Evidence-Based Medicine

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Evidence-Based Medicine

General Information

NEWS:

In medicine, evidence can be confusing "Critics condemn evidence-based medicine as "cookbook medicine" that devalues the doctor's experience and the patient's preference. Proponents argue that evidence from randomized controlled trials has stanched the flow of private and public dollars for useless or even harmful treatments. More important, they say, the information has saved countless lives. Both sides agree on one point: Keeping up with the latest evidence is virtually impossible. … Doctors have always had to juggle what they learned in their training, what they're seeing in their own patients and what they read in medical journals … Today, though, an average of 82 randomized controlled trials are published each day in the medical literature. … McMaster University physician Gordon Guyatt, a professor of clinical epidemiology and biostatistics who coined the term 'evidence-based medicine' in 1990, says doctors should have a "healthy respect" for the evidence, but should not be tyrannized by it.."

NICE is to root out ineffective treatments in NHS "The National Institute for Health and Clinical Excellence (NICE) has been charged with purging from the NHS treatments that do not improve health or are poor value for money. The health minister Andy Burnham said guidance to address poor clinical practice will help make health services more equitable across the country and reduce ineffective practices."

Not all guidelines are created equal

Stroke Trials' History Shows Bias Toward Good News "Negative and even neutral findings from stroke trials are less likely to be published than positive findings, according to new research. What makes the new study especially noteworthy is that stroke research in general has a more negative track record than other areas of medicine, the researchers noted. … The findings reflect an earlier study published in May in the Journal of the American Medical Association, which showed that clinical trials funded by drug companies and other for-profit entities were more likely to report positive findings than similar trials funded by nonprofit groups."

What is the best evidence for determining harms of medical treatment?

ARTICLES:

Evidence and advocacy: Are all things considered? "Although reaching consensus can be difficult, a consensus reached by one group, using one process, may differ from one reached by another group using a different process.7 This underscores the role of individuals and influences in the achievement of consensus, particularly in the absence of stronger evidence. What is important in this ongoing exchange is not just about differences in consensus, but differences in mandate. It is not surprising that recommendations from groups such as the Canadian Expert Drug Advisory Committee (CEDAC) differ from those of CDA's CPG Expert Committee; their mandates are clearly different. The CDA should, however, recognize that its mandate "to advocate for and increase treatment options" is separate from its community-service mandate in creating evidence-based CPGs."

Evidence-Based Medicine "This process of looking at the state of the evidence before making a decision is called evidence-based medicine or evidence-based health care. It means based on scientific evidence or supported by proof. It means not relying only on the views of experts, but on the most objective knowledge as well. The goal is to help patients get the most appropriate treatment for them. After considering the evidence and the person's own values and judgment about their options, a patient and experienced doctor can come to a better decision."

Getting evidence-based treatment "But even when there is evidence, you may not get treatment based on the latest evidence when you walk in your health professional's door – unless you ask for it. Asking for evidence-based treatment allows you to weigh up the benefits and risks of the treatment and talk to your health professional about your options. … It all sounds pretty complex, and it can be daunting. Doctors and professionals may be resistant to using evidence-based practice, they may not have had time to review new evidence or there may not be enough research done on the treatment. But consumer advocate Karen Carey Hazell says asking the following questions will encourage your health professional to go back to the evidence – if there is any – to find the answers for you. "

Guidelines-are they useful? (Epilepsia. 2006) "Although guidelines may not answer all questions it is critical that clinicians using them consider the available evidence, as well as the quality of the evidence, when incorporating the information in their decision making."

Holiday review. EBM and lesser-known ABCD relatives.

Is "First Do No Harm" a Lost Concept in Medical Education? "Most schools provide no instruction in systems thinking, and no applied experience in examining the patient care processes, which constitute everyday practice in the real world of healthcare. Thoughtless design of care processes can and does permit human error to reach, and kill, patients every day. One would expect that teaching the prevention of iatrogenic patient deaths would be a priority in our nation's medical schools, but it is not. Further, medical schools direct little attention either to the concepts of human factors or to the fundamentals of effective communication. Human failings -- whether reflected by behavioral aberrations or by error resulting from worker fatigue -- contribute to patient deaths every day. So do failures in communication. Almost 80% of preventable patient deaths are caused in part by communications failures."

JAMA patient page. Evidence-based medicine. "In the 1990s, evidence-based medicine emerged as a way to improve and evaluate patient care. It involves combining the best research evidence with the patient's values to make decisions about medical care. Looking at all available medical studies and literature that pertain to an individual patient or a group of patients helps doctors to properly diagnose illnesses, to choose the best testing plan, and to select the best treatments and methods of disease prevention. Using evidence-based medicine techniques for large groups of patients with the same illness, doctors can develop practice guidelines for evaluation and treatment of particular conditions."

