Speech and Hearing Sciences

Evidence-Based Medicine [also referred to as Evidence-Based Practice] is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Source: Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2.

The EBP process has 5 steps, as discussed in Albarqouni et al. (source below)

1. Ask - Develop a relevant, answerable clinical question
2. Acquire - Plan, search & find the best available evidence
3. Appraise - Critically appraise articles for validity & applicability
4. Apply - Integrate the evidence into practice
5. Assess - Evaluate your clinical decision

Source: Albarqouni L, Hoffmann T, Straus S, et al. Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA Netw Open. Published online June 22, 20181(2):e180281. doi:10.1001/jamanetworkopen.2018.0281

Melnyk Model (example pyramid below):
I. Systematic reviews or  meta-analyses of RCTs (randomized control trial).
II.  Well-designed RCTs
III. Well-designed, controlled trials without randomization
IV. Well-designed cohort and case-control studies
V. Systematic reviews of descriptive and qualitative studies
VI. Descriptive and qualitative studies
VII. Expert consensus reports

Source: Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & Wilkins.

Example PICO Statements from CINAHL Evidence based practice care sheets:

 1.  In the elderly at risk of falling, is tai chi effective in reducing the risk and preventing falls as compared with those who do not practice tai chi?

 2. Are alcohol based hand rubs more effective or less effective in reducing HRI's than soap and water techniques?

 3.   Is peer-pressure more effective than educational interventions in improving hand hygiene practices?

 4.   Are PPI's (proton pump inhibitors) effective medical therapy for esophagitis and GERD in children and adolescents?

 5.   In older adults with wandering, is music therapy or exercise/activities more effective in decreasing wandering/pacing?