Evidence-based is a descriptor that is often used to describe medically related reference sources. Unfortunately, it is often used indiscriminately and without merit. For a clinical reference resource to truly be called evidence-based, conclusions must be based on the best available evidence. Conclusions can be based on the best available evidence only if the evidence is consistently and systematically identified, evaluated and selected.
Step 1: Identifying the Evidence
Perform Systematic Searching
When adding a new clinical topic to a product or critically revising an existing topic, appropriate databases (MEDLINE, CINAHL and others) are searched to identify the best available evidence. In addition, numerous sources are searched for evidence-based reviews (such as Cochrane Database of Systematic Reviews) for guidelines and more. Continuous systematic literature surveillance is conducted, and updates are made to content.
The content is updated as follows:
Systematically: As researched evidence is released impacting the topic content, updates are made systematically (ongoing, continuous review based on surveillance). Top priority content may be updated frequently as a result of new studies that impact the information contained in the topics.
Scheduled: Topic content not impacted and updated based on the systematic surveillance process receives a scheduled literature review process and is clinically revised or rewritten as necessary.
- Systematic Literature Surveillance
- Continuous, systematic literature and regulatory surveillance process.
- Search includes: CINAHL, MEDLINE, SocINDEX will Full Text, PsychINFO, Rehabilitation and Sports Medicine Source, Practice Guidelines and Cochrane Database of Systematic Reviews.
- Clinical review of literature and content topic. Updates are made to content topics impacted by the literature changes identified in the surveillance process and all changes/updates in the researched literature are discovered and applied.
- New reviewed/updated date is applied.
- Scheduled Review
- All clinical content topics have a scheduled clinical review within the calendar year.
- Scheduled review can also include formatting updates, as needed.
- New reviewed/updated date is applied.
- Customer Feedback
- Customer feedback is clinically reviewed when received. Content edits are made, if necessary, after clinical analysis is completed by the editorial team.
- Editorial corrections are made immediately as part of ongoing clinical review and continuous improvement.
Step 2: Selecting the Best Available Evidence
Each topic is assessed for clinical relevance, and each relevant article is further assessed for validity relative to existing product content. The most valid articles are used to create the Skills, Decision Support Topics, Quick Lessons, Evidence-Based Care Sheets and Clinical Reviews.
Determining Relevance
Determining clinical relevance is the first consideration in systematically selecting the best available evidence from the literature retrieved. The relevance of information is different for every user. EBSCO Nursing & Health Professions products are used in clinical care by nurses and other disciplines with a wide range of experience and interests and is also used in continuing education.
When adding information, the following is considered:
- This information has a direct bearing on patient-oriented outcomes.
- This information is useful in clinical decision-making.
- In situations where the evidence does not clearly support or refute a clinical fact, opposing views are presented.
- Some medical information is not clinically relevant but is widely publicized. Summarization of this type of information (often with commentary) is relevant to the users if it is likely the interprofessional team will be asked about it during clinical encounters. It is important to point out where this type of information is not clinically applicable.
Determining Validity
Clinically relevant articles must be assessed to determine the scientific validity of conclusions and facts presented before consideration for use.
Step 3: Evaluate the Evidence (Critical Appraisal)
Examine the topic to evaluate the methodologic quality and results and determine its level of evidence. The goal is to represent the best available evidence for the specific content under consideration. Evidence types may be labeled in several ways as outlined under Levels of Evidence.
Step 4: Objectively Reflect the Relevant Findings and Quality of the Evidence
When reporting the evidence, the following is considered:
- What are the most relevant outcomes to report on the topic?
- Were all relevant outcomes reported in the original article?
- For relevant outcomes, what is the magnitude of effect?
- Were the findings clinically significant?
- In the case of no statistically significant differences, were the findings robust enough to rule out clinically significant difference?
- Are there any methodologic limitations sufficient to alter the reliability of clinical conclusions?
Step 5: Synthesizing Multiple Evidence Reports
Evaluate the findings, both positive and negative, from the relevant articles and organize in a systematic fashion.
Step 6: Derive Conclusions and Recommendations from the Evidence Synthesis; Obtain Peer Review
Based on the synthesis of relevant evidence, conclusions about current knowledge are drawn and recommendations for clinical practice are made.
Step 7: Change Conclusions When New Evidence Alters the Best Available Evidence
The final step in our evidence-based methodology is changing conclusions when new evidence alters the best available evidence. This step is crucial because new evidence is published every day. The Systematic surveillance process and clinical review occurs continuously.
As soon as new evidence is evaluated, it is added to the appropriate topic(s) in context. Latest Revision date is provided on topics when a topic has been updated based on best available evidence or when a topic has been clinically reviewed and revised. If used, the Original Document date definition is the date the topic was first written.