Evidence-based medicine in anaesthesia

2017 ◽  
Author(s):  
Ann Merete Møller
Keyword(s):  
Evidence Based Medicine ◽  
Meta Analysis ◽  
Consort Statement ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Question ◽  
Clinical Expertise ◽  
Clinical Databases ◽  
Patient Values ◽  
Based Medicine

Evidence-based medicine (EBM) is defined as ‘The judicious use of the best current evidence in making decisions about the care of individual patients’. Evidence-based medicine (EBM) is meant to integrate clinical expertise with the best available research evidence and patient values. The purpose of EBM is to assist clinicians in making the best decisions. Practising EBM includes asking an answerable, well-defined clinical question, searching for information, critically appraising information retrieved, extracting data, synthesizing data, and making conclusions about the overall effect. The clinical question includes information of the following elements: the population, the intervention, and the clinically relevant outcomes in focus. The clinical question is a tool to make the focus of the question clearer, and an aid to build the following search strategy. A comprehensive and reproducible literature search is essential for conducting a high-quality and up-to-date search. The search should include all relevant clinical databases. Papers retrieved after the search must be critically appraised and evaluated for the risk of bias. Evidence-based methods are used in the production of systematic reviews, and the development of clinical guidelines. Whether a meta-analysis should be performed depends on the quality and nature of the extracted data. Practising EBM may be challenged by a lack of well-performed trials, various types of bias (including publication bias), and heterogeneity between existing trials. Several tools have been constructed to help the process; examples are the CONSORT statement, the PRISMA statement, and the AGREE instrument.

scholarly journals KNOWLEDGE, ATTITUDE AND PERCEPTION TOWARD EVIDENCE BASED MEDICINE AMONG MEDICAL STUDENTS IN SHENDI UNIVERSITY- SUDAN

2021 ◽  
Vol 9 (3) ◽  
pp. 149-155
Author(s):  
Naba’a Alkhair ALshaikh ◽  
Haghamad Allzain ◽  
Bashier Eltayeb Shumo
Keyword(s):  
Medical Students ◽  
Evidence Based Medicine ◽  
Clinical Care ◽  
Current Status ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Cross Sectional ◽  
Poor Knowledge ◽  
Based Medicine

Evidence-based medicine (EBM) is the “conscientious, explicit, and judicious use of current best evidence (Thamer Z. et al. 2018 .It is the evolving science of clinical care. It is the judicious use of the best current evidence in making decisions about the care of the individual patient.  It also integrates clinical expertise, patient desires, values, and needs .  (Michael LeFevre.2014 ) The current study intended to assess Knowledge, attitude and perception toward EBM among medical students in Shendi University in Sudan. It was descriptive cross-sectional one, from October to December 2020; It included one hundred and twenty one (121) medical students. Data was collected employing structural self –administered questionnaire and the data collected was analyzed by SPSS. The findings of the study described the current status of level of awareness and use of EBM .More than half of students have poor knowledge toward EBM. Approximately half or less have good attitude compared with their poor knowledge, while the perception of the importance of evidence based medicine was good (72%).

The Other War on Drugs: The Pharmaceutical Industry, Evidence-Based Medicine, and Clinical Practice

2007 ◽  
Vol 19 (1) ◽  
pp. 49-70 ◽  
Author(s):  
Howard I. Kushner
Keyword(s):  
Evidence Based Medicine ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Epidemiology ◽  
Meta Analysis ◽  
General Medicine ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Based Medicine

Over the past decade, evidence-based medicine (EBM) has become the standard for medical practice.1 Evidence-based practices have been established in general medicine and specialized fields; new evidence-based journals have been launched.2 Although its roots can be found in mid-nineteenth-century medical philosophy, contemporary EBM was largely developed by the clinical epidemiology program at McMaster University in 1992.3 According to the McMaster manifesto published in JAMA, EBM “deemphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research.”4 The most frequently cited definition of EBM is reliance on the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,” based on an integration of “individual clinical expertise with the best available external clinical evidence from systematic research.”5 However, as Stefan Timmermans and Aaron Mauck recently observed, EBM “is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation.”6

scholarly journals Evidence-based Medicine: Top Ten Things to Know!