The problem of evidence-based medicine in developing countries. "The utilization of research, which is the backbone of evidence-based medicine, is in a terrible state in developing countries. A recent study conducted in a hospital in Pakistan found that only 20% of residents read medical journals monthly, only 12% had ever written for medical journal publication, and 12% had never read a medical journal.3"

JOURNAL ARTICLES:

A web-based library consult service for evidence-based medicine: Technical development (BMC Medical Informatics and Decision Making 2006)

Common pitfalls in the conduct of clinical research. (Med Princ Pract. 2006)

Development of clinical guidelines: methodological and practical issues. (Neurol Sci. 2006) "The key elements for developing a clinical guideline are (a) guidelines are developed by multidisciplinary groups, (b) they are based on a systematic review of the scientific evidence, and (c) recommendations are explicitly linked to the supporting evidence and graded according to the strength of that evidence. Besides reporting the statistical strength of the randomised controlled trial results, it is necessary to consider the strength of the evidence, the methodological quality of the studies and the external validity by applying a "considered judgement" to the whole amount of the data. The Scottish Intercollegiate Guidelines Network (SIGN) process for developing guidelines is based on 4 steps: (a) methodological evaluation, (b) synthesis of evidence, (c) considered judgement and (d) grading system."

Evidence-based Medicine. (Epilepsia. 2006) "There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science."

Evidence-based medicine and its role in ethical decision-making. (J Eval Clin Pract. 2006) "The recent emergence of evidence-based medicine (EBM) presents medical ethics with the challenge of analyzing what is the current best medical evidence in ethical decision making. . Ethical decision making must be informed and legitimated by the best available medical research. Nevertheless, ethical decision making is still primarily a choice based on values and norms."

[Evidence-Based Medicine and Psychotherapy: What are Adequate Research Methods?] (Psychother Psychosom Med Psychol. 2006)

Evidence-based medicine: Fifteen years later. Golem the good, the bad, and the ugly in need of a review? (Med Sci Monit. 2006)

Evidence-based medicine: What it is and what it is not. (Injury. 2006)

Improving the use of research evidence in guideline development: 1. Guidelines for guidelines. (Health Res Policy Syst. 2006) "The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the first of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this."

Italian Stroke Guidelines (SPREAD): evidence and clinical practice. (Neurol Sci. 2006) "Evidence-based medicine's aims are to retrieve, screen and compound the best external evidence with the experience of the physician, and to best respond to the specific medical need of each individual patient. Clinical questions are better answered when good systematic reviews of randomised trials or good randomised clinical trials are available. On the other hand, in a clinical scenario, difficulties in applying the evidence may be amplified due to variability of disease conditions, feasibility of intervention and patient's preferences. Guidelines are recommendations, based as much as possible on evidence, aimed at supporting clinical judgement/diagnostic skills/treatment decisions in everyday practice. . Professionals should not forget that clinical decisions often reflect several issues, not only scientific ones, including personal experience, applicability of intervention and patient's preferences."

Lay perceptions of evidence-based information - a qualitative evaluation of a website for back pain sufferers. (BMC Health Serv Res. 2006) "Possible explanations for participants' lack of trust in research and their apparent difficulties in applying this research to their own situations include aspects that may be typical for the general public including the media's presentation of research, and a lack of familiarity with and feelings of distance to research evidence. Other aspects may be typical for patient groups with chronic and unclear medical conditions, such as a lack of trust in the health care establishment in general."

Screening for disease: making evidence-based choices. (Clin J Oncol Nurs. 2006)

Taking stock of evidence-based medicine: opportunities for its continuing evolution. (J Eval Clin Pract. 2006)

The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands. (Eur J Clin Pharmacol. 2006)

The hard art of soft science: Evidence-Based Medicine, Reasoned Medicine or both? (J Eval Clin Pract. 2006)

Towards evidence-based critical thinking medicine? Uses of best evidence in flawless argumentations. (Med Sci Monit. 2006)

Why are physicians not persuaded by scientific evidence? A grounded theory interview study (BMC Health Services Research 2006) "Physicians occasionally provide treatment without expecting remarkable therapeutic effectiveness, as exemplified by the use of eye drops. This finding highlights that scientific evidence alone cannot easily change physicians clinical practices, unless evidence-based practices are accepted by the general public and supported by health policy."

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