indexing for publications in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and much more. Created by the National Library of Medicine, MEDLINE uses MeSH (Medical Subject Headings). MEDLINE Complete is a full text companion to the MEDLINE index and provides full text for over 2,500 medical journals. Many are available with no embargo to allow users to access the information as soon as it is published. Scroll down to find the checkbox labeled EBM to limit to evidence based medicine, and the review articles box to limit to that type of study.
- PubMed This link opens in a new windowCovers: 1950-. A service of the National Library of Medicine that includes citations from MEDLINE and other life science journals for biomedical articles. PubMed includes links to full text articles and other related resources. Offers comprehensive coverage of all areas of human and veterinary medicine, dentistry, nutrition, toxicology, pathology, public health, and health services administration.
- National Quality Measures ClearinghouseFrom the U.S. Dept. of Health and Human Services-- look for the Agency for Healthcare Research and Quality (AHRQ).
- APA PsycINFO This link opens in a new windowYou may limit by methodology, among other parameters, by scrolling down for choices of study, language and so on.
- TRIP database: clinical search engine"The TRIP Database is a clinical search tool designed to allow health professionals to rapidly identify the highest quality clinical evidence for clinical practice." Usually you'll find summaries rather than full reports, but this varies.
They have a "Pro" version that costs $, but some material is still freely available. - National Center for Biotechnology Information"As a national resource for molecular biology information, NCBI's mission is to develop new information technologies to aid in the understanding of fundamental molecular and genetic processes that control health and disease."
Levels of Evidence
Example Levels of Evidence
|
Sources of Evidence |
Classification |
|---|---|
| Meta-analysis of multiple well-designed controlled studies |
1A |
| Well-designed randomized controlled trials |
1 |
| Well-designed non-randomized controlled trial (quasi-experiments) |
2 |
| Observational studies with controls (retrospective studies, interrupted time-series studies, case-control studies, cohort studies with controls) |
3 |
| Observational studies without controls (cohort studies without controls and case series) |
4 |
Robey, R. R. (2004, April 13). Levels of Evidence. The ASHA Leader.http://www.asha.org/Publications/leader/2004/040413/f040413a2.htm
There are other examples. This is a commonly-used hierarchy.
Another Hierarchy for EBM
Rating System for the Hierarchy of Evidence: Quantitative Questions
Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT's), or evidence-based clinical practice guidelines based on systematic reviews of RCT's
Level II: Evidence obtained from at least one well-designed Randomized Controlled Trial (RCT)
Level III: Evidence obtained from well-designed controlled trials without randomization, quasi-experimental
Level IV: Evidence from well-designed case-control and cohort studies
Level V: Evidence from systematic reviews of descriptive and qualitative studies
Level VI: Evidence from a single descriptive or qualitative study
Level VII: Evidence from the opinion of authorities and/or reports of expert committees
Above information from "Evidence-based practice in nursing & healthcare: a guide to best practice" by Bernadette M. Melnyk and Ellen Fineout-Overholt. 2005, page 10. From: http://researchguides.ebling.library.wisc.edu/content.php?pid=325126&sid=2940230
In addition:
Practice based on empirical research is more likely to be sound. Looking for systematic reviews of the literature allows you to have some confidence that the practices recommended are based on more than just a few patients. Systematic reviews that include meta-analyses of the data in the articles are more likely to be reliable.
Things to consider: Did they ask a good question? the 'right' question? Did they make their methods explicit? Was their search detailed? Was it comprehensive? What did they miss, and why?
A different model for evaluation that I also like is called the rhetorical triangle: the three points of the triangle are author, audience and purpose (Laura Wukovitz, http://Research Guides.hacc.edu/milex). This brings into consideration that there are often social dimensions to even the most data-driven science (sometimes colloquially known as whose ox is being gored, or in other words, who benefits from a particular publication, and in what way(s)?
- Health Care Standards for Systematic Reviews from the Institute of MedicineA very detailed description of how these kinds of reviews should be done in medical fields.