Skip to main content
SpringerLink
Log in

Evidence-Based Practice

What Does it Really Mean?

  • Primer
  • Published:
Disease Management & Health Outcomes

Summary

Evidence-based medicine is the process of finding and applying the best available clinical research evidence to the management of individual patients. This first requires posing an appropriate answerable clinical question about diagnostic possibilities, prognosis, risks, diagnostic tests or treatment. We then need to rapidly and efficiently identify the best clinical research evidence to answer these questions. This may involve using either ‘predigested’ sources of evidence, such as systematic reviews or evidence-based guidelines, or, when these are not available, finding the primary evidence ourselves. Finally, this research evidence needs to be weighed, appraised and integrated with our clinical expertise to apply it to the individual patient problem.

Recent studies have suggested that 82% of treatment decisions in a general medical ward and 69% of decisions in ambulatory care can be based on convincing evidence, more than half of which comes from randomised controlled trials. The key problem then is finding and integrating such evidence into routine practice. The recently established Cochrane Collaboration is beginning to provide a systematic summary of randomised trial evidence of the effects of treatment, but will take 5 to 10 years to provide comprehensive coverage. However, a number of other summary sources, together with skills in using ‘Medline’ efficiently and effectively, will provide practitioners with ready access to the best evidence. We illustrate these methods with several cases from ambulatory practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sackett DL, Richardson WS, Rosenberg W, et al. Evidence-based medicine: how to practice and teach EBM. 1st ed. New York: Churchill Livingstone, 1997

    Google Scholar 

  2. Office of Technology Assessment of the Congress of the United States. Assessing the efficacy and safety of medical technologies. Washington, DC: US Government Printing Office, 1978

    Google Scholar 

  3. Cochrane Collaboration. The Cochrane Library: issue 1 (CD-ROM). Oxford: Cochrane Collaboration, 1997

    Google Scholar 

  4. Ellis J, Mulligan I, Rowe J, et al. Inpatient general medicine is evidence based. Lancet 1995; 346: 407–10

    Article  PubMed  CAS  Google Scholar 

  5. Gill P, Dowell AC, Neal RD, et al. Evidence based general practice: a retrospective study of interventions in one training practice. BMJ 1996; 312: 819–21

    Article  PubMed  CAS  Google Scholar 

  6. Oxman AD, Cook DJ, Guyatt GH, et al. Users’ guides to the medical literature. VI. How to use an overview. JAMA 1994; 272: 1367–71

    Article  PubMed  CAS  Google Scholar 

  7. American College of Physicians. ACP Journal Club on disk: vol. 1. Philadelphia: American College of Physicians, 1997

    Google Scholar 

  8. American College of Physicians. Evidence-based medicine. London: BMJ Publishing Group

  9. Best evidence. London: BMJ Publishing Group, 1997

  10. Panzer RJ, Black ER, Griner PF, editors. Diagnostic strategies for common medical problems. Rev. ed. Philadelphia: American College of Physicians, 1991

    Google Scholar 

  11. Gorroll AH, May LA, Mulley AG. Primary medical care: office evaluation and management of the adult patient. 3rd ed. Philadelphia: J.B. Lippincott, 1995

    Google Scholar 

  12. Report of the U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore: Williams & Wilkins, 1996

  13. Haynes RB, Wilczynski NL, McKibbon KA, et al. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc 1994; 1: 447–58

    Article  PubMed  CAS  Google Scholar 

  14. Guyatt GH, Sackett DL, Cook DJ, et al. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? JAMA 1993; 270: 2598–601

    Article  PubMed  CAS  Google Scholar 

  15. Girlanda P, Dattola R, Venuto C, et al. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and long-term efficacy. J Neurol 1993; 240: 187–90

    Article  PubMed  CAS  Google Scholar 

  16. Herskovitz S, Berger AR, Lipton RB. Low-dose, short-term oral prednisone in the treatment of carpal tunnel syndrome. Neurology 1995; 45: 1923–5

    Article  PubMed  CAS  Google Scholar 

  17. Ellis J, Folkers K, Watanabe T, et al. Clinical results of a crossover treatment with pyridoxine and placebo of the carpal tunnel syndrome. Am J Clin Nutr 1979; 32: 2040–6

    PubMed  CAS  Google Scholar 

  18. Ellis JM, Folkers K, Levy M, et al. Response of vitamin B-6 deficiency and the carpal tunnel syndrome to pyridoxine. Proc Natl Acad Sci USA 1982; 79: 7494–8

    Article  PubMed  CAS  Google Scholar 

  19. Spooner GR, Desai HB, Angel JF, et al. Using pyridoxine to treat carpal tunnel syndrome: randomized control trial. Can Fam Physician 1993; 39: 2122–7

    PubMed  CAS  Google Scholar 

  20. Stransky M, Rubin A, Lava NS, et al. Treatment of carpal tunnel syndrome with vitamin B6: a double blind study. South Med J 1989; 82: 841–2

    Article  PubMed  CAS  Google Scholar 

  21. Jaeschke R, Guyatt GH, Sackett DL, et al. Users’ guides to the medical literature. VI. How to use an article about a diagnostic test. A. Are the results of the study valid? JAMA 1994; 271: 389–91

    Article  PubMed  CAS  Google Scholar 

  22. Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache 1991; 31: 167–71

    Article  PubMed  CAS  Google Scholar 

  23. Bonadio WA. Assessing patient clinical appearance in the evaluation of the febrile child. Am J Emerg Med 1995; 13: 321–6

    Article  PubMed  CAS  Google Scholar 

  24. Laupacis A, Wells G, Richardson WS, et al. Users’ guides to the medial literature. V. How to use an article about prognosis. JAMA 1994; 272: 234–7

    Article  PubMed  CAS  Google Scholar 

  25. Koretz RL, Abbey H, Coleman E, et al. Non-A, non-B post-transfusion hepatitis: looking back in the second decade. Ann Intern Med 1993; 119: 110–5

    PubMed  CAS  Google Scholar 

  26. Levine M, Walter S, Lee H, et al. Users’ guides to the medical literature. IV. How to use an article about harm. JAMA 1994; 271: 1615–9

    Article  PubMed  CAS  Google Scholar 

  27. Neugut AI. Commentary on ‘meta-analysis: use of combined oral contraceptives in the past 10 years is associated with an increased risk for breast cancer.’ Evidence-Based Medicine 1996; 1: 220. Abstract of: Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 1996; 347: 1713–27

    Article  Google Scholar 

  28. Griner PF. Infectious mononucleosis. In: Panzer RJ, Black ER, Griner PF, editors. Diagnostic strategies for common medical problems. Philadelphia: American College of Physicians, 1991: 196–204

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Social and Preventive Medicine, Medical School, The University of Queensland, Herston Road, Herston, Queensland, 4006, Australia

    John W. Bennett & Paul Glasziou

Authors
  1. John W. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Glasziou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John W. Bennett.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bennett, J.W., Glasziou, P. Evidence-Based Practice. Dis Manage Health Outcomes 1, 277–285 (1997). https://doi.org/10.2165/00115677-199701060-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199701060-00001

Search

Navigation