| Evidence-based Medicine |
Article Index for Evidence-based |
Website Links For Medicine |
Information AboutEvidence-based Medicine |
| CATEGORIES ABOUT EVIDENCE-BASED MEDICINE | |
| medical informatics | |
| evidence-based medicinemedical informatics | |
| evidence-based medicine | |
| biostatistics | |
| medical informatics | |
| quality assurance | |
|
EBM recognizes that many aspects of medical care depend on individual factors such as Quality and value-of-life judgments, which are only partially subject to scientific methods. EBM, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best ''prediction'' of outcomes in medical treatment, even as debate about which outcomes are desirable continues. OVERVIEW Using techniques from Science , Engineering , and Statistics , such as Meta-analysis of Medical Literature , Risk-benefit Analysis , and Randomized Controlled Trial s, EBM aims for the ideal that Healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. Generally, there are three distinct, but interdependent, areas of EBM. The first is to treat individual patients with acute or chronic pathologies by treatments supported in the most scientifically valid medical literature. Thus, medical practitioners would select treatment options for specific cases based on the best research for each patient they treat. The second area is the Systematic Review of medical literature to evaluate the best studies on specific topics. This process can be very human-centered, as in a Journal Club , or highly technical, using computer programs and information techniques such as Data Mining . Increased use of Information Technology turns large volumes of information into practical guides. Finally, evidence-based medicine can be understood as a medical "movement" in which advocates work to popularize the method and usefulness of the practice in the public, patient communities, educational institutions, and continuing education of practicing professionals. Evidence-based medicine has demoted ''ex cathedra'' statements of the "medical Expert " to the least valid form of evidence. All "experts" are now expected to reference their pronouncements to scientific studies. CLASSIFICATION Two types of evidence-based medicine have been proposed.1 Evidence-based guidelines Evidence-based guidelines (EBG) is the practice of evidence-based medicine at the organizational or institutional level. This includes the production of guidelines, policy, and regulations. Evidence-based individual decision making Evidence-based individual decision (EBID) making is evidence-based medicine as practiced by the individual Health Care Provider . There is concern that current evidence-based medicine focuses excessively on EBID. HISTORY Although testing medical interventions for efficacy has existed for several hundred years, and arguably more, only in the 20th century did this effort evolve to impact almost all fields of health care and policy. Professor . The explicit methodologies used to determine "best evidence" were largely established by the McMaster University research group led by David Sackett and Gordon Guyatt . The term "evidence based" was first used in 1990 by David Eddy. 23 The term "evidence-based medicine" first appeared in the medical literature in 1992 in a paper by Guyatt ''et al''. Guyatt G, Cairns J, Churchill D, et al. Medicine Working Group’ "Evidence-based medicine. A new approach to teaching the practice of medicine." ''JAMA'' 1992;268:2420-5. PMID 1404801 QUALIFICATION OF EVIDENCE Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of Randomized , Double-blind , Placebo -controlled trials involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more. Practising evidence-based medicine requires clinical expertise, but also expertise in retrieving, interpreting, and applying the results of scientific studies and in communicating the risks and benefits of different courses of action to patients. |
|
|