scholarly journals Use of TNF blockers and other targeted therapies in rare refractory immune-mediated inflammatory diseases: evidence-based or rational?

2010 ◽  
Vol 69 (12) ◽  
pp. 2067-2073 ◽  
Author(s):  
Dominique Baeten ◽  
P Martin van Hagen
Keyword(s):  
Targeted Therapies ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Inflammatory Diseases ◽  
Case Series ◽  
Evidence Based ◽  
External Evidence ◽  
Immune Mediated ◽  
Number Of Patients ◽  
Based Medicine

Evidence-based medicine implies that clinical decision making should be based on external research evidence when available. This external evidence includes, but is certainly not restricted to, randomised controlled trials (RCTs). The development of powerful but often expensive targeted therapies for immune-mediated inflammatory diseases (IMIDs) is one of the major successes of evidence-based medicine but, paradoxically, also threatens the traditional RCT-based approach. Indeed, the increasing availability of these drugs decreases the number of patients available for RCTs, questions the ethical basis for the use of placebo groups and raises the issue of cost-efficacy. These considerations become even more important in rare phenotypically diverse and potentially life- or organ-threatening IMIDs such as sarcoidosis, Behçet's disease and uveitis. Using the successful application of tumour necrosis factor blockade in these diseases as an example, this review defends the concept that pathophysiological insights in cellular and molecular disease pathways as well as limited case series are valid sources of external evidence for the rational use of targeted therapies in these rare refractory conditions. If authors fail to redefine their concept of rational therapy along the lines of not only evidence-based but also pathophysiology-based and practice-based medicine, they may underestimate the potential of novel drugs in rare refractory IMIDs and thereby jeopardise the health of their patients.

scholarly journals Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one

2008 ◽  
Vol 101 (10) ◽  
pp. 493-500 ◽  
Author(s):  
Kausik Das ◽  
Sadia Malick ◽  
Khalid S Khan
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Adult Learning Theory ◽  
Clinical Decision ◽  
Evidence Based ◽  
Educational Training ◽  
Practice Teaching ◽  
Approach To Teaching ◽  
Indispensable Tool ◽  
Based Medicine

Summary Evidence-based medicine (EBM) is an indispensable tool in clinical practice. Teaching and training of EBM to trainee clinicians is patchy and fragmented at its best. Clinically integrated teaching of EBM is more likely to bring about changes in skills, attitudes and behaviour. Provision of evidence-based health care is the most ethical way to practice, as it integrates up-to-date, patient-oriented research into the clinical decision making process, thus improving patients' outcomes. In this article, we aim to dispel the myth that EBM is an academic and statistical exercise removed from practice by providing practical tips for teaching the minimum skills required to ask questions and critically identify and appraise the evidence and presenting an approach to teaching EBM within the existing clinical and educational training infrastructure.

scholarly journals Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part two

2008 ◽  
Vol 101 (11) ◽  
pp. 536-543 ◽  
Author(s):  
Sadia Malick ◽  
Kausik Das ◽  
Khalid S Khan
Keyword(s):  
Adult Learning ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Adult Learning Theory ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Use ◽  
Evidence Based Healthcare ◽  
Based Medicine ◽  
Oriented Research

Summary Evidence-based medicine (EBM) is the clinical use of current best available evidence from relevant, valid research. Provision of evidence-based healthcare is the most ethical way to practise as it integrates up-to-date patient-oriented research into the clinical decision-making to improve patients' outcomes. This article provides tips for teachers to teach clinical trainees the final two steps of EBM: integrating evidence with clinical judgement and bringing about change.

Evidence-based medicine and machine learning: a partnership with a common purpose

2020 ◽  
pp. bmjebm-2020-111379
Author(s):  
Ian Scott ◽  
David Cook ◽  
Enrico Coiera
Keyword(s):  
Machine Learning ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Rigorous Approach ◽  
Common Purpose ◽  
Future Outcomes ◽  
Based Medicine

From its origins in epidemiology, evidence-based medicine has promulgated a rigorous approach to assessing the validity, impact and applicability of hypothesis-driven empirical research used to evaluate the utility of diagnostic tests, prognostic tools and therapeutic interventions. Machine learning, a subset of artificial intelligence, uses computer programs to discover patterns and associations within huge datasets which are then incorporated into algorithms used to assist diagnoses and predict future outcomes, including response to therapies. How do these two fields relate to one another? What are their similarities and differences, their strengths and weaknesses? Can each learn from, and complement, the other in rendering clinical decision-making more informed and effective?

