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This research guide is created specifically for Nursing Courses and topics such as Evidence Based Practice and PICO Formatting. It will help with library resources like finding articles, using databases, and much more!

Evidence Based Practice Stages and Pyramid

 

WHAT IS EVIDENCE BASED PRACTICE?

The most common definition of EBP is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP 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 systematicresearch." (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002) 

The difference between Meta-Analysis and Systematic Review

A meta-analysis and a systematic review are both methods used to synthesize research findings, but they differ in their scope and methodology.

  1. Systematic Review:

    • Purpose: A systematic review aims to comprehensively collect, evaluate, and synthesize all relevant studies on a specific research question or topic.
    • Process: It follows a structured and predefined protocol that includes a thorough search of the literature, selection of studies based on strict criteria, assessment of the quality of included studies, and a qualitative or quantitative synthesis of the findings.
    • Outcome: The result is a detailed, unbiased summary of the evidence on the topic, often highlighting gaps in research and providing recommendations for practice or further study.
  2. Meta-Analysis:

    • Purpose: A meta-analysis is a subset of a systematic review that quantitatively combines the results of multiple studies to arrive at a single conclusion about the effect of a treatment or intervention.
    • Process: After identifying and selecting studies through a systematic review, a meta-analysis statistically aggregates the data from these studies, typically using effect sizes, to produce an overall estimate of the effect.
    • Outcome: The result is a more precise estimate of the effect size or association, often presented in the form of a pooled average with confidence intervals.

In summary, a systematic review can exist without a meta-analysis, but a meta-analysis is always part of a systematic review if the data allows for quantitative synthesis.

Common Articvle Types in EBP

Here are the basic types of scientific articles commonly used in evidence-based practice:

  1. Original Research Article (Empirical Study):

    • Purpose: Presents new research findings from original experiments, clinical trials, or observational studies.
    • Structure: Typically follows the IMRaD format—Introduction, Methods, Results, and Discussion.
    • Significance: Provides primary evidence on the effectiveness of interventions, diagnostic accuracy, or risk factors, contributing directly to evidence-based practice.
  2. Systematic Review:

    • Purpose: Synthesizes all relevant studies on a specific research question using a systematic and transparent method.
    • Structure: Includes a comprehensive literature search, selection criteria, quality assessment, and summary of findings.
    • Significance: Provides a high level of evidence by integrating results from multiple studies, often used to guide clinical practice guidelines.
  3. Meta-Analysis:

    • Purpose: Combines data from multiple studies (usually included in a systematic review) to produce a single, quantitative estimate of an intervention's effect.
    • Structure: Uses statistical techniques to aggregate results, typically presented with pooled effect sizes and confidence intervals.
    • Significance: Offers a more precise estimate of the effect size, often considered the highest level of evidence when available.
  4. Clinical Practice Guidelines:

    • Purpose: Provides evidence-based recommendations for clinicians on the diagnosis, management, and treatment of specific conditions.
    • Structure: Developed by expert panels, usually based on systematic reviews and meta-analyses, with graded recommendations.
    • Significance: Guides healthcare professionals in making informed decisions, ensuring that patient care is based on the best available evidence.
  5. Case Report/Case Series:

    • Purpose: Describes the clinical presentation, diagnosis, treatment, and outcomes of a single patient (case report) or a small group of patients (case series).
    • Structure: Detailed account of individual cases, often highlighting unusual or novel aspects.
    • Significance: Provides evidence that may lead to the generation of new hypotheses or contribute to the body of knowledge on rare conditions.
  6. Cohort Studies:

    • Purpose: Observes a group of individuals over time to study the outcomes associated with specific exposures or interventions.
    • Structure: Follows participants prospectively or retrospectively, comparing outcomes between exposed and unexposed groups.
    • Significance: Provides evidence on the association between risk factors and outcomes, helping to inform clinical decision-making.
  7. Randomized Controlled Trial (RCT):

    • Purpose: Tests the effectiveness of an intervention by randomly assigning participants to an experimental group or a control group.
    • Structure: Includes randomization, blinding, and controlled conditions to reduce bias.
    • Significance: Considered the gold standard in clinical research for establishing causality and guiding evidence-based practice.

These types of articles form the backbone of evidence-based practice, helping to inform clinical decisions and policy-making with the best available scientific evidence.

Evidence Based Practice Resources

Books about EBP

British Medical Journal- Recent Issues

  • Reducing the environmental impact of healthcare to improve health, sustainability and equityThis link opens in a new windowMar 21, 2025

    As the impacts of climate change and the transgression of other planetary boundaries on human health become evident, so is the impact of healthcare on climate change and environmental degradation. This interplay between human health and the environmental impact of healthcare increasingly emerges as a critical concern. Healthcare delivery, while aimed at preserving human health, paradoxically contributes to environmental pollution and greenhouse gas emissions, either directly from healthcare facilities or indirectly from the supply chain of healthcare goods and services.1 As healthcare professionals, we must confront this paradox, recognising the need to assume a role in mitigating the environmental impacts of our practices and also in advocating for a broader change in professional culture towards sustainability.2

    While striving to adhere to the principle of ‘first, do no harm’, healthcare is an important contributor to climate change, environmental degradation, biodiversity loss, and resource depletion.3...

  • Can the HEARTS initiative reduce the burden of cardiovascular disease?This link opens in a new windowMar 21, 2025
    What is HEARTS?

    Cardiovascular disease (CVD) continues to exert a heavy burden in most countries in the world, with high blood pressure continuing to be one of the most important drivers of this burden. The urgency to tackle CVD has never been clearer.

    WHO launched a global effort (the Global Hearts Initiative) with five technical packages aimed at targeting major drivers of the CVD burden, including actions on tobacco (MPOWER), physical activity (ACTIVE), some aspects of diet such as reducing salt (SHAKE) and trans fats intake (REPLACE) and HEARTS. HEARTS is a set of activities to improve cardiovascular risk management in primary care, with a focus on high blood pressure.1

    The HEARTS technical package is an institutionalised model of care and a set of guidelines for cardiovascular risk management, focusing on hypertension control and secondary prevention in primary healthcare. HEARTS is structured around six pillars, focusing...

  • A call for community-shared decisionsThis link opens in a new windowMar 21, 2025
    Introduction

    Shared decision-making in medicine is widely viewed as a collaboration between the patient and the clinician. For example, Montori et al state, ‘The patient and clinician must collaborate to arrive at a useful formulation of the problem’.1 Patients are encouraged to evaluate care choices in light of the benefits and harms of each, state their preferences and identify the best course of action along with their doctor.2 Despite its broad reach, shared decision-making solely between a patient and doctor has clear limits. Over 30 years ago, Brock and Wartman cautioned that ‘[p]atients do not have an unqualified right to make even rational individual choices that risk serious harm to others’.3 Elywin et al noted that ‘limits on shared decision-making will occur when... wider interests overrule individual wishes’.4 These authors lay out problems with shared decisions for antibiotics, opioids and...