Orthopaedic Surgery: Evidence Based Medicine

"The integration of individual clinical expertise with the best available clinical evidence from systematic research."
David L Sackett, W Scott Richardson, William Rosenberg, Brian Haynes, Evidence Based Medicine--How to Practice and Teach EBM, 2000.
 

The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine (EBM) follows four steps: formulate a clear clinical questions from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. 
Rosenberg W, Donald A. Evidence based medicine: An approach to clinical problem-solving. BMJ. 1995;310:1122-1126

"The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are 'chopped off' the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied)."
Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016 Aug;21(4):125-7. doi:10.1136/ebmed-2016-110401. Epub 2016 Jun 23. PMID: 27339128; PMCID: PMC4975798.

Step 1: Assess your patient and determine the pertinent issues. You may be looking for evidence about therapy options, prognosis or diagnostic techniques.

Step 2: Ask a clinical question. Use the PICO model to formulate a clear and concise clinical question.

Step 3: Acquire the best evidence. Search the appropriate databases and resources to find the best evidence.

Step 4: Appraise the evidence. Determine whether the information you found is relevant, valid and applicable to your patient.

Step 5: Apply the evidence to your patient. Ensure that the evidence and recommendations meet your patient's values and expectations.