Evidence-Based Treatment (EBT) or Evidence-Based Practice (EBP) refers to the practice of incorporating study results and procedures into everyday practical application by practitioners. While study results may seem like an obvious source of knowledge for practitioners, in reality it has been a difficult procedure to transfer that knowledge from the researcher to the practitioner. Thus, EBT establishes guidelines on finding, critically analyzing, incorporating, and applying the knowledge to practice.
For an excellent description of the origins, process, and future directions of EBT (referred to as Evidence-Based Medicine here), please refer to this book chapter, located in the SAGE Reference Library database:
Hupert, J. & Niederman, J. (2009). Evidence-based medicine. In M. W. Kattan (Ed.), Encyclopedia of medical decision making (pp. 468-470). Thousand Oaks, CA: SAGE Publications Ltd. doi: 10.4135/9781412971980.n140
The EBT Process contains four steps:
1) Formulating the question
2) Searching for and acquiring evidence from literature
3) Assessing the evidence for methodological validity and analyzing the study results for statistical significance and importance
4) Applying, where appropriate, the valid study results to the patient
EBT is a patient-centered process, so your information need will begin when a patient presents physical or mental symptoms. To ensure that you, as a practitioner, are providing the best options to your patient, you will need to design a query that takes into account the particular symptoms and condition of your patient. Designing an appropriate question is critical. A well thought out question will focus your research efforts and provide clear criteria to evaluate search results. The PICO method of question formulation is most commonly used in EBT.
Patient, population, or problem
Example of a PICO formulated question:
P: In a group of otherwise healthy 10-12 year olds who are exhibiting symptoms of asthma, I: what are the effects of bronchodilators, C: versus theophylline (comparison can also be placebo), O: to control and eliminate asthma symptoms?
PubMed (an open access database), MEDLINE, CINAHL, Cochrane Library and OVID (subscription databases available through the Northcentral University Library) are excellent resources to use when in need of evidence based literature.
PubMed, MEDLINE, CINAHL, and many other medical databases use MeSH subject headings as the official terms to describe concepts related in medical articles. MeSH (Medical Subject Headings) terms, which are created by the National Library of Medicine, can be thought of as a dictionary or thesaurus which assists in finding and using the correct terms to find the most relevant articles. To view examples of clinical questions translated to database searches, see the guide Evidence Based Medicine: Acquiring Evidence (under #2 Narrow your search with filters).
Identifying MeSH terms can also be a challenge. PubMed includes a searchable database of MeSH terms which allow the user to type in a keyword and see the closest matching MeSH terms. To watch a short video demonstration of searching the PubMed MeSH database, see the tutorial Use MeSH to Build a Better PubMed Query.
PubMed has designed a search page specifically for clinical queries. This will assist you in using the appropriate filters, selecting clinical categories, and finding systematic reviews of primary research. To access this search screen select Clinical Queries under the PubMed Services menu, or click the link below for PubMed Clinical Queries.
MEDLINE also uses a similar Methodology limits. To access MEDLINE, go to the Library home page and select A-Z Databases, or select from the Resource box below.
Scroll down and select MEDLINE. There are two special search limits in MEDLINE that you can use to better refine your search results: EBM Reviews and Clinical Queries.
By checking the EBM Reviews box, you will only retrieve search results from selected journals that publish EBM Reviews. These articles will generally be meta-analyses of primary research studies.
The Clinical Queries limit allows you to limit your search to articles that address a particular area of your topic. MEDLINE will limit based upon nine areas: Therapy, Diagnosis, Prognosis, Reviews, Clinical Prediction Guides, Qualitative, Causation (Etiology), Costs, and Economics. The "High Sensitivity" option for each area will run a broad search and retrieve all relevant material. The "High Specificity" option for each area will run a narrower search and only retrieve the most relevant results. The "Best Balance" option for each area will combine both of the above options.
For more information about the Clinical Queries limit see the EBSCOhost support article What are MEDLINE Clinical Queries?
CINAHL also uses a similar Methodology limit. To access CINAHL, go to the Library home page and select A-Z Databases, or select from the Resource box below.
In CINAHL, you may limit your search to Evidence-Based Practice using the checkbox shown below. Applying this limiter allows you to limit results to:
OVID Nursing Full Text
OVID also uses a similar Methodology limit. To access OVID, go to the Library home page and select A-Z Databases, or select from the Resource box below.
On the OVID Basic Search screen, select from among the options under the field EBM-Evidence Based Medicine, as shown below.
Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about Cochrane groups. To access Cochrane Library, go to the Library home page and select A-Z Databases, or select from the Resource box below.
Select Advanced Search and then click on Search limits to choose your content type as shown below.
Steps 3 and 4 of the EBT process will vary depending on the type of information you find in step 2. If you are working with primary studies then you will need to evaluate that study for validity and understand how the results of that study apply to your patient's particular case. If you have found meta-analyses of primary resources then much of the validation will be provided for you in the analysis.
Remember, EBT is a patient-centered process, so you must take into account other factors like patient preference and cost of treatment when determining the options for the patient. Through EBT research you may have found promising options for the patient, but your experience and judgment will be an important part of the process.
Bickman, L. (2008). A Measurement Feedback System (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 47(10), 1114-19.
Colorado Division of Criminal Justice, Office of Research and Statistics. (2007). Evidence based correctional practices (Accession Number 023340). Retrieved from http://nicic.gov/Library/023340
Evidence-Based Mental Health
Journal published by the British Medical Journal Publishing Group. Archives (pre-2006) are available upon completing a free registration. Recent articles may be requested through the Northcentral University Library Interlibrary Loan service.
Hupert, J. & Niederman, J. (2009). Evidence-Based Medicine. In M. Kattan (Ed.), Encyclopedia of medical decision making. Retrieved from http://www.sage-ereference.com.proxy1.ncu.edu/medical/Article_n140.html
Kazdin, A. (2006). Arbitrary metrics: Implications for identifying evidence-based treatments. American Psychologist, 61(1)42-49.
Patterson, J. E., Miller, R. B., Carnes, S., & Wilson, S. (2004). Evidence-Based Practice for marriage and family therapists. Journal of Marital and Family Therapy, 30(2), 183-195.
Tanenbaum, S. J. (2005). Evidence-Based Practice as mental health policy: Three controversies and a caveat. Health Affairs, 24(1). doi: 10.1377/hlthaff.24.1.163
Welch-Ross, M.K. & Fasig, L. (Eds.). (2007). Handbook on communicating and disseminating behavioral science. Retrieved from http://www.sage-ereference.com.proxy1.ncu.edu/hdbk_behavioralsci/TableOfContents.html
In particular, see chapters in Part V: Disseminating Behavioral Medicine Research to Practitioners: Recommendations for Researching, and Disseminating and Implementing Evidence-Based Practices for Mental Health.