Editorial

Show Me the Evidence: Now What Do I Do with It?

Authors: Leslie Citrome, MD, MPH

Abstract

The process of evidence-based medicine (EBM) “involves tracking down the best external evidence with which to answer our clinical questions.”1 The next question that comes up is how to appraise this evidence. The busy clinician is inundated with information provided in journal articles, CME offered by professional organizations, industry-sponsored lectures, and practice guidelines. EBM philosophy demands that we make sure that the clinical study under review is relevant to the patient for whom we want to apply the results. In addition to assessing the generalizability of the study (are the study subjects similar to my patient?), the availability of the intervention (is it on formulary?), and its clinical significance (what is the number needed to treat (NNT) to see a difference?), the careful clinician will need to be aware of common biases and confounds that exist in clinical studies. The paper by Hsu et al2 in this issue outlines the pitfalls encountered when interpreting evidence.

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References

1. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71–72.
 
2. Hsu JL, Banerjee D, Kuschner WG. Understanding and identifying bias and confounding in the medical literature. South Med J 2008;101:1240–1245.
 
3. Citrome L, Jaffe A, Levine J, et al. Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients. Psychiatr Serv 2004;55:1006–1013.
 
4. Citrome L, Jaffe A, Levine J, et al. Incidence, prevalence, and surveillance for diabetes in New York State psychiatric hospitals, 1997–2004. Psychiatr Serv 2006;57:1132–1139.
 
5. Citrome L. Show me the evidence: using number needed to treat. South Med J 2007;100:881–884.
 
6. Guyatt GH, Rennie D. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago, IL, AMA Press, 2001.
 
7. Guyatt GH, Rennie D. Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. Chicago, IL, AMA Press, 2001.
 
8. Straus SE, Richardson WS, Glasziou P, et al. Evidence-based Medicine: How to Practice and Teach EBM. Edinburgh, Elsevier Churchill Livingstone, 2005, ed 3.