2012 ◽  
Vol 46 (1) ◽  
pp. 1-3
Author(s):  
Raman Mundi ◽  
Simran Mundi ◽  
Mohit Bhandari
Keyword(s):  
Evidence Based Medicine ◽  
Randomized Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Health Care Decisions ◽  
Research Findings ◽  
Patient Values ◽  
Based Medicine

ABSTRACT Evidence-based medicine is the conscientious use of the current best evidence in making health care decisions. It involves the incorporation of research findings, patient values and preferences, clinical circumstances and your own clinical expertise. This approach is not a blinkered adherence to only randomized trials, but to the best available evidence in clinical decision making. The skills of an EBM practitioner require asking clinically important questions, conducting searches for the best available evidence, appraising this evidence critically, and deciding whether to apply this evidence to patients. How to cite this article Mundi R, Mundi S, Bhandari M. Evidence-based Medicine: Top Ten Things to Know! J Postgrad Med Edu Res 2012;46(1):1-3.

scholarly journals Appraisal of meta-analysis

1998 ◽  
Vol 22 (11) ◽  
pp. 698-701
Author(s):  
Apu Chakraborty ◽  
James P. Warner ◽  
Robert Blizard
Keyword(s):  
Mood Disorders ◽  
Evidence Based Medicine ◽  
Journal Club ◽  
Meta Analysis ◽  
Clinical Implications ◽  
Evidence Based ◽  
Clinical Question ◽  
Ventricular Size ◽  
Clinical Questions ◽  
Based Medicine

Aims and methodPrompted by a clinical question, we critically appraised a meta-analysis of neuroimaging in our evidence-based journal club.ResultsThe results of the meta-analysis suggested differences in ventricular size and sulcal width between controls and people with schizophrenia and mood disorders. However, we were unable to answer the question that prompted this exercise.Clinical implicationsAlthough the evidence-based medicine approach facilitates appraisal of complex articles, some clinical questions are not yet answerable.

scholarly journals Evidence Based Medicine: A Paradigm for Clinical Practice

2018 ◽  
Vol 11 (02) ◽  
pp. 74-81
Author(s):  
KR Reddy
Keyword(s):  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Medical Curriculum ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Clinical Literature ◽  
Evidence Evaluation ◽  
Quality Of Medical Care ◽  
Patient Values ◽  
Based Medicine

Evidence based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values. In the practice of EBM it is the physician’s duty to find the best and most current information and apply it judiciously for the benefit of the patient. The practice of EBM involves formulating a clear clinical question from a patient’s problem, searching the literature to acquire the evidence, then critically appraising the evidence for its validity and usefulness, and applying the results by implementing useful findings into clinical practice, and finally evaluating this application of evidence on patient. An important rule in EBM is that it starts with the patient and ends with the patient. Evidence based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluation from the clinical literature. Incorporation of EBM into one’s practice will not only make one a better clinician, it also allows one to provide the best possible quality of medical care to his or her patients. Thus EBM can be incorporated as an integral part of the medical curriculum.

scholarly journals Understanding evidence-based medicine using a funnel analogy

2020 ◽  
Author(s):  
Erik Meira
Keyword(s):  
Decision Maker ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Process Information ◽  
External Evidence ◽  
Patient Values ◽  
Based Medicine

The framework of evidence-based medicine (EBM) consisting of the best available external evidence, clinical expertise, and patient values/circumstances is often described by educators and clinicians as “three legs to a stool”. Unfortunately, this analogy seems to be easily misunderstood as separate pillars equally weighted and considered independently from each other. This may be causing confusion and imperfect adoption by physical therapists.EBM may be better described as a sequential “funneling down” of information instead of as a three-legged stool. The totality of the evidence goes in at the top to be synthesized by clinical expertise into manageable concepts that can then be presented as options to the patient who is the ultimate decision maker. This may be a better way to process information into a more usable format for the support of patients.

Quality assurance and quality improvement in medical practice – Part 2. Evidence-based medicine

2012 ◽  
Vol 153 (4) ◽  
pp. 137-143 ◽  
Author(s):  
Sándor Gődény
Keyword(s):  
Medical Practice ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Health Technologies ◽  
Patient Values ◽  
Based Medicine

For assuring and improving quality of healthcare, everyday medical practice should be based on appropriate scientific evidence and results of health technology assessment. Evidence-based medicine is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care, when health technologies are used. On one hand health technologies which proved to be effective should be available for all patients, on the other hand, because of the limited financial resources of the health care system, they should be cost-effective, not to spend on interventions proved to be ineffective or even harmful. For effective implementation of evidence-based practice, development of more clinical guidelines, that contain explicit recommendations, and improvement of quality approach are necessary in Hungary. Orv. Hetil., 2012, 153, 137–143.

scholarly journals Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Stimulated Recall ◽  
Previous Discussion ◽  
Based Medicine ◽  
Stimulated Recall Interviews ◽  
Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Strategic Decision ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Strength Of Evidence ◽  
Based Medicine ◽  
Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

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