Editing Evidence-based medicine (section)

=== Steps ===
The steps for designing explicit, evidence-based guidelines were described in the late 1980s: formulate the question (population, intervention, comparison intervention, outcomes, time horizon, setting); search the literature to identify studies that inform the question; interpret each study to determine precisely what it says about the question; if several studies address the question, synthesize their results ([[meta-analysis]]); summarize the evidence in evidence tables; compare the benefits, harms and costs in a balance sheet; draw a conclusion about the preferred practice; write the guideline; write the rationale for the guideline; have others review each of the previous steps; implement the guideline.<ref name=eddy4 />

For the purposes of medical education and individual-level decision making, five steps of EBM in practice were described in 1992<ref>{{cite journal | vauthors = Cook DJ, Jaeschke R, Guyatt GH | title = Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group | journal = Journal of Intensive Care Medicine | volume = 7 | issue = 6 | pages = 275–282 | year = 1992 | pmid = 10147956 | doi = 10.1177/088506669200700601 | s2cid = 7194293 }}</ref> and the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers was summarized into five steps and published in 2005.<ref name="Sicily statement on evidence-based">{{cite journal | vauthors = Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J | display-authors = 6 | title = Sicily statement on evidence-based practice | journal = BMC Medical Education | volume = 5 | issue = 1 | pages = 1 | date = January 2005 | pmid = 15634359 | pmc = 544887 | doi = 10.1186/1472-6920-5-1 | doi-access = free }}</ref> This five-step process can broadly be categorized as follows:

# Translation of uncertainty to an answerable question; includes critical questioning, study design and levels of evidence<ref>{{cite journal | vauthors = Richardson WS, Wilson MC, Nishikawa J, Hayward RS | title = The well-built clinical question: a key to evidence-based decisions | journal = ACP Journal Club | volume = 123 | issue = 3 | pages = A12–A13 | year = 1995 | pmid = 7582737 | doi = 10.7326/ACPJC-1995-123-3-A12 }}</ref>
# Systematic retrieval of the best evidence available<ref>{{cite journal | vauthors = Rosenberg WM, Deeks J, Lusher A, Snowball R, Dooley G, Sackett D | title = Improving searching skills and evidence retrieval | journal = Journal of the Royal College of Physicians of London | volume = 32 | issue = 6 | pages = 557–563 | year = 1998 | doi = 10.1016/S0035-8819(25)01804-5 | pmid = 9881313 | pmc = 9662986 }}</ref>
# Critical appraisal of evidence for [[internal validity]] that can be broken down into aspects regarding:<ref name="doi"/>
#* Systematic errors as a result of selection bias, information bias and confounding
#* Quantitative aspects of diagnosis and treatment
#* The effect size and aspects regarding its precision
#* Clinical importance of results
#* External validity or generalizability
# Application of results in practice<ref>{{cite journal | vauthors = Epling J, Smucny J, Patil A, Tudiver F | title = Teaching evidence-based medicine skills through a residency-developed guideline | journal = Family Medicine | volume = 34 | issue = 9 | pages = 646–648 | date = October 2002 | pmid = 12455246 }}</ref>
# Evaluation of performance<ref>{{cite journal | vauthors = Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD | display-authors = 6 | title = Audit and feedback: effects on professional practice and healthcare outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 6 | issue = 6 | pages = CD000259 | date = June 2012 | pmid = 22696318 | doi = 10.1002/14651858.CD000259.pub3 | pmc = 11338587 }}</ref>