Finding reliable evidence for high quality patient care and decision-making is a must for healthcare practitioners and managers.
Parts of this webpage guide have been adapted from the Centre for Evidence-Based Medicine Toronto’s Introduction to EBM (2014) http://ktclearinghouse.ca (Online) [Accessed April 2014]
Evidence based healthcare (EBH) has been described as the "integration of best research evidence with clinical expertise and patient preferences and expectations. When these three elements are integrated, healthcare providers and patients form an alliance which can hopefully optimize clinical outcomes and quality of life”
Population-based outcome studies have found that therapies that are evidence-based have more positive effects on patient care than opinion-based healthcare. For example, heart attack survivors prescribed aspirin or beta-blockers have lower mortality rates than those who aren’t prescribed these drugs.
EBH comprises of 5-steps
Step 1 A decision needs to be made arising from a patient’s care or service development
Step 2 You formulate a focused clinical question, accounting for your population group and problem, intervention and any comparisons or outcomes
Step 3 You identify the appropriate resources to search for the best evidence — here’s where the library can help the most
Step 4 Critically appraise the evidence- the library can help you here too!
Step 5 Implement in practice, if applicable
Before you search think about:
- What kinds of patients you are interested in, for example, population group (age? gender? ethnicity?) and problem, disease or condition
- What intervention or treatment you are concerned with, for example, drug therapy, diagnostic test or surgical procedure.
- Which, if any, comparisons you want to make, for example, different population groups or interventions
- What are outcomes you are looking for, for example, improved quality of life, less morbidity, complications or improvement in function
“Best evidence” can be classically categorized into a hierarchy- the higher up you go on the hierarchy the more you can rely on the findings.
- Systematic reviews and meta-analyses- reviews in which all available evidence on a particular topic is summarized
- Randomised controlled trials-a group of patients are allocated- preferably randomnly, where possible and ethical, to receive different treatments. Outcomes are then compared
- Cohort studies- involves identification of 2 groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest
- Case control studies - involve identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking back to see if they had the exposure of interest
- Cross sectional surveys - observations of a defined population at a single point in time or time interval. Exposure and outcome are determined simultaneously
- Case reports-reports on single subjects or patients with an outcome of interest; sometimes collected together into a short series
- Expert Opinion — consensus of experience amongst professionals
- Anecdotal — Joe Bloggs in the bar told you
There are specialist online resources that you can go to which evaluate and summarise available research evidence. These can be divided into:
- Synopsis/Answering Services
- Summaries and Digests
- Guidelines and Pathways
- Synthesis and Reviews
- Specialist Databases
- Database Search Filters
- Critical Appraisal Resources
Click on the links to look at key resources in each of these areas. A good starting point for finding evidence-based material on the web might be NICE Evidence Search.
NICE Evidence Search, produced by NICE, aims to allow easy access to a range of UK evidence based resources online. No password is needed, although you can register with the site if you want to save searches.
The site also provides links to other NHS resources, such as healthcare databases, electronic journals and ebooks, available via NHS OpenAthens.
- A-Z of Topics
- Public Health Information
- Quality, Innovation Productivity and Prevention (QIPP) Collection.
Rapid best evidence answers to clinical questions in Emergency Medicine.
Evidence-Based Mental Health
These three titles, from the BMJ publishing group, critically appraise the validity of the most clinically relevant articles and summarize them including commentary on their clinical applicability. You will need your NHS OpenAthens username and password to access these titles.
DARE (Database of Abstracts of Reviews of Effects)
DARE is focused primarily on appraising systematic reviews that evaluate the effects of health care interventions and the delivery and organisation of health services. Produced by the NHS Centre for Reviews and Dissemination.
An evidence-based knowledge system that helps healthcare staff make the right decisions at the point of care. It covers over 3,400 clinical topics, providing evidence-graded treatment recommendations as well as diagnostic and other information. Access via NHS Open Athens, the trust intranet, or download the mobile app, for information on the go.
