As you consider Evidence, think of the Pyramid, with the most highly regarded articles at the top!
Need help evaluating the evidence? Check out these checklists from the Critical Appraisal Skills Programme (CASP).
Peer-Reviewed articles have been evaluated by other researchers and experts in the field before being accepted for publication. Peer review generally indicates a higher level of credibility or validity to the article. Not all journals are peer-reviewed!
Review Articles are journal articles that summarize a number of studies on the same topic. Review articles can lead you to extensive lists of research articles on a similar topic. It may not be possible to tell what criteria the author used in selecting the studies to be included or excluded.
Research Articles are journal articles that describe individual research studies. Well-designed research studies provide the foundation for practicing evidence-based medicine.
A Literature Review is a scholarly analysis of a body of research about a specific issue or topic. (See Lit Review tab for more information)
A Meta-Analysis is a statistical technique for combining the findings from independent studies to assess the clinical effectiveness of healthcare interventions.
A Random Control Trial (RCT) is an experiment that delivers an intervention or treatment; subjects are randomly assigned to control and experimental groups, so it is the strongest design to support cause and effect relationships.
A Systematic Review is a comprehensive, unbiased review of multiple research studies that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that research question.
Evidence-based practice (EBP) is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients....It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognized that health care is individualized and ever changing and involves uncertainties and probabilities.
McKibbon KA. Evidence-based practice. Bull Med Libr Assoc. 1998 Jul;86(3):396-401.
EBP combines nursing expertise, patient preference, and peer-reviewed literature
There are five elements to consider when developing a good clinical research question:
| P | I | C | O | T |
| Patient or Problem | Intervention | Comparison Intervention | Outcome | Time |
| Describe as accurately as possible the patient or group of patients of interest |
What is the main intervention or therapy you wish to consider? |
Is there an alternative treatment to compare? | What is the clinical outcome? | Time it takes to demonstrate a clinical outcome. |
| Patient or Problem | Intervention (a cause, prognostic factor, treatment, etc.) |
Comparison Intervention (if necessary) |
Outcomes | |
|---|---|---|---|---|
| Tips for Building | Starting with your patient, ask “How would I describe a group of patients similar to mine?” Balance precision with brevity. |
Ask “Which main intervention am I considering?”Be specific. | Ask “What is the main alternative to compare with the intervention?”Again, be specific. | Ask “What can I hope to accomplish?” or “What could this exposure really affect?”Again, be specific. |
| Example | “In patients with heart failure from dilated cardiomyopathy who are in sinus rhythm …” | “… would adding anticoagulation with warfarin to standard heart failure therapy …” | “… when compared with standard therapy alone …” | “… lead to lower mortality or morbidity from thromboembolism. Is this enough to be worth the increased risk of bleeding?” |