Evidence Based Medicine (EBM)

Evidence-based medicine (EBM) is defined by its proponents as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
The practice involves integrating a clinician's individual clinical experience with the best available external clinical evidence derived from systematic research.
The rapid growth of EBM has been primarily driven by the underlying uncertainty regarding the evidentiary basis for many commonly accepted medical practices.

Pediatric practice relies on EBM to develop safe, effective, and age-appropriate treatment protocols, keeping in mind the unique physiological and developmental stages of children.
EBM allows pediatricians to transition away from relying on "anecdotal evidence" (such as case reports or unverified single-clinician observations), which is scientifically unacceptable for drawing definitive conclusions about treatments.
EBM provides the foundation for accurately evaluating the protective efficacy of vaccines, optimizing pediatric drug dosing, and establishing early warning systems and surveillance for infectious diseases.
It emphasizes the use of randomized clinical trials and systematic reviews to make unbiased diagnostic and therapeutic decisions for pediatric patients.

Basic Steps in the Practice of EBM

Step 1: Ask (Formulate the question): The first step involves converting the need for information into an answerable, structured clinical question. This is commonly done using the PICO framework (Population/Patient, Intervention, Comparison, Outcome).
Step 2: Acquire (Search for evidence): This step requires systematically searching the medical literature and clinical databases to retrieve the best available evidence to answer the formulated clinical question.
Step 3: Appraise (Critically evaluate): The retrieved evidence must be critically appraised for its validity (closeness to the truth) and its impact (the size of the effect and precision of the estimate).
Step 4: Apply (Implement the findings): The appraised evidence is then integrated with the physician's own clinical expertise and the patient's unique biological characteristics, values, and clinical circumstances to make a shared healthcare decision.
Step 5: Assess (Evaluate performance): The final step is to evaluate the effectiveness and efficiency of the clinician in executing the first four steps, seeking ways to continuously improve the process for future patient encounters.

A systematic review is a comprehensive review of all studies that conform to a strict set of criteria relating to a particular research question of interest.
Systematic reviews are particularly vital for investigating and synthesizing the results of clinical trials to prevent biases and improve statistical power.
To perform these reviews or to practice EBM, clinicians search specific, highly structured databases.

Database Name	Description and Role in EBM
Cochrane Collaboration	An international network of individuals committed to preparing, maintaining, and disseminating systematic reviews of the effects of healthcare interventions. It aims to minimize duplication, avoid bias, and keep clinical evidence up to date.
Cochrane Central Register of Controlled Trials	A comprehensive component of the Cochrane Collaboration containing over 400,000 citations of reports of randomized trials and other studies potentially relevant for inclusion in systematic reviews.
MEDLINE / PubMed	The Medical Literature Analysis Retrieval System online, accessible via the PubMed database (PubMed.gov), which serves as the principal search engine for peer-reviewed biomedical literature and clinical evidence.
PROSPERO (Outside Information)	An international prospective register of systematic reviews in health and social care, utilized to register review protocols and avoid duplication of effort.
Embase (Outside Information)	A highly versatile biomedical and pharmacological database often used alongside MEDLINE to ensure comprehensive literature retrieval when conducting a systematic review.