What is evidence based practice" Dr. David Sackett explains:
"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 (or evidence-based medicine) involves 5 steps:
1. Ask a focused question to satisfy the health needs of a specific patient
Type |
Explanation |
Types of evidence to answer |
Therapy (Treatment) | Questions look at the effectiveness of interventions in improving outcomes in sick patients/patients suffering from some condition. Most frequently asked type of question. | Randomised Controlled Trial (RCT) |
Prevention | Questions examine the effectiveness of an intervention or exposure in preventing morbidity and mortality. When assessing preventative measures, it is important to evaluate potential harms as well as benefits. | RCT or Prospective Study |
Diagnosis | Questions look at the ability of a test or procedure to differentiate between those with and without a condition or disease. | RCT or Cohort Study |
Prognosis (Forecast) | Questions root out the probable cause of a patient's disease or the likelihood that she or she will develop an illness. | Cohort Study and/or Case-Control Study |
Etiology (Causation) | Questions about the harmful effect of an intervention or exposure on a patient | Cohort Study |
Meaning | Questions concerning patients' experiences | Qualitative Study |
2. Find the best evidence by searching the literature
Meta Search Engines (searches all levels of evidence at once) |
TRIP Database, The Cochrane Library |
Systematic Reviews or Meta-Analyses | Medline, PubMed, Cochrane Database of Systematic Reviews (CDSR) |
Critically Appraised Topics | DynaMed PLUS |
Critically Appraised Articles | ACP Journal Club, JAMAevidence |
RCTs, Cohort Studies, and Case-Controlled Studies | Medline, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) |
Background Information or Expert Opinion | Textbooks, periodicals, editorials |
3. Critically appraise the literature. You are testing for validity, clinical relevance, and applicability
4. Apply the results in clinical practice
5. Evaluate the outcomes in your patient
e-Library of Evidence for Nutrition Actions (eLENA) from World Health Organization has many ideas for nutrition interventions.
Comparison intervention
Outcome
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