Learn about Evidence Based Medicine and the PICO search model

1. Evidence-Based Medicine
in the Library
Rebecca Burbank
Nov. 22nd, 2013

2. Learning Objectives
• What is Evidence-Based Medicine
(EBM)?
• How can the Library support EBM
practitioners?
• What are a few helpful tools and
resources?

3. Evidence-Based Medicine
• Founded in statistics and systematic
review
• Focused on individual patients
Duke MCLA &UNC Health Sci Library
(2013). Introduction to evidencebased practice. Retrieved from
http://guides.mclibrary.duke.edu/eb

4. EBM is “the conscientious, explicit and
judicious use of current best evidence
in making decisions about the care of
the individual patient. It means
integrating individual clinical expertise
with the best available external clinical
evidence from systematic research.”
(Sackett, 1996)

5. Why do practitioners need EBM?
• Improved healthcare
• The need for proven practices in
medicine
• Standardization of practices
• Reduction of unnecessary care and
costs

6. Practicing EBM
•
•
•
•
•
•
Craft a clinical question
Search the medical literature
Identify the best study for the query
Critically appraise the study
Determine the clinical application
Evaluate your individual results
Mayer, D. (2004). Essential evidencebased medicine. Cambridge, UK:
Cambridge University Press.

7. Evidence Cycle
Assess
Ask
Apply
Patient
Acquire
Appraise
Duke MCLA &UNC Health Sci Library

8. How can we help you?
Librarians support EBM by teaching
users…
– To decode their clinical scenarios
• Define search query, identify alternate terms,
what is MeSH?
– Identification of appropriate sources
• Do I need a cohort study or an RCT?
– Appraisal of literature
• Look for bias in studies, determine validity

9. Problem Area
Formulating a
research question

11. PICO
Patient or Intervention or Comparison Outcomes
Problem Indicator
or Control
Tips for
Building
How would I
describe a
group of
patients like
mine?
Which main
intervention am I
considering?
What is the main What do I
alternative to
hope to
compare?
accomplish?
Patient specific
outcomes.
Balance
precision
with brevity.
Be specific.
Be Specific.
CEBM
Be specific.

12. Clinical Scenario
Mathew is a 16 year old who suffers with
major depressive disorder. He is currently
receiving cognitive-behavioral therapy
and wants to know if adding psychiatric
medication (like selective serotonin reuptake inhibitors or SSRIs) to his treatment,
will improve his treatment outcome.
Patient or
Adolescent SSRIs AND
Intervention
Problem
AND MDD
CBT
Comparison
CBT
or Control
Improve
Outcomes
treatment

13. Clinical Query
Would combining SSRIs and CBT improve
treatment in an adolescent with major
depressive disorder, when compared to CBT
alone?
Comparison
Patient or
Outcomes
Intervention or Control
Problem
Example
Adolescent
Depression
OR
Adolescent
“major
depressive
disorder”
SSRIs AND (CBT CBT OR
OR
psychotherapy
psychotherapy)
Reduced
depression
OR improved
treatment

14. Questions : Foreground vs.
Background
Background
questions
asked
Amount of expertise

16. Adolescent depression
SSRIs
Psychotherapy OR CBT
Improved treatment

20. Clinical Scenario
Ms. Baxter is a 60 year old woman with
osteoarthritis of the hip. Her daughter
has given her a magnetic bracelet to
relive the hip pain. Ms. Baxter is
skeptical and asks you, her physical
therapist, if there is any evidence to
support this.
Patient or
Adult
Problem
woman
Magnets OR
Intervention
Magnetic
or Indicator
bracelets
Comparison Reduced
N/A
Outcomes
or Control
pain
Duke MCLA &UNC Health Sci Library

21. Which is the Best Question?
A. Do magnets relive pain?
B. In women, do magnets reduce pain
from osteoarthritis of the hip?
C. In women, do magnetic bracelets
reduce pain from arthritis?

22. Clinical Scenario
Edith is a 85 year old woman who has
periods where she cannot remember
words or how to speak (aphasia). Her
husband asks her doctor if they should
be worried about Alzheimer's disease.
Patient
Woman or
Problem
elderly
Intervention
Aphasia
or Indicator
Comparison Alzheimer's
No aphasia Outcomes
or Control
OR
dementia

23. Clinical Query
What is the frequency of Alzheimer’s disease
amongst elderly women who are experiencing
aphasia?
Patient or Intervention
Problem or Indicator
Example
Comparison
or Control
Outcomes
Elderly
women
No aphasia
Alzheimer's
OR dementia
Aphasia OR
“memory lapse”

24. Recap
• EBM is the balance of patient’s
interests, clinical expertise, and best
available evidence
• The library can teach PICO to guide
the research process and create
clinical queries
• The Trip search engine can be used to
satisfy both background and
foreground questions

25. Thank You
Be sure to stop in for the next installment
EBM in the Library: Analyzing Statistical
Strength
This presentation can be found on slideshare!
@beckyburbank

26. References
•
CEBM (2009). Asking focused questions. Retrieved November 19,
2013 from http://www.cebm.net/?o=1036
•
Duke MCLA &UNC Health Sci Library (2013). Introduction to evidencebased practice. Retrieved November 19, 2013 from
http://guides.mclibrary.duke.edu/ebmtutorial
•
Mayer, D. (2004). Essential evidence-based medicine. Cambridge,
UK: Cambridge University Press.
•
Sackett, D. L., Rosenberg, W. M. C., Muir, G. J. A., & Brian, H. R. (1996).
Evidence based medicine: what it is and what it isn't. BMJ, 312(7023),
71.
•
Welty, E., Hofstetter, S., & Schulte, S. J. (2012). Time to re-evaluate
how we teach information literacy: Applying PICO in library
instruction. CRL News, 73(8), 476-477.