scholarly journals The Limitations of Evidence Based Practice for Emergency Medicine

2000 ◽  
Vol 7 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Am Kelly ◽  
C Horsley
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Evidence Based Practice ◽  
Clinical Problem ◽  
Evidence Based ◽  
Based Medicine

Evidence based practice (EBP), also known as evidence based medicine, has been suggested as a more suitable basis for decision-making in clinical practice than the traditional ‘expert' based approach. Central to EBP is the application of evidence (as found in the published literature) to an individual clinical problem. EBP, however, has limitations that may raise questions regarding its applicability to particular types of clinical situations including many of the problems encountered in Emergency Medicine. This article discusses the background and limitations of EBM and suggests some ways that the principles can be incorporated into Emergency Medicine practice.

scholarly journals Confirmation bias by consumers of clinical research demonstrates the need for implementation science

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
James Peter Meza
Keyword(s):  
Clinical Practice ◽  
Clinical Research ◽  
Implementation Science ◽  
Research Design ◽  
Evidence Based Medicine ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Confirmation Bias ◽  
Evidence Based ◽  
Based Medicine

<p>The Journal's Editor holds that, although Evidence-based medicine typically only looks for bias of the research design, still evidence-based practice must also include the biases of those using the research evidence and how it is deployed in clinical practice.</p>

scholarly journals The case against ‘the evidence’: A different perspective on evidence-based medicine

2002 ◽  
Vol 180 (1) ◽  
pp. 8-12 ◽  
Author(s):  
D. D. R. Williams ◽  
Jane Garner
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Clinical Care ◽  
Treatment Decision ◽  
Evidence Based ◽  
Treatment Decision Making ◽  
Critical Commentary ◽  
Evidenced Based ◽  
Based Medicine

BackgroundAn evidenced-based approach to psychiatry is playing an increasingly prominent role in treatment decision-making for individual patients and for populations. Many doctors are now critical of the emphasis being placed on ‘the evidence’ and concerned that clinical practice will become more constrained.AimsTo demonstrate that evidence-based medicine is not new, sources of evidence are limited and psychosocial aspects of medicine are neglected in this process.MethodSome of the literature is reviewed. Ideas and arguments are synthesised into a critical commentary.ResultsThese are considered under four headings: evidence-based medicine is not new; what evidence is acceptable; the doctor as therapist; and the emergence of a new utilitarian orthodoxy.ConclusionsIt is agreed that a degree of professional consensus is necessary. However, too great an emphasis on evidence-based medicine oversimplifies the complex and interpersonal nature of clinical care.

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 Psychiatry in the future

2004 ◽  
Vol 28 (8) ◽  
pp. 277-278
Author(s):  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Cochrane Collaboration ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Policy Makers ◽  
The Future ◽  
The Cochrane Collaboration ◽  
Based Medicine

In an era of evidence-based medicine, policy-makers and researchers are preoccupied by the task of ensuring that advances in research are implemented in routine clinical practice. This preoccupation has spawned a small but growing research industry of its own, with the development of resources such as the Cochrane Collaboration database and journals such as Evidence-Based Mental Health. In this paper, I adopt a philosophically quite unfashionable methodology – introspection – to address the question: how has research affected my practice?

Sign in / Sign up

Export Citation Format

Share Document