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

scholarly journals The role of evidence-based laboratory medicine in health service

2002 ◽  
Vol 21 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Nada Majkic-Singh
Keyword(s):  
Health Care ◽  
Clinical Experience ◽  
Evidence Based Medicine ◽  
Laboratory Tests ◽  
Laboratory Medicine ◽  
Systematic Research ◽  
Evidence Based ◽  
External Evidence ◽  
Based Medicine ◽  
The Impact

Evidence-based laboratory medicine (EBLM) is the use of the current best evidence of the utility of laboratory tests in making decisions about the care of individual patients. This practice means integrating laboratory and clinical experience with the last available external evidence from systematic research. It means that the definition of EBLM focuses on two key elements: experience and evidence from systematic research. Although the term evidence-based medicine (EBM) was created in Canada at Mc Master University by a group lad by Dr Gard Guyatt, there are various claims as to the origin of its practice. Regardless of its origins, many factors have come together over the past 30 years to drive the movement to EBM. One factor is those individual physicians, faced with numerous medical informations; the second factor is the global phenomenon of increasing health care costs and third is that patients who have generally more education, want the best in diagnostics and therapies. It means that evidence-based medicine has been driven by the need to cape with information overload, by costcontrol, and by public impatient for the best in diagnostics and treatment. Clinical guidelines care maps, and outcome measures are quality improvement tools for the appropriateness, efficiency and effectiveness of health services. Laboratory professionals must direct more effort to demonstrating the impact of laboratory tests on a greater variety of clinical outcomes. Evidence-based laboratory medicine aims to advise clinical diagnosis and management of disease through systematic researching and disseminating generalisible new knowledge that meets the standard of critical review on clinically effective practice of laboratory investigations. In laboratory medicine, the use of tests increases; new tests are constantly introduced, but "old" tests are seldom removed from the repertoire. This, together with limited public funds for the health care should underline the challenge for laboratory professionals to provide evidence for the utility of different tests. This practice means integrating laboratory and clinical experience with the best available external evidence from systematic research therefore, it is important that advice given by laboratory medicine professionals are sound and based on evidence in the pre-analytical, analytical, and post-analytical phases of the diagnostic process. This paper provides an insight into the rationale, methodology and the phases of the EBLM.

scholarly journals Knowledge, Attitude, and Practice of Evidence-Based Medicine among Emergency Doctors in Kelantan, Malaysia

2021 ◽  
Vol 18 (21) ◽  
pp. 11297
Author(s):  
Mohd Ghouse Ahmad Ghaus ◽  
Tuan Hairulnizam Tuan Kamauzaman ◽  
Mohd Noor Norhayati
Keyword(s):  
Evidence Based Medicine ◽  
Positive Attitude ◽  
Skill Training ◽  
Good Practice ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Based Medicine ◽  
Emergency Doctors

This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.

Application of research evidence in clinical practice

2020 ◽  
pp. 73-79
Author(s):  
Andrea Cipriani ◽  
Stefan Leucht ◽  
John R. Geddes
Keyword(s):  
Health Care ◽  
Evidence Based Medicine ◽  
Research Evidence ◽  
Clinical Decision Making ◽  
Evidence Based ◽  
Individual Patient Level ◽  
Patient Values ◽  
The Individual ◽  
Theory Of Evidence ◽  
Based Medicine

The aim of evidence-based medicine is to integrate current best evidence from research with clinical expertise and patient values. However, it is known that one of the major challenges for clinicians is to move from the theory of evidence-based medicine to the practice of it. Evidence-based practice requires new skills of the clinician, including framing a clear question based on a clinical problem, searching and critically appraising the relevant literature, and applying the findings to routine clinical decision-making, ideally at the individual patient level. Scientific evidence is increasingly accessible through journals and information services that should combine high-quality evidence with information technology. However, the process is not straightforward, as there are several barriers to the successful application of research evidence to health care. This chapter discusses both the prospects for harnessing evidence to improve health care and the problems that clinicians will need to overcome to practise ‘evidence-based-ly’.

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