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Using EBM Effectively

Using EBM effectively takes more than understanding how to interpret outcomes from something you read. It involves knowing the right question to ask, turning that question into a good search, knowing the best place to look, finding what is available and then using the evidence you find in the care of your patient. Use the "5 A's" as a step-by-step guide to locate best evidence.

1. Assess
   • Identify the clinical problem. What is it you want to know?
2. Ask
   • Use the PICO formula to create a good question:
     • P=PATIENT – Who is your patient?
     • I=INTERVENTION – Are you looking to diagnose? Treat? Learn about a prognosis?
     • C=COMPARISON – Is there a control? Placebo? A "gold standard"?
     • O=OUTCOME – What do you hope to accomplish? Better/best treatment? Decreased mortality?
   • A good PICO might read "In an 86-year old man with coronary artery disease, is aspirin a more effective agent than heparin in reducing risk of stroke?"
3. Acquire
   • Use your PICO formula to search for good evidence. Start your search using only two to three terms - you can always add more. Use the information resources on the EBM home page as a starting point.
4. Appraise
   • What have you found? Where did you find it? Are the results significant to your patient? How strong is the evidence? Are there any confounding variables such as bias present?
5. Apply
   • Now apply and discuss the evidence you have found with your patient.