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MD Research Project Guide: Evidence-based medicine

A guide for the School of Rural Medicine's MD research project

What is evidence-based medicine?

Evidence-based medicine is the integration of the best available research evidence, with our clinical expertise and our patient’s unique values and circumstances. It also requires a consideration of the practice context in which we are working.

The aim of EBM is to find reliable, accurate and relevant evidence to support our clinical care in a timely manner.

Initially, we wanted to consider whether our clinical question is worth answering – searching for and weighing the evidence will take time, so we need to consider if it is an appropriate use of our time.

Case: Catrina Martin is taking oral ferrous sulfate for her iron deficiency anaemia, and has developed gastro-intestinal side effects.  She wonders if this is the best treatment for her anaemia. She tells you that a friend has mentioned she found Maltofer had fewer side effects for her.

A quick look at the Global Burden of Disease statistics reveals iron-deficiency anaemia as one of the most prevalent conditions worldwide, and a leading cause of disease burden[1] – in Australia, IDA is estimated to affect between 10-55% of women, and is associated with loss of productivity, tiredness and lethargy, with more serious adverse effects in pregnant women[2]. Non-adherence is a common reason for treatment failure, with GI side effects being common.

So it would seem even on a quick assessment, using robust evidence sources from peer-reviewed sources or authoritative sources, that this is an important condition to manage due to the potential burden of disease, and prevalence of the condition. This is the rationale for our clinical question.

Once we have established that the issue is important enough to spend time researching, we need an efficient process to find and weigh up the evidence.

The 4 steps we undertake to do this are:

  1. Ask an answerable question. Structuring the question using PICO, or a similar format, helps to turn our clinical question into an answerable one
  2. Acquire the evidence, by undertaking an efficient and effective search of the literature
  3. Appraise the evidence, considering the strength of the evidence, and potential sources of bias
  4. Apply the evidence, considering whether the evidence is applicable to our patient in their particular circumstances, and whether the evidence is practical to apply in our context.

[1] Carapetis J, Dadi AF. Erratum: Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 (The Lancet (2017) 390 The Lancet. 2017 Oct 28;390(10106):e38.

[2] Low MS, Grigoriadis G. Iron deficiency and new insights into therapy. The Medical Journal of Australia. 2017 Jul 1;207(2):81-7.

Acknowledgement

Information sourced from Dr Skye Boughen's MED111 Population Health EBM Workbook.

Charles Sturt University acknowledges the traditional custodians of the lands on which its campuses are located, paying respect to Elders, both past and present, and extend that respect to all First Nations Peoples.Acknowledgement of Country

Charles Sturt University is an Australian University, TEQSA Provider Identification: PRV12018. CRICOS Provider: 00005F.