Evidence-Based Decision-Making worksheet ausing your PICO question/topic”
PICO Question: A 45-year-old female presents with a moderate gingival bleeding, will flossing with regular dental floss compared to flossing with water flosser be more effective and result decrease in gingival bleeding?

P: Patient presents with a moderate gingival bleeding
I: Using regular dental floss
C: Using a Water flosser
O: Result in decreased gingival bleeding 

  Locate clinical research article that pertain (support, or related) to PICO question and evaluate with the EBDM worksheet .  There is a Word document for the EBDM worksheet, if you type, please use a different color font.  Make sure to complete all parts (A through G)

Name  ___________________                                                                   Topic  _______________________

EBDM Worksheet

PART A.  Skill 1 – Convert Information Needs/Problems into Clinical Questions So That They Can Be Answered

1. Write your Background questions – general knowledge questions that ask the who, what, where, when, how, and why for what you need to learn more about.

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• Summarize the findings from your Background questions

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• Define your question using PICO by identifying: Problem, Intervention, Comparison Group, and Outcome

Your questions should be used to help establish your search strategy.

Patient/Problem ________________________________________

Intervention  ___________________________________________

Comparison   ___________________________________________

Outcome  ______________________________________________

• Write out your question.

____________________________________________________________________________________________________________________________________________________________________________________________

• Identify the type of question/problem appropriate for your patient.  Circle one:

Therapy/Prevention       Diagnosis             Etiology, Causation, or Harm       Prognosis

PART B.  Understanding the Publication Type So That Appropriate Studies Can Be Identified

1. Type of study (Publication Type) to include in the search:  Check all that apply, and then number from highest (#1) to lowest level of evidence.

• _____ Meta-Analysis 
• _____ Clinical Trial
• _____ Cohort Study
• _____ Editorials, Letters Opinions

• _____ Systematic Review
• _____ Practice Guideline
• _____ Case Control Study
• _____ Animal Research

• ____ Review
• ____ Randomized Controlled Trial
• ____ Case Series or Case Report
• ____ In Vitro/Lab Research

PART C.   Skill 2.  Conducting a Computerized Search with Maximum Efficiency for Finding the Best External Evidence with which to Answer the Question

1. List main topics and alternate terms from your PICO question that can be used for your search.  Circle MeSH terms.

__________________________________________________________________________________________________________________________________________________________________________________________________________________

• List your inclusion criteria – gender, age, year of publication, language, etc.

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• List where you plan to search (i.e. EBM Reviews, MEDLINE, PubMed, CINAHL, Cochrane).

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• List the web addresses of the Internet search and attach the information summary.

WEBSITE ADDRESS

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List irrelevant terms that you may want to exclude in your search.

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INFORMATION FOUND

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• Attach your search strategy here (printed from the PubMed history tab), or fill in the table.

	Search History	Results
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
#11
#12
#13
#14
#15

PART D.  Skill 3.  Critically Appraising the Evidence for Its Validity and Usefulness.

1. Summarize the results of the evidence that you found for your patient.

Article Reference #1
Type of Study:	Level of Evidence:	Does this answer my question?      YES    NO	Will I use this for my patient?      YES    NO
Are the results of the trial valid?
What are the results?
Will the results help my patients?

Article Reference #2
Type of Study:	Level of Evidence:	Does this answer my question?      YES    NO	Will I use this for my patient?      YES    NO
Are the results of the trial valid?
What are the results?
Will the results help my patients?

Article Reference #3
Type of Study:	Level of Evidence:	Does this answer my question?      YES    NO	Will I use this for my patient?      YES    NO
Are the results of the trial valid?
What are the results?
Will the results help my patients?

Article Reference #4
Type of Study:	Level of Evidence:	Does this answer my question?      YES    NO	Will I use this for my patient?      YES    NO
Are the results of the trial valid?
What are the results?
Will the results help my patients?

