scholarly journals Evidence-Based Medicine and Clinical Research: Both Are Needed, Neither Is Perfect

2018 ◽  
Vol 72 (Suppl. 3) ◽  
pp. 13-23 ◽  
Author(s):  
Hania Szajewska
Keyword(s):  
Health Outcomes ◽  
Clinical Research ◽  
Evidence Based Medicine ◽  
Health Data ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Basic Principles ◽  
The World ◽  
Pediatric Nutrition ◽  
Based Medicine

Currently, it is impossible to think of modern healthcare that ignores evidence-based medicine (EBM), a concept which relies on 3 pillars: individual clinical expertise, the values and desires of the patient, and the best available research. However, EBM is not perfect. Clinical research is also far from being perfect. This article provides an overview of the basic principles, opportunities, and controversies offered by EBM. It also summarizes current discussions on clinical research. Potential solutions to the problems of EBM and clinical research are discussed as well. If there were specific issues related to pediatric nutrition, an attempt was made to discuss the basic principles and limitations in this context. However, the conclusions are applicable to EBM and clinical research in general. In the future, considering that new ways of obtaining health data will continue to emerge, the world of EBM and clinical research is likely to change. The ultimate goal, however, will remain the same: improving health outcomes for patients.

The Principles of Evidence-Based Medicine

Cephalalgia ◽  
2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 10-13 ◽  
Author(s):  
S Wiebe
Keyword(s):  
Clinical Practice ◽  
Clinical Research ◽  
Evidence Based Medicine ◽  
Information Overload ◽  
Clinical Performance ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Performance Information ◽  
Research Findings ◽  
Based Medicine

Evidence-based medicine (EBM) integrates individual clinical expertise with the best available external evidence in the care of individual patients. By enabling clinicians to directly appraise and apply current clinical research, EBM deals with the problems of deterioration in clinical performance, information overload, and lag in application of research findings to clinical practice. Thus, EBM is a useful tool to address the problems faced by clinicians attempting to provide optimum, current care for their patients. The rationale for EBM, its principles and application, as well as some limitations, are described here.

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.

scholarly journals Impact of deliberate practice on evidence-based medicine attitudes and behaviours of health care professionals

2020 ◽  
Author(s):  
Eelco Draaisma ◽  
Lauren A. Maggio ◽  
Jolita Bekhof ◽  
A. Debbie C. Jaarsma ◽  
Paul L. P. Brand
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Research ◽  
Health Care Professionals ◽  
Evidence Based Medicine ◽  
Deliberate Practice ◽  
Medical Decision ◽  
Evidence Based ◽  
Teaching Activities ◽  
Based Medicine

Abstract Introduction Although evidence-based medicine (EBM) teaching activities may improve short-term EBM knowledge and skills, they have little long-term impact on learners’ EBM attitudes and behaviour. This study examined the effects of learning EBM through stand-alone workshops or various forms of deliberate EBM practice. Methods We assessed EBM attitudes and behaviour with the evidence based practice inventory questionnaire, in paediatric health care professionals who had only participated in a stand-alone EBM workshop (controls), participants with a completed PhD in clinical research (PhDs), those who had completed part of their paediatric residency at a department (Isala Hospital) which systematically implemented EBM in its clinical and teaching activities (former Isala residents), and a reference group of paediatric professionals currently employed at Isala’s paediatric department (current Isala participants). Results Compared to controls (n = 16), current Isala participants (n = 13) reported more positive EBM attitudes (p < 0.01), gave more priority to using EBM in decision making (p = 0.001) and reported more EBM behaviour (p = 0.007). PhDs (n = 20) gave more priority to using EBM in medical decision making (p < 0.001) and reported more EBM behaviour than controls (p = 0.016). Discussion Health care professionals exposed to deliberate practice of EBM, either in the daily routines of their department or by completing a PhD in clinical research, view EBM as more useful and are more likely to use it in decision making than their peers who only followed a standard EBM workshop. These findings support the use of deliberate practice as the basis for postgraduate EBM educational activities.

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.

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