Evidence-Based Practice is all about information management for providing quality patient care. Understanding the principles and concepts behind Evidence-Based Practice can help us enhance the services and resources we provide to our health care workers. There are lots of ways to do this within the constraints of budgets and staffing. Some examples:
• Using the PICO framework when conducting a reference interview for a literature search
• Using the PICO framework to formulate the search strategy
• Reinforcing this process by appending the PICO and search strategy to the results
• Highlighting the EBM resources within your collections so that they are easier to find and use
• Adding the Clinical Queries as customized filters to your institution’s PubMed MyNCBI Share account
• Create a LibGuide or Google Site that supports the teaching of EBP within your institution by making appraisal worksheets, EBM calculators, teaching tips, forms, and articles for Journal Clubs easily accessible
But Evidence-Based Practice is also for us as consumers of health information. Understanding the difference between a randomized controlled trial (RCT) and an observational study is essential for understanding the implications of the results for these types of studies. A cohort study that observes a group of people over time for possible outcomes cannot determine a cause and effect relationship. At best it can report a possible association or connection between an exposure and an outcome. The rigorous methodology of a properly done randomized controlled trial however can show a cause and effect relationship.
Understanding the difference between an absolute difference, a relative difference and the number needed to treat should also be important to us as consumers of medical information. These numbers can all report the same results but using relative over absolute can make very small difference appear to be much larger. For example the results from a recent RCT showed the absolute difference between adverse events in the treatment group compared to the control group was .08% but the relative difference was 26%! Which number makes for a better story?
There are a couple of interesting TED Talks on the topic:
Ben Goldacre: Battling Bad Science http://www.ted.com/talks/ben_goldacre_battling_bad_science.html
David H. Newman: truth that lasts
Check out out the MLGSCA/NCNMLG Joint Meeting in La Jolla, CA in July. There will be a refresher class on Evidence Based Practice on Wednesday July 23rd from 8am to 12pm. We’ll follow a Journal Club Format and review the study methodology and results for RCTs, systematic reviews and qualitative studies.