Evidence-Based Medicine

Steps of EBM
There are five steps in practicing EBM «5 A’s»:
1. Ask: Asking answerable questions.
2. Acquire: Searching for the best evidence.
3. Appraise: Critically appraising the evidence.
4. Apply: Applying the evidence to individual patient care, and,
5. Asses: Evaluating the process.
Asking answerable questions
The practicing physician is always faced with the dilemma of how best to
answer the clinical questions either arising, for example, from failure of therapy
or from the inquisitive patient. By extension questions could also come from
diverse areas that have stake in health care delivery.
In order to be able to search for evidence regarding a particular clinical issue, a
proper answerable question must be formulated. This is not always as easy as
it may seem. It can be done by making sure the question contains four areas
abbreviated by the acronym PICO. ‘P’ stands for the description of patient
or population; ‘I’ for the intervention, ‘C’ for the comparison group; ‘O’ for the
outcome.
Clinical Scenario
Ibrahim is a 60 years old businessman, with no prior history of any cardiovascular
event. He presented to your clinic for follow up, he wanted your advice about
using aspirin, as it was recommended for one of his friends, who had a heart
attack recently.
Formulation a clinical question:
* Patient / Population : Primary prevention
* Intervention : Aspirin
* Comparison : Placebo
* Outcome : Prevention of Cardiovascular events
Searching for the best evidence
Considering the time lapse between writing a book and the book hitting the
stand, may be five years in some cases- by which time some information might
have become obsolete, books cannot be considered as the best source of
evidence. They are good for teaching purposes reference to a limited extent
and it needs update regularly.
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