Evidence-Based Practice  

1972 Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services to champion provision of "health care which had been shown in properly designed evaluations to be effective." He stressed the importance of using evidence from randomized controlled trials (RCT's) because these were "likely to provide much more reliable information than other sources of evidence." http://www.cochrane.org/about-us/history/archie-cochrane

1981 David Sackett published How to Read Clinical Journals . . how to read them critically. CMAJ 124(5):555-558

1992, Gordon Guyatt at McMaster University led the Evidence-based Medicine Working Group and published Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992;268:2420–2425. While emphasizing the need for rigorously evaluated scientific evidence, EBM leaders placed the application of evidence in the context of the individual patients expectations and desires.

1993 - 2000 Evidence-based Medicine Working Group publishes a series of twenty-five Users' Guides to the Medical Literature in JAMA.

1997 "Evidence-Based Medicine" added to MeSH.

2009 "Evidence-Based Practice - Dentistry - Nursing" added to MeSH

Evidence based medicine "an approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease". (from JAMA 296 (9), 2006)

EBM is the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.

It can be broken down into 5 steps: 

1. Formulating an answerable question
2. Searching the literature efficiently
3. Appraising the literature critically
4. Applying the result to clinical practice or patient
5. Evaluating the outcomes of the applied evidence in your practice or patient

Time constraints
Volume of information
Inability to access articles
Lack of critical appraisal skills
Lack confidence in making change based on research evidence
Lack of sense of control over practice
Culture resistance to change, decisions based on history
Lack of organization valuing or supporting evidence-based practice
Lack of consensus on what constitutes evidence