Produced by BMJ publishing it consists of current evidence-based reviews of the treatments for more than 250 conditions. Browse the resource by specialty or use the search box.
NHS staff at the following Trusts can access Clinical Evidence with their NHS Athens password: St. George’s Healthcare Trust, South West London and St. George’s Mental Health Trust and NHS Wandsworth
Published by the BMJ, this single source combines the latest research evidence, guidelines and expert opinion – presented in a step-by-step approach, covering prevention, diagnosis, treatment and prognosis. NHS staff can access Best Practice onsite at St.George's Library.
NICE Clinical Knowledge Summaries
Clinical Knowledge Summaries (CKS) is a readily accessible summary of the current evidence base and practical guidance on best practice in respect of over 300 common and/or significant primary care presentations.
NICE Pathwaysis an online tool that provides quick and easy access, topic by topic, to the range of guidance from NICE, including quality standards, technology appraisals, clinical and public health guidance and NICE implementation tools.
SIGN (Scottish Intercollegiate Guidelines Network)
Guidelines produced for NHS Scotland.
Sign also produce an award winning mobile app, freely available for iPhone, iPad and Android devices this app allows you to search for latest guidelines from almost anywhere.
The Cochrane Library
The Cochrane Libraryis freely available (no password required) and will enable you to identify systematic reviews and other high quality reviews which have been conducted to good standards. A review is an attempt to synthesise the results and conclusions of two or more publications on a subject. A systematic review is a review which aims at a comprehensive overview of all the literature on a subject. It will synthesise the results and conclusions of any primary studies in the field that satisfy certain standards of scientific rigour and technique.
References from over 100 journals are assessed for quality and relevance and added to a searchable database to support clinical decision-making. Free registration required.
Orthoevidence focuses on presenting high-quality evidence within the field of orthopaedics, thereby providing orthopaedic healthcare professionals with only relevant content. The website is designed to save clinician the most time by
- searching for randomized controlled trials and meta-analyses in over 60 orthopaedic journals each month
- critically appraising each included article
- creating a unique summary report (Advanced Clinical Evidence Report) which highlights the important take-home information.
OTseeker is a database that contains over 4,000 abstracts of systematic reviews and randomised controlled trials relevant to occupational therapy.
The Physiotherapy Evidence Database (PEDro) has been developed to give rapid access to bibliographic details and abstracts of over 9,000 randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy.
speechBITE seeks to enable speech pathology clinicians and researchers to efficiently access the best available evidence to inform speech pathology practice and research
The TRIP database is a specialist search engine on which you will find references to evidence-based information.
Primary research databases such as Medline also offer specialist search strategies to help you find material higher up the evidence hierarchy.
You can apply a clinical queries search filter to your Medline and Embase search in the NHS interface.
Limit your Medline and Embase search results to clinical queries search filters
Use the Clinical Queries options in PubMed to focus your search results on items higher-up the evidence hierarchy.
Visit our databases page for access to these.
SIGN Search Filters
A list of search filters used by SIGN to develop their clinical guidelines.
The NHS Centre for Reviews and Dissemination provides information on optimal search strategies.
Critical Appraisal Skills Programme (CASP)
Resources including checklists and tutorials to help you judge the quality of research.
Dr. Chris Cates’ EBM Website
Resources to help you make sense of statistics
Online learning modules from the Canadian NCCMT
Free interactive learning tools to help you develop y our appraisal skills.
Greenhalgh, T. (2014) How to read a paper. 5th edn . London: Blackwells
Nordenstrom, J. (2007) Evidence-based medicine in Sherlock Holmes' footsteps. London: Blackwells
Strauss, S. (2005) Evidence based medicine: how to practice and teach EBM. 3rd edn. London: Elsevier/Churchill Livingstone
Last Updated: Wednesday, 15 March 2017 11:17