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1、Evidence-Based MedicineEVIDENCE-BASED MEDICINEIntroductionEvidence-based medicine (EBM) is a relatively new approach to the teaching and practice of medicine. Historically, physicians clinical decision-making was based on the knowledge received during their medical training and experiences gained th
2、rough individual patient encounters i.e. opinion-based.Evolution of epidemiology, and subsequently clinical epidemiology, resulted in methods that allowed the objective critique of therapies used in clinical practice. Epidemiologic principles were applied to problems encountered in clinical medicine
3、 and an increasing number of clinical trials and medical journals emerged. The past two decades have witnessed an acceleration of the information explosion and with it the volume of medical publications. Clinicians faced the difficult task of keeping track of a large amount of new and potentially im
4、portant information. On the other hand the Continuing Medical Education (CME) as a means of keeping physicians up-to-date was growing, moving from lectures by experts to small group learning, tutorials and interactive feedback sessions. However studies have shown that CME had limited impact on modif
5、ying physician performance. A legitimate concern is that many physicians will fail to recognize new and necessary changes in practice and patient care will suffer as doctors become outdated and their performance deteriorates over time.Multicentered, randomized trials now make it possible to answer f
6、undamental questions about common medical interventions. The practice of evidence-based medicine requires an understanding of clinical epidemiology, as well as excellent communication skills, patience, and a commitment to provide the patient with the knowledge required to make informed choices. It i
7、s important that physicians become familiar with the meaning of EBM and its role in influencing the provision of care and use of health resources.What is Evidence-Based Medicine?Evidence-based medicine has been defined as the conscientious, explicit, and judicious use of current best evidence in mak
8、ing decisions about the care of individual patients.The concept of evidence-based medicine is defined as the integration of individual clinical expertise with the best available clinical evidence from systematic research.Process EBM is the proves of systematically reviewing, appraising and using cli
9、nical research findings to aid the delivery of optimum clinical care to patients.Simply put, it means applying the best information to manage patient problems, diagnosis, prognosis, harm, patient safety etc. It is based on the assumption that: 1) medical literature, and thus useful information about
10、 patient care, is growing at an alarming rate; and 2) in order to provide best care for patients, doctors must be able to continuously upgrade their knowledge, i.e. by accessing, interpreting and using medical literature in a timely fashion.What is the problem? Why is there a need for EBM? Dont we a
11、lready practice medicine fairly uniformly based on a common fund of evidence?.Bottom line: we are now often practicing medicine based on clinical judgment that is not well informed by the best evidence of medical research a slippery slope to diminished effectivity and/or compromised competence. Why
12、evidence-based medicine?The first reaction of any doctor to EBM is likely to be Well, of course thats what I always do. The second response, perhaps more thoughtful and certainly more honest, will be a degree of confusion: What does it really mean? How does one actually do evidence based medicine? S
13、urely there is not enough time? What kind of doctor am I if my medicine is not evidence based?Some doctors perceived EBM as diminishing the role of clinical acumen and experience, fearing that the art of decision-making will be lost. It should be noted that EBM neither excludes the vital role played
14、 by experience, nor advocates the replacement of sound clinical judgment. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. EBM respects clinical skills while emphasizing the need to develop new skills in
15、information management. The physician of the new millennium, whether specialist or generalist, requires a basic understanding of research methodology to go along with practical strategies for seeking out, assessing and applying the most useful information in concert with patients preferences.Althoug
16、h we need this new evidence daily, we usually fail to get it, because we dont get the evidence, both our up-to-date knowledge and our clinical performance deteriorate with time. Trying to overcome clinical entropy through traditional CME programs doesnt improve our clinical performance. A different approach to clinical learning has been shown to be effective in keeping practitioners up to date: EBM
