Integrating evidence based medicine into routine clinical practice: seven years' experience at the Hospital for Tropical Diseases, London

[Posted as supplied by author] Notes for presenters at EBM meetings Evidence based medicine (EBM) has four steps:

• Formulation of a clear clinical question
• Searching the literature for relevant articles
• Evaluation (critical appraisal) of the evidence for its validity and usefulness
• Implementation of findings.

The chair of the EBM session will have identified the question and done the literature search. Each participant contributes a critical appraisal of the paper(s) they have been allocated.

There is a large literature on critical appraisal. The key papers from the JAMA series “Users’ Guide to the Medical Literature” are in the EBM file in the library. Useful texts include:

• Sackett DL, Haynes RB, Tugwell P, Guyatt GH. Clinical Epidemiology: a basic science for clinical medicine. Lippincott Williams & Wilkins, 1991.
• Greenhalgh T. How to read a paper. BMJ Books, 2000.
• Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone, 2000.

Useful headings for the critical appraisal of papers are:

Study design

• type of study (observational or interventional? what type?)
• population studied
• case definition

Intervention

• if an intervention study, what was the intervention?

Results (e.g. for intervention studies)

Patients

• if an intervention study, how were they allocated to the study groups?
• are all patients accounted for, and how complete is follow up?
• were patients and health workers blinded to the treatment allocation?

Results

• was a valid measure of effect used?
• how large and how precise was the treatment effect?
• was the analysis appropriate?

Strengths of the study

What does this study add?

Weaknesses of the study

What, if anything, was done badly?

Relevance to our patients

Can these results be applied to our patients?

Presentation

Please prepare overheads; at the end of the session, give them to the chair, along with the paper you appraised.