Pharmacy: Evidence Based Practice

What is Evidence Based Practice?

A nice, clear definition of the term "evidence based practice" based on Dr. David Sackett's pioneering work in the field.

Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice.

Evidence-based practice involves 5 steps:

1. Ask a focused question to satisfy the health needs of a specific patient

What is your clinical question? - use the P.I.C.O. model below.

What type of clinical question is this? Therapy? Diagnosis? Use the table below.

What is the best study design to answer this type of clinical question? Use the table below.

2. Find the best evidence by searching the literature

What is the highest level of literature to support the question? See the pyramid below.

Where should you look for this material? See the table below.

3. Critically appraise the literature: testing for validity, clinical relevance, and applicability

What are the results of the study?

4. Apply the results in clinical practice

5. Evaluate the outcomes in your patient

Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

Point of Care Tools

DynaMed
DynaMed includes thousands of medical graphics and images to help make accurate diagnoses. Topics include concise summaries and detailed recommendations based on the most current evidence. Specialty content can be found in the following areas: Allergy, Cardiology, Critical Care, Dermatology, Ear, Nose, and Throat (ENT), Emergency Medicine, Endocrinology, Gastroenterology, Gynecology, Hematology, Infectious Diseases, Nephrology, Neurology, Obstetrics, Oncology, Orthopedics & Sports, Medicine, Pediatrics, Primary Care, Psychiatry, Pulmonary Medicine, Rheumatology, Surgery, Vascular Medicine. DynaMed content is extensively reviewed by clinical experts.
Access Note: For seamless and secure access to DynaMed, please upgrade to the latest version of Firefox, Chrome, or Edge.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
UpToDate Lexidrug
A full-text collection of drug information databases, corresponding to the drug information handbooks in Lexi-Comp's Clinical Reference Library.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
Clinical Key
Provides access to current medical and surgical content including First Consult, journals, medical and surgical books, medical videos and images.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
Natural Medicines
A resource providing information on dietary supplements, natural medicines, and complementary alternative and integrative therapies.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
PEN: Practice-based Evidence in Nutrition
Current and authoritative guide to answers to day-to-day nutrition questions encountered in dietetics practice in all settings. Access Note: Since access to this resource is restricted to 9 simultaneous users, please click on Log Out at the end of your session.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
RxFiles: Objective Comparisons for Optimal Drug Therapy
Academic service providing objective, comparative drug information to physicians, pharmacists and allied health professionals
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
VisualDx
VisualDx is a web-based system that assists "in the identification of dermatologic, infectious, genetic, metabolic, nutritional and occupational diseases, benign and malignant growths, drug-induced conditions, and other injuries."
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.

Systematic Reviews

Cochrane Library
A collection of databases that contain high-quality, independent evidence to inform healthcare decision-making. Cochrane reviews represent the highest level of evidence on which to base clinical treatment decisions.
Access is restricted to current students, faculty, and staff of the University of Saskatchewan, and walk-in users, for educational, research, and non-commercial personal use. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.
PubMed
Contains more than 19 million citations for biomedical articles from MEDLINE and life science journals. Note: To search for reviews select 'Clinical Queries'
This is an Open Access resource freely available on the Internet. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.To access full text, you must authenticate with your NSID.
Trip
Searches over 75 sites of high-quality medical information. Provides direct, hyperlinked access to the largest collection of 'evidence-based' material on the web as well as articles from premier on-line journals such as the BMJ, JAMA, NEJM etc.
This is an Open Access resource freely available on the Internet. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.To access full text, you must authenticate with your NSID.
ACCESSSS
ACCESSSS is a federated search engine which provides current best evidence for clinical decisions. It conducts literature searches simultaneously in several different evidence-based information services.
*Note:* Users will have to create an account to search for resources.
This is an open access resource freely available on the Internet. Systematic copying or downloading of electronic resource content is not permitted by Canadian and international copyright law.

Clinical Guidelines

CMA Infobase: Clinical Practice Guidelines
This Canadian Medical Association database provides access to nearly 2000 clinical practice guidelines produced or endorsed in Canada. It offers a number of search and browse capabilities, including a search by MeSH terms under the Basic Search option.
Canadian Cardiovascular Society
Canadian Diabetes Association : Clinical Practice Guidelines
Osteoporosis Canada
Society of Obstetricians and Gynaecologists of Canada

PICO Model

Breaking up your question into these 4 elements (which you can easily remember with the mnmeonic device PICO) will make your literature search process easier:

Patient, population, &/or problem

Description of the patient, population and/or the target disorder of interest
What are the most important characteristics of the patient?
How would you describe a group of patients similar to yours?
What is the disorder and condition of interest?

Intervention

Which intervention, prognostic factor, diagnostic tool, or exposure are you considering?

Comparison intervention

What alternative do you want to compare with the intervention?
Examples: standard of care, reference standard, Placebo

Outcome

What outcome you hope to accomplish or measure?

Evidence of Reviews Pyramid

Sources of research may be either pre-appraised (summaries), primary literature or more anecdotal.

Systematic Reviews or Meta-analysis	MEDLINE, Cochrane Library
Critically-Appraised Topics	DynaMed
Critically-Appraised Articles	ACP Journal Club
Randomized Controlled Trials	Original articles (search MEDLINE)
Cohort Studies	Original articles (search MEDLINE)
Case-Controlled Studies etc.	Original articles (search MEDLINE)
Background Info/Expert Opinion	Books, editorials

Books in the Library

Contemporary Drug Information by Claude J. Gaebelein; Brenda L. Gleason
Call Number: RM263.G32 2008
Teaches the basics of drug information, literature evaluation, and biostatistics, and relates these topics to evidence-based pharmaceutical care.
Evidence-Based Pharmacotherapy by Chiquette, E.
Call Number: RM263.C55 2007
Evidence-Based Pharmacy by Bond, C.
Call Number: RS100.4.G7E895 2000
ISBN: 0853694362
Pharmacist's Guide to Evidence-Based Medicine for Clinical Decision Making by Bryant, P.J.
Call Number: RS92.B765 2008
ISBN: 9781585281770
Provides a practical approach for applying sound EBM principles to your clinical decision making process.