Article Reference #5
Type of Study:	Level of Evidence:	Does this answer my question?      YES    NO	Will I use this for my patient?      YES    NO
Are the results of the trial valid?
What are the results?
Will the results help my patients?

PART E.  Evaluating the Websites Where Information Pertinent to the Patient is Found

Skill 3.  Critically Appraising the Evidence for its Validity and Usefulness

	URL of page evaluated: http://	URL of page evaluated: http://
Information about the Site
Domain	.com, .org, .net.edu.mil/ .gov/other: _______________	.com, .org, .net.edu.mil/ .gov/other: _______________
Is the domain appropriate for the content?	YesNo	YesNo
Is the purpose and mission of the website appropriate for the information posted?	YesNo	YesNo
Ownership	Private: _______________Public:  _______________	Private: _______________Public:  _______________
Webmaster contact info	Name: Address: Email:	Name: Address: Email:
Date information was posted	mm/dd/yr	mm/dd/yr
Date site was last updated	mm/dd/yr	mm/dd/yr
Credibility of information
Is the information current?	YesNo	YesNo
Is it clear who wrote the page/information?	Name: Email: Credentials:	Name: Email: Credentials:
Is the writer qualified to discuss the topic?	YesNo	YesNo
Is there bias, opinions?	YesNo	YesNo
Is the information referenced, reliable, and accurate from print/published research?	YesNo Describe your answer:	YesNo Describe your answer:
Are the sources current and well-documented?	YesNo	YesNo
Are there links to more resources?	YesNo	YesNo
What is the purpose of the information? Check all that apply.	InformPersuadeSell	ExplainDiscloseAdvertise	InformPersuadeSell	ExplainDiscloseAdvertise
Sponsorship
Is the sponsor clearly identified?	YesNo	YesNo
Is there an advisory board or are there consultants?	YesNo	YesNo
Are the partnerships or advertisements clear?	YesNo	YesNo
Is the information usable based on the above?	YesNo	YesNo

PART F.  Skill 4.  Applying the Results of the Appraisal, or Evidence, in Clinical Practice

1a. Outcome Measures for Article #1

CER	EER	ARR	RR	RRR	OR	NNT	Sensitivity	Sensitivity	NPV	PPV

2a.  Questions to ask prior to applying evidence to practice for Article #1                                                            Rationale

Are the study groups similar enough to apply to the patient?	Yes	No
Is this available, affordable, and appropriate for the patient in this setting?	Yes	No
Will this help the patient meet his/her goals/address his/her chief complaint?	Yes	No
Is the difference large enough to warrant the treatment?	Yes	No
Are there adverse events that influence a potential recommendation?	Yes	No

1b. Outcome Measures for Article #2

CER	EER	ARR	RR	RRR	OR	NNT	Sensitivity	Sensitivity	NPV	PPV

2b.  Questions to ask prior to applying evidence to practice for Article #2                                                           Rationale

Are the study groups similar enough to apply to the patient?	Yes	No
Is this available, affordable, and appropriate for the patient in this setting?	Yes	No
Will this help the patient meet his/her goals/address his/her chief complaint?	Yes	No
Is the difference large enough to warrant the treatment?	Yes	No
Are there adverse events that influence a potential recommendation?	Yes	No

1c. Outcome Measures for Article #3

CER	EER	ARR	RR	RRR	OR	NNT	Sensitivity	Sensitivity	NPV	PPV

2c.  Questions to ask prior to applying evidence to practice for Article #3                                                            Rationale

Are the study groups similar enough to apply to the patient?	Yes	No
Is this available, affordable, and appropriate for the patient in this setting?	Yes	No
Will this help the patient meet his/her goals/address his/her chief complaint?	Yes	No
Is the difference large enough to warrant the treatment?	Yes	No
Are there adverse events that influence a potential recommendation?	Yes	No

