scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.


2017 ◽  
Vol 5 (3) ◽  
pp. 357
Author(s):  
Marie-Caroline Schulte

The importance of being evident is what counts for medicine. The diagnosis must be evident and the treatment must be based on evidence. If that evidence is and always must be based on statistics, as we have seen, it becomes questionable. Evidence is good when it is robust and when it fits the individual patient. Only then does evidence-based medicine (EBM), make sense and only then the patient can be sure to be treated in the best possible way. EBM, the movement of medicine that is strictly based on evidence which is judged in a hierarchical order, is under scrutiny and heavily criticised, chiefly because it has lost the patient out of its focus. Numbers are more important than the individual diagnosis and treatment is administered according to population-based statistics and not ‘made to order’. Although this criticism is very valid, the solution cannot be to simply replace EBM with something else, but the solution must be to still base medicine and medical treatment on the best available evidence we have, while putting the patient back into focus. In order to do so, it is important to topple evidence hierarchies, to divide EBM into research and practice and to acknowledge that sometimes the statistical best evidence is not the best evidential treatment for the actual patient.


Author(s):  
Ioannis Apostolakis ◽  
Periklis Valsamos ◽  
Iraklis Varlamis

Evidence-based medicine (EBM) refers to the careful examination of all the available evidence when making decisions about the care of the individual patient. It assumes that well known medical practices and solutions are combined with the patient’s preferences and necessities in order to provide the most appropriate solution per case. The abundance of medical information in the web, the expansion of Semantic Web and the evolution of search services allowed the easier retrieval of scientific articles. Although the available infrastructure exists and continuously improves in performance, EBM still remains a complicated and sensitive process of high importance and has a need for Quality Assurance (QA). The purpose of this chapter is twofold: first, to provide an introduction on the concepts of Evidence-based Medicine, and second, to stress the necessity for structured methodologies that will assure the quality of the EBM process and ameliorate the final recommendations therapy. Since evidences are the building blocks of EBM, we capitalize on their quality and provide a critical overview of the existing methodologies in Quality Assurance of evidences.


Neurology ◽  
2018 ◽  
Vol 91 (14) ◽  
pp. 657-662 ◽  
Author(s):  
Hugues Duffau

Brain lower-grade gliomas (LGG) usually occur in young adults who enjoy an active life. This tumor has a high risk of malignant transformation resulting in neurologic deterioration and finally death. Early and multistage therapeutic management can increase survival over 10 years. Preservation of functional neural networks and quality of life is crucial. In the era of evidence-based medicine, the issues discussed are those associated with the design, analysis, and clinical application of randomized controlled trials (RCTs) for LGG. RCTs should take account of the following: considerable variability in the natural course of LGG; limited prognostic value of molecular biology at the individual level; large variability of brain organization across patients; technical and conceptual progress of therapies over years; combination or repetition of iterative treatments, taken as a whole and not only in isolation; and long-term consequences on oncologic and functional outcomes. As it is difficult to translate the results of an RCT into benefits for a unique patient with LGG, personalized decisions must be made by considering the tumor behavior, individual pattern of neuroplasticity, and patient needs, and not by administrating a standardized protocol exclusively based on an RCT.


Author(s):  
Andrea Cipriani ◽  
Stefan Leucht ◽  
John R. Geddes

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’.


Author(s):  
Farnaz Mohamadhoseinzadeh Hashemi ◽  
Mehrnoosh Jafari ◽  
Seyed Mojtaba Hosseini

Introduction: The utilization of the medical research results is one of the most important indicators in the development of this profession, which provides effective care to patients and improves the quality of care. However, performing based on the evidence-based results has been unsuccessful in some cases. This study aimed to investigated and prioritize the factors affecting evidence-based medicine among physicians affiliated to Iranian Health insurance. Methods: This descriptive cross-sectional study was conducted on 150 physicians affiliated to Iranian Health insurance in Tehran city in 2018. The simple random sampling method was used to collect the data. The data collection tool was a questionnaire containing of three parts: demographic questionnaire, Fonk (1995) evidence-based medical barriers questionnaire that included four domains and 25 questions, as well as a researcher-made questionnaire that prioritized the factors influencing evidence-based medicine implementation. Data were analyzed by SPSS version 21 and Expert Choice software using hierarchical analysis method. Results: Most physicians were male (53.3%) and worked as an official employee. Among four dimensions, the highest mean and standard deviation was related to organizational impact, while the lowest was related to the quality of research and possible outcomes. Regarding the factors of organizational impacts, the highest weight or priority was attributed to the feeling of insufficient independence to change care methods with a weight of 0.259. Among the factors related to the research quality, the highest weight and priority was related to the factor of methodological defects in the research with a weight of 0.192. Considering the factors related to the skills of conducting research, the highest priority and weight was attributed to the lack of documentary evidence for the performance change with a weight of 0.320. Moreover, regarding the factors related to communication and access to the findings of the research, the highest weight and priority was in the factor of unavailability of actual articles (0.475). Conclusion: The findings of this study showed that physicians considered problems and barriers related to organization, individual, and quality of research studies. Therefore, facilities should be created for using research findings as well as the conditions for updating physicians' knowledge, skills, and attitudes to use the research results.  


Sign in / Sign up

Export Citation Format

Share Document