Evidence-Based Medicine
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Evidence-Based Medicine
General Information
NEWS:
ARTICLES:
Getting evidence-based treatment “What is evidence-based treatment? In the last 15 years or so there's been more emphasis on testing the evidence behind biological logic or age-old assumptions handed down over the years, in a practice called evidence-based medicine. This is where biological assumptions are tested through randomised controlled trials (see below) to find out if the logic's fine, or the treatment is useless or, like the example above, dangerous. Once tested, the information is published in peer-reviewed scientific journals and used by government organisations such as the National Health and Medical Research Council (NHMRC) to make policies and guidelines for health professionals. The evidence, particularly behind drug treatments, has improved but there are still many types of treatments like surgery, physical therapies, natural therapies, dietary advice and counselling that haven't been properly tested. 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. “
Why Do Doctors and Patients Not Follow Guidelines? “Summary: Guidelines are recommendations regarding clinical behaviour, and their implementation is a complex process that is influenced by different factors, related both to the characteristics of guidelines themselves and to the social, organizational, economic and political context or to implementation strategies. During the last few years, different studies and theories have tried to explain the reason why doctors and patients do not follow the guidelines. Following the guidelines most of all depends on the characteristics linked to the doctor's and patient's subjectivity, which can be a real obstacle. Knowledge, attitude, skills, experiences, believes and values play a fundamental role both in physician and patient. By addressing these issues to physician's and patient's adherence, more exhaustive approaches to guidelines development and spread can be applied in order to improve care and outcomes.”
JOURNAL ARTICLES:
Glycemic control in type 2 diabetes: time for an evidence-based about-face? (Ann Intern Med. 2009) “Some diabetes guidelines set low glycemic control goals for patients with type 2 diabetes mellitus (such as a hemoglobin A(1c) level as low as 6.5% to 7.0%) to avoid or delay complications. Our review and critique of recent large randomized trials in patients with type 2 diabetes suggest that tight glycemic control burdens patients with complex treatment programs, hypoglycemia, weight gain, and costs and offers uncertain benefits in return. We believe clinicians should prioritize supporting well-being and healthy lifestyles, preventive care, and cardiovascular risk reduction in these patients. Glycemic control efforts should individualize hemoglobin A(1c) targets so that those targets and the actions necessary to achieve them reflect patients' personal and clinical context and their informed values and preferences.”
Rethinking Randomized Clinical Trials for Comparative Effectiveness Research: The Need for Transformational Change (Annals 2009)
The GRADE System for Rating Clinical Guidelines (PLoS Med 2009)
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