1d. Outcome Measures for Article #4

CER	EER	ARR	RR	RRR	OR	NNT	Sensitivity	Sensitivity	NPV	PPV

2d.  Questions to ask prior to applying evidence to practice for Article #4                                                           Rationale

Are the study groups similar enough to apply to the patient?	Yes	No
Is this available, affordable, and appropriate for the patient in this setting?	Yes	No
Will this help the patient meet his/her goals/address his/her chief complaint?	Yes	No
Is the difference large enough to warrant the treatment?	Yes	No
Are there adverse events that influence a potential recommendation?	Yes	No

1e. Outcome Measures for Article #5

CER	EER	ARR	RR	RRR	OR	NNT	Sensitivity	Sensitivity	NPV	PPV

2e.  Questions to ask prior to applying evidence to practice for Article #5                                                           Rationale

Are the study groups similar enough to apply to the patient?	Yes	No
Is this available, affordable, and appropriate for the patient in this setting?	Yes	No
Will this help the patient meet his/her goals/address his/her chief complaint?	Yes	No
Is the difference large enough to warrant the treatment?	Yes	No
Are there adverse events that influence a potential recommendation?	Yes	No

3. Using evidence-based decision-making, scientific evidence is only one component to the decision-making process.  Please synthesize all four of the components to decide on a course of action for your patient.

Summary of Scientific Evidence:	Summary of your Experience/Judgment:	Summary of Patient Preferences/Values:	Summary of Clinical/Patient Circumstances:
Overall Recommendations to the Patient based on the EBDM Process:

PART G.  Skill 5.  Evaluating the Process and Your Performance

Rate your performance of each aspect of EBDM by identifying where you are on the competence continuum.  Outline how you plan to strengthen your weaknesses in the comments section.

Novice	Beginner	Competent	Proficient	Expert
Lacks full understanding, requires frequent guidance, and need to learn theory and rules	Understands the theory but cannot always connect it to practice	Integrates theory and practice and demonstrates the basic abilities of EBDM	Makes analytical thinking with intuitive experience with greater depth and breadth of understanding in a wide range of cases	Effortlessly completes tasks as normal, blending the highest level of judgment and skill

Skill 1.  Converting information Needs/Problems into Clinical Questions So That They Can Be Answered

1. PICO, Asking Good Questions

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Define the specific PICO components
Formulate a well-built question derived from a patient case using the PICO format
Identify additional keywords based on PICO
Identify inclusion criteria
Use the PICO process for your own questions
Use the PICO process with staff, students, colleagues
Comments:

• Research Design and Sources of Evidence and Levels of Evidence

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Distinguish between publication types
Identify and select appropriate study designs according to the type of question being asked
Define the levels of evidence
Comments:

Skill 2. Conducting a Computerized Search with Maximum Efficiency for Finding the Best External Evidence with which to Answer the Question

• Finding the Evidence: Using PICO to Guide the Search

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Identify inclusion criteria
Use PubMed to search the literature
Identify MeSH with the PubMed MeSH database
Use MeSH terms when searching
Combine search terms with Boolean Operators
Limit the search based on inclusion criteria
Track the process with the Search History
Search different/multiple databases
Comments:

Skill 3.  Critically Appraising the Evidence for Its Validity and Usefulness

• Critical Appraisal of the Evidence

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Identify where the selected study is in the hierarchy of levels of evidence
Screen and select appropriate abstracts
Critically appraise the validity of research studies
Use evidence to answer a PICO question
Comments:

Skill 4.  Applying the Results of the Appraisal, or Evidence, in Clinical Practice

• Applying the Evidence to Practice

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Incorporate EBDM into practice
Present Research findings to patient
Use the scientific evidence as a resource in clinical decision-making
Comments:

Skill 5.  Evaluating the Process and Your Performance

• Self-Evaluation

Rate your level of ability to:	Novice	Beginner	Competent	Proficient	Expert
Conduct a self-evaluation
Make improvements based on past experience
Identify additional learning needs